4 October 2012

Medicines for the Poor: The Dispensary

The dispensary on Temple Row (far right), next to Styles's Hotel, c. 1800.
The building had originally been a dwelling house built in around 1720,
reputedly by William Westley.




















When writing the previous post about the Hotel on Temple Row, I noticed in the picture used (included above also) that one of the houses near the Hotel was being used as Birmingham’s dispensary. I had conducted some research into the dispensary on Union Street (built 1806-08), as it was designed by William Hollins, and although I knew it had earlier beginnings I had not looked into where those beginnings lay. Finding it in the image spurred me to have a look at the history of the dispensary. There is more than one way to look at an image, which is why this post includes that same image. The last post explored the opulent and exclusive hotel, its post-chaises and assemblies with the image being used to represent that world, yet in about the same year (c. 1800) there was an outbreak of typhus which particularly affected the poor who were suffering due to deficient harvests. Dr. Bree was physician at the dispensary that year and helped to administer remedies to those suffering (explored below), and many of those would have come to Temple Row’s dispensary looking for help for themselves or their family. This forms a stark contrast that is not instantly visible in an image, and was not meant to be captured by the artist.
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In 1792 an idea began to grow among a few of Birmingham’s inhabitants to begin a dispensary based on those begun in London and that had been popping up in other provincial towns. The dispensaries dealt with lighter medical cases providing a service for the poor distributing medicines, offering medical assistance, inoculations and midwifery services. In William Hutton’s words, the aim of the dispensary was;
“[t]o supply the industrious of the labouring classes, who are not able to pay a surgeon for his services, with medical and surgical relief, for the payment of a trifling subscription. It also affords, by the contribution of the opulent and benevolent, relief to those who are unable to contribute any sum themselves.”*
The first dispensary opened in 1793 in the building on Temple Row; in the first year of its life 325 patients were treated (246 sick patients, 48 midwifery patients and 31 inoculations).*

Dispensaries became popular as they provided a more basic service which supported the work of hospitals (like Birmingham’s own hospital on Summer Lane). They also came about at a time when there were growing concerns about the distribution of wealth marked by the success of many industrialists,* and the continuing poverty of those who turned the industrial cogs from the very bottom. It is worth noting that Birmingham had struggled for many, many years to open its hospital due to lack of funds coming in from the town’s wealthier inhabitants, much to the shame of some. The dispensary’s success probably came due to the early involvement of Matthew Boulton (in 1793), the wealthy proprietor of the Soho manufactory, who stated that ‘if the funds of the institution are not sufficient for its support, I will make up the deficiency’.*

Institutions like dispensaries were part of a surge of philanthropic endeavours of the time but, as Roy Porter also states, they also acted as a kind of ‘social balm’.* The assistance of institutions like dispensaries covers up the fact that the poor needed charity because their wages were too low to pay for their own health care, or to maintain a lifestyle that would engender better health. An instance of this can be seen during the national outbreak of typhus in 1799 and 1800, which affected Birmingham badly and was attended to by the then physician of the dispensary, Dr. Robert Bree. Bree states that provisions in those years were scarce and dear, due to bad seasons, and that there was want for employment; he states that’ [m]any families had subsisted on barley and potatoes, in scanty portions, for many months, frequently without even a pound of butcher's meat for their Sunday's dinner. I have seen not unfrequently beans boiled with salt and water in a soup, that served for food during several days'.* He noted that it was the poor that suffered the most greatly from the fever in those years due mainly to this lack of nourishment (you can see Dr. Bree’s remedies for the typhus below).

Dispensaries were predominantly an urban phenomenon, supporting the large populations of towns, but these greater populations also helped to develop medical knowledge as a single physician could view several instances of the same disorder. The variety and scope of experience that could be gained in the towns often attracted young physicians, and in 1805 it was stated that ‘Birmingham had, for a long period, been considered by the surrounding country as the seat of superior medical experience and authority’.* Case books though, were rarely kept (very few case descriptions survive for Birmingham) so it is difficult to gain insight into the kinds of ailments ministered to and treatments given, though physicians did sometimes record their findings in medical journals so as to expand medical knowledge.

The general interior layout of dispensaries was to have the dispensing department (where the drugs would be arranged, usually on shelves on the wall), waiting rooms, consulting rooms and private examination rooms on the ground floor, and then the committee rooms, the medical officers’ rooms and the housekeepers' rooms on the floor(s) above. It was probably not till the custom built dispensary was erected on Union Street that the accommodation was to this standard. The Union Street dispensary (which I will explore further in a future post) opened in 1808 and moved from Temple Row to that premises; and there the dispensary housed an apothecary, someone to compound and dispense medicines and a house midwife, as well as physicians (see notes below) and surgeons attending.

NOTES
* References on request.
DR. BREE'S REMEDIES FOR TYPHUS
Dr. Bree took much worth in Dr. James Currie’s treatment of typhus with aspersions (showers or sprays) of cold and tepid water, which he thought much more beneficial than the usual treatments of bark and stimulant cordials. He did give treatments of cordials as well though, and describes the recipe he used. 'Take oak bark bruised, and roughly powdered; horse radish roots sliced; of each, an ounce. Boil the oak bark in two pints of water, till one pint be consumed. Add, before the boiling is finished, the horse radish. Then cover the vessel till the decoction is cold, and strain it for use. Sometimes elixir of vitriol was added to this, and if purging was threatened, or general uneasiness was felt, thirty drops of tincture of opium were added to each pint. Two ounces were given every four or five hours'. Together with 'the aid of aspersion of water’ Dr. Bree claimed much success in the survival rates of his patients.
PHYSICIANS AT THE DISPENSARY
(if you can add to or alter this list, please add the details to ‘comments’ or email me)
At Temple Row1796-c. 1800: Dr. John Butt SALT recommended by Erasmus Darwin (see letter of recommendation here), retired due to ill health.
c. 1799-c. 1805: Dr. Robert BREE
1802-1804: Dr. ROGERS (died of scarlet fever contracted from a patient in 1804).
1805: Dr. MALE
At Union Street
c. 1814-1821: Dr. John BOOTH (and the Birmingham Infirmary)
1822-1833: Dr. John DARWALL (Detailed information on Darwall here.)
Oct 1835-?: Dr. Thomas Ogier WARD (previously at Wolverhampton dispensary and studied the cholera there in 1832).

3 comments:

  1. I had conducted some research into the dispensary on Union Street (built 1806-08), as it was designed by William Hollins, and although I knew it had earlier beginnings I had not looked into where those beginnings lay. Finding it in the image spurred me to have a look at the history of the dispensary. http://findmybud.com/

    ReplyDelete
  2. Jenni, I have found two "Report of the state of Birmingham Dispensary" from 1804-5 and 1805-6 with full list of committee, governors and subscribers. I'll send you a copy

    ReplyDelete