'If the parish screw him, let him screw the parish': Professionalization and reform of the Poor Law medical service in nineteenth-century Britain

This dissertation centers on issues of middle-class identity and professionalization among doctors of the Poor Law medical service in mid-nineteenth-century Britain. Using medical journals and pamphlet literature, I trace attempts by general practitioners across England to reform the Poor Law medical service and to clarify their right to middle-class status, since their income levels were often barely middle-class. This was a significant departure from standard models of middle-class identity; faced with the fact that their income might never support the expected lifestyle of a member of the middle class, these doctors tried to change the definition by stressing gentility, education, and service to the nation. I argue, however, that the movement to reform the Poor Law interfered with this attempt to redefine middle-class status. Reform efforts often drew attention back to money, the very issue these doctors were trying to downplay.;Specifically, I look at two models of reform, represented by the Poor Law Medical Reform Association (PLMRA), which was active from 1856 through 1868, and the Metropolitan Poor Law Medical Officers Association, which was active from 1866 through 1869. The stories of these groups have not been told by historians, and this is an important gap in our knowledge of the Poor Law and of the medical profession as a whole. The PLMRA, led by Richard Griffin, strictly emphasized the needs of medical professionals, demanding such reforms as job security, lighter workloads, and especially better and more equitable pay. The Metropolitan Association, led by Joseph Rogers, worked toward many of the same goals, but this group couched the need for reform in terms of concrete improvements for the sick poor. By broadening the benefits of reform, this second model proved far more successful in gaining support from outside the profession, as it separated reformers from the selfish, pinch-penny image of Poor Law doctors that the first reform model had produced. Unfortunately, Poor Law medical officers, hoping for more immediate improvement of their individual situations, tended to favor the PLMRA's model, so despite the Metropolitan Association's success in gaining reform legislation, its reform model was eventually abandoned.