HC Deb 22 June 1870 vol 202 cc717-27

Order for Second Reading read.


, in moving that the Bill be now read a second time, said, that the object which the measure had in view was not merely to do a slight act of justice to medical officers of the poor, by entitling them to superannuation after the age of 60, but indirectly to confer a substantial benefit on the poor themselves, and to relieve the local taxation of this country. The sanitary condition of the country was in a most deplorable state, and it cried aloud for alteration and improvement. The amount of preventible disease which stalked abroad in the rural districts, as well as in the cities and towns, was really alarming, and some means should be found to put an end to such a state of things. He found, from Reports which had been laid upon the Table of that House, that there were about 1,000,000 cases of preventible illness occurring annually in the United Kingdom, and no less than 111,318 deaths resulting from preventible diseases. These facts afforded sufficient reason for them to say that some change was absolutely necessary in the matter of Poor Law medical relief. The present system of such relief was introduced into this country in the year 1834, and it must be admitted that it brought about a great improvement in regard to the poor. But notwithstanding that improvement, there was one great drawback, and that was the power which was given to the Poor Law Guardians to appoint and control the medical officers. In conjunction with every hon. Member who had studied the question, he hoped and trusted that the time was not far distant when the Government would feel it to be their duty to take up the subject, and to re-model and re-cast the whole system of Poor Law medical relief. He was surprised that they had not done so long since. He asked the House to assent to the second reading of the Bill, on the grounds—first, of justice to men who had sacrificed both time and money; secondly, of economy; and thirdly, of common humanity to the poor of the country. The medical officers gave themselves up to their duties with a devotion that was truly admirable. They ran great risks, and in several cases they had brought fever home to their own houses, and in some instances they themselves fell victims. Their remuneration was so small that they could not I retire when ago and infirmities came upon them, but were obliged to continue to do their work as best they could. Two objections had been raised to the Bill, the same as those urged against a similar Bill he introduced and passed last Session for Ireland. The first was that the people of this country were already over-taxed; and, the second, that the whole of the time of these medical officers was not employed. As abstract propositions he agreed with them. But this Bill, if passed into a law, would have the effect of lessening taxation, by improving the health of the poor. The rich, were equally interested in the success of the measure with the poor, because zymotic diseases were preventible diseases, and if proper precautions were taken they might be stamped out. The small amount of money necessary for this purpose would be more than provided by the economy which was capable of being introduced into local expenditure. If the medical officer had a private practice, and was not dependent upon the salary attached to the office, it did not require much observation to know that he had quite work enough to entitle him to the consideration that was now asked for him. He held that these medical officers were not parochial officers; they ought, in fact, to be considered officers of the State, and not be subjected to the whim and caprice of guardians, because they efficiently discharged their duties. Over 72 per cent of the poverty of the United Kingdom arose from disease, and for the sake of the public welfare the medical officers ought to be well cared for. These men were liable to be called on at all hours of the clay and night, and had to proceed great distances in all weathers, for a remuneration that was truly disgraceful. In 239 unions the average pay was from 8d. to 3s. per case, and in 384 from 3s. to 7s. per case. The average salary in the metropolis was £81 per annum, and in the country £49 per annum. If the Government would take the subject up they would confer a lasting benefit on the profession.


seconded the Motion. He asked it as an act of justice, and not as an act of charity, that the medical officers should be put on the same footing as the clerks and other officers of Unions. The profession had not taken its proper position from a want of esprit de corps; but a change for the better had taken place amongst the medical officers of the Army, Navy, and Indian Service, which had greatly benefited them, and he should like to see the same reasonable combination amongst the Union medical officers. He hoped the innate soundness of the claim would be acknowledged by the House. As a Poor Law Guardian he knew that the remuneration of the Union medical officers was scandalously low, especially in the country—in some cases not more than £30 a year, and rarely more than £80. It was no excuse to say that all the time and skill of the medical officer was not taken up, though in almost all populous districts it was nearly so. The medical officers braved every kind of danger in the exercise of their profession, and it was melancholy to see the suffering, paralysis, fever, and early death to which, they were subjected by attendance on the poor in workhouses and other places. He was sure that no one among the public would deny that they were entitled to some small superannuation. He thought that if a reasonable retiring allowance was given they would improve the service—they would get a better class of men, and would retain their services longer than at present; and they would get rid of many of those complaints which were now so frequently made to the Poor Law Board.

Motion made, and Question proposed, "That the Bill be now read a second time."—(Dr. Brady.)


said, he must oppose the measure, first, on the general ground that the granting of superannuation allowances was unwise in policy. It was most impolitic, either in the guardians or the State, to make provision for old age in the case of men in a position to make such provision for themselves, and if this policy were once admitted as sound no limit could be put to it, and the State would have to provide superannuation allowances for the labourer in the fields or the factory hand, simply because they had done their duty by the State in their youth. He also opposed the measure in the interests of the medical officers themselves. He admitted they were underpaid, but he must point out that guardians who would treat medical officers with the indignity with which many Boards at present treated them would not scruple to use the superannuation allowance as an instrument for lowering the pay; and the threat to introduce another medical man to the parish would force the local doctor to comply. Thus the medical officers would be more the tools of the guardians and of the Poor Law Board than they were at present. The profession felt that, and the majority of them were therefore opposed to the measure. A Bill of this kind was an attempt merely to patch up a system which required re-casting altogether. He moved that the Bill be read a second time upon this day three months.


seconded the Amendment. He said that claims for superannuation allowances had been raised on behalf of so many professions of late that it was high time to make a stand against the further extension of the system. He quite admitted that the medical men had, like others, to struggle to support themselves and educate their children. This Bill, however, was against public policy, and he was sure would be objected to by the great body of ratepayers. In the Union with which he was connected, there was no difficulty in procuring the services of the most efficient men to fill the position of medical officers, and he did not believe there was a medical man in the whole Union who was in favour of the Bill.

Amendment proposed, to leave out the word "now," and at the end of the Question to add the words "upon this day three months."—(Mr. Joshua Fielden.)


said, he quite sympathized with the feelings of those who looked with jealousy upon the increase of superannuation allowances; but the necessity which obliged the authorities to resort to them arose from the permanency of the appointments and the difficulty of removing the officer when he ceased through age to be competent to perform the duties devolving upon him. He agreed with the hon. Gentleman opposite (Mr. Mellor) that the opinions of the ratepayers ought to be consulted, and he believed that the Bill could not be supported on the strict ground of justice. Superannuation allowances were, as a rule, only given to persons who were under a permanent contract to devote the whole of their time to the service of the public, and for this class a regular scale of retirement, after a certain period of service, was fixed by law. That was not the case with medical officers of Unions. As a matter of justice superannuation could not be demanded by them; but as a question of expediency it might be worth while to consider whether it would not be advantageous to the public service to grant such a boon to a valuable profession. The contract, or implied contract, of permanent employment could not well be broken without giving something in the way of compensation. Nor was it necessarily a question of actually increasing their remuneration. The question was, whether medical officers would accept a lower salary with superannuation, or a higher salary without superannuation. The hon. Member opposite (Mr. J. Fielden), who asked why labourers should not be superannuated by the State, must remember that it was not in the interest of the employed, but in that of the employer that these superannuations were granted; it was necessary to offer some bonus to the official to enable him to retire, for it seldom happened that a man came to the conclusion he was too old to perform his duties. It would be a short-sighted policy for the guardians to retain the services of any officer except so long as he was able to perform his duties competently. On behalf of the Government, he should support the Motion, because the Bill would have the effect of improving the medical service in Poor Law Unions by enabling Boards of Guardians, when they chose, to grant superannuation allowances to medical officers.


said, that after the declaration of the right hon. Gentleman (Mr. Goschen), it would be of little use to say anything on the other side, but he would nevertheless venture to refer to one or two points. To begin with, he believed we were now for the first time introducing the principle of superannuation in favour of persons who were only partially employed, and confessed he looked with some jealousy on such an extension of the principle. He had long entertained the opinion that Poor Law medical officers were very badly paid; and, indeed, it was in consequence of this that a partial attempt was made to compensate them by giving them a quasi permanence in their offices. But how had that system worked? In a great many instances they discharged their duties by deputy—a practice which was extremely unfortunate for the poor. There must, of course, be some kind of agreement or permission to employ a deputy; but he asked whether, in the event of this principle of superannuation being conceded, the duties would not always continue to be discharged by deputy after the medical officer was unable by reason of age or infirmity to perform them in person? Every gentleman who held such an appointment would make his money by taking pupils, and such a system would surely be detrimental to the interests of the poor. A year or two ago a case occurred in the East-end of the metropolis when it was proved that a pauper who died under very painful circumstances had been attended by the deputy of the medical officer, who said by way of excuse—"See what I have to do, and the money I am paid for doing it." The adoption of this superannuation scheme would, he feared, perpetuate the employment of deputies, and no greater evil could result to the poor than that. If the guardians wanted to prevent a medical officer from receiving the superannuation allowance, they would insist on his not employing a deputy. The better plan would be to pay these medical gentlemen a fair price for their work.


said, the first objection brought against the Bill by the hon. Member for the West Riding (Mr. Fielden) was so purely theoretical that it might apply to all questions of superannuation, but ought to have no weight in regard to this particular measure. Perhaps it might be true that there should be no such thing as superannuation, and that all these officers should exercise a sagacious prudence during their lives, so as to have a provision for their sickness and old age. But then their incomes must be of a character to render this economy possible. In the case of officers of the Army they gave superannuation, because their pay was so small that they could not save money. If it were just in such a case, it was far more necessary in the instance of Poor Law medical officers, who receive such miserable pittances for the exercise of most irksome duties, involving much professional knowledge, and exposing them not unfrequently to danger of life. The next objection, taken by the right hon. Member for Oxfordshire (Mr. Henley), was more practical. The right hon. Gentleman said they were introducing a new principle when they proposed to give retiring allowances for partial services—that was, for persons whose time was only partly and not wholly given to the public. But the right hon. Member was wrong in thinking that this had not already been done on previous occasions. Last year they passed a precisely similar measure for the Poor Law medical officers of Ireland; and clerks and auditors to Boards of Guardians, who only gave their time partially to their duties, were entitled to superannuation. It was quite true that Poor Law medical officers gave only part of their time; but then their pay was only for that portion, and miserably indeed were they paid for it. The average payment was about 3s. 3d. per case—not for each visit, but for each case, which might last for a month or longer; and out of this poor pittance they had in most cases to supply drugs and all medical appliances. Only a portion of the time was demanded, and thus paid for, but that portion was exacted to the full extent. But he supported this Bill on public grounds. The services of medical officers, especially when they were efficient, were of very great importance to the community. Perhaps that was more obvious in Ireland than in England, where the result of their efforts had been to mitigate to a very large extent the fever of Ireland, which was at one time its peculiar scourge, to stamp out small-pox, and to resist the last invasion of cholera in a remarkable degree. Cholera in its last appearance in this country invaded Ireland. Formerly when it did so it desolated that country; but on the last occasion it found a new army of efficient medical Poor Law officers ready to resist its attack, and during the whole time that it remained, Ireland did not lose more than London did in a fortnight. The money saving to the country of these remarkable hygienic achievements had been infinitely greater than the cost of the medical service which had thus proved its utility—he did not mean the mere saving from preventible disease, but also from the pauperism which invariably followed in its train. No doubt, largely guided by these considerations, the House last year passed the Superannuation Bill for the medical officers in Ireland; and the question now was whether they should extend this principle to England. Unfortunately for this country the Poor Law medical service was not so well organized, and consequently the hygienic effects of their services to the State was not so conspicuous as in Ireland; but it was because he thought this Bill would have the effect of improving their condition, and of giving to the Poor Law medical officers that recognition of public service which was so important to them and the country, that he was anxious to see the principle of the measure extended. The operation of the Bill was made permissive. The immediate advantage would be that those medical officers whom age and infirmity prevented from discharging their duties would give way to more efficient men. The right hon. Member for Oxfordshire opposed the Bill because he thought it would lead to duties being performed by deputy. To his (Dr. Playfair's) view the very reverse effect would be produced. The old, worn-out parish doctor was often tempted to send his pupils or a deputy to attend on pauper patients; but with these powers of superannuation, younger and more efficient medical men were alone likely to be kept in their service. He supported the Bill further because he thought it would tend to diminish the poor rates. It was far cheaper to prevent pauperism than to pay for the support of pauperism. Preventible disease and sickness lay at the root of the pauperism of this country. If they properly paid and organized their medical combatants, whose profession it was to fight with disease, so that they had a right to count upon their services and efficiency, the economy to the country would be great. It was because this Bill gave the first official recognition of the public character of these services, and was, he hoped, the first step to its proper reorganization, that he gave to it his hearty support.


said, he should give his support to the measure on economical grounds. No one who knew how badly the medical officers were paid could doubt but that for the fact of their having other practice they could not be induced to take office under the Poor Law Board. The poor ought to have the best possible medical advice, because we should then get rid of a large amount of disease, and also effect a considerable pecuniary saving


said, he had placed his name on the back of the Bill because he thought a great injustice had been done for a long period to a most useful and deserving body of men. He admitted that to some degree it was useful to a young medical man to accept the office of Poor Law medical officer, but in other respects it was likely to keep men out of practice; for, as a general rule, the members of the richer classes did not much like to employ the parish doctor. He thought it was an act of sound justice to give such officers a small superannuation. These gentlemen, who had very limited incomes, and were obliged to marry young, could not in the majority of cases afford the money necessary to insure their lives.


said, he must support the hon. Member for the West Riding (Mr. J. Fielden) in his opposition to the Bill. While sympathizing with the kind-hearted benevolence of his hon. Friend (Mr. Brady) he thought they ought not to legislate solely under the influence of a benevolent impulse, and he protested against the adoption of a principle which, if once admitted by Parliament, would lead to applications for similar allowances from other officers engaged in the public service. The true reason why medical men were badly paid was that there were too many of them for the demand. He regretted that the right hon. Gentleman who represented the Poor Law Board in that House had not at once given his strenuous opposition to the measure.


said, he wished to explain why Scotland ought to be exempted from the operation of this Bill, which he should most cordially support in the interests, not of the medical officers alone, but of the poor and the ratepayers. The hon. Member who had just sat down had stated that the supply of medical officers was in excess of the demand; but this very circumstance in repect to tenants in Ireland had been loudly urged by hon. Members on the Ministerial side in justification of a departure from the strict principles of political economy. In Scotland the Poor Law medical officers were not permanently appointed, and, indeed, they were in other respects in a far less favourable position than their English and Irish brethren. They were appointed annually, their salaries were in most cases wholly inadequate, and very often they were required to contract to supply medicines out of their salaries. A Select Committee was at the present moment considering the subject of the Scotch Poor Law system, and he had no doubt they would recommend that the medical officers in that country should be put on the same footing with those in England and Ireland both as regards permanence of appointment and superannuation allowances; but as that Committee had not yet presented their Report it would be inadvisable to include Scotland in the present Bill. Unlike the right hon. Gentleman the Member for Oxfordshire (Mr. Henley), he was of opinion that the granting of superannuation allowances would prevent medical officers from doing their business by deputy. A provision was made for the families of medical officers who fell in battle, and it would be a very fair extension of that principle if it were enacted that the wives and children of Poor Law medical officers who died in consequence of infection or contagion should be provided for out of the Consolidated Fund.


said, he could perceive no analogy between the case of a medical man who was slain in battle and of one who died in the service of a Poor Law Union. He felt that medical officers were very much underpaid. Think of a medical man being appointed to attend a large district and find medicines at £40 a year. Why this was less than hon. Members paid to their butlers. Men of honour could not take such situations. It had been said that a medical man was seeking practice during the time he received the £40 a year; but if he did so he must devolve the duties on a very young assistant. It was a sham to talk about attendance on the medical wants of the poor at £40 a year, but if this Bill were carried, the Boards of Guardians would pay £10 a year less on the ground that the medical officers would be entitled to superannuation. He should oppose the second reading, and he hoped the hon. Member for the West Riding would divide the House.


said, he should give his support to the Bill, which his experience as a Poor Law Guardian had shown to be necessary. He thought the poor would be greatly benefited by such legislation.


said, that the Bill would make an addition to the establishment charges which had been so loudly complained of throughout the country. He could not, however, refrain from supporting the measure, as justice ought to be done to these gentlemen; but he trusted that in the end the charge would be imposed on the public funds instead of the local rates.


said, that in Ireland a better class of Poor Law medical officers had arisen in consequence of a provision being made for old age. He had known cases, previously, where a good medical man was, owing to the want of superannuation, kept on as an officer to a too late age to his own prejudice, to the injury of the poor, and to the deterioration of the pockets of the ratepayers. The medical man was entitled to as much consideration as the military man.


said, the policy of the Poor Law Board was to make the medical officers permanent, for otherwise they would not be independent of the guardians; but, in order to obviate the inconvenience of permanency and hold out some inducement to them to retire when they became old or feeble, it was necessary that there should be a superannuation allowance.

Question put, "That the word 'now' stand part of the Question."

The House divided:—Ayes 139; Noes 28: Majority 111.

Main Question put, and agreed to.

Bill read a second time, and committed for To-morrow.