Queen Mary and Westfield College London University PhD Thesis ...

the Apothecary was to receive £80 per annum, with coals, candles and (by 1772, at least), soap
and house provisions, and while responsible for stocking the shop himself, was kept tabs on by
being required 'to deliver a List to the Committee every Saturday of all Medicines necessary for
the Shop'88.
It is important, of course to see such initiatives within the broader spectrum of charitable
provision during the period. The Governors and officers of London hospitals had long been
at pains to reduce the expense of hospital care for the poor, although medicine was conceived
as just one important facet of the charity they provided In a letter written in 1682, Edward
Browne, then Physician to St. Barts, asked his father (Sir Thomas Browne), to 'thinke of some
good effectual cheape medicines for the hospitall', encouraging him that 'it will be a piece of
charity, which will be beneficiall to the poore, hundred of years after we are all dead and gone9.
During the eighteenth century, such efforts to make medical treatment more affordable for those
in reduced circumstances gradually snowballed. The introduction of apothecaries' shops and
other measures aimed at streamlining the excess baggage of hospital administration around
mid-century were part of this wider phenomenon in which Bethiem clearly shared. On the other
hand, this meant that good health was by no means seen as an entitlement for the poor, but was
essentially a commodity at the disposal of the governing elite, while medical officers who saw
their hospital duties as charity were less apt to provide a thorough attendance. Contrariwise,
unsalaried apothecaries and surgeons, who viewed hospital practice as good business, were not
so prepared to moderate their bills.
For surgery at Bridewell and Bethlem procedures, had, in fact, since the seventeenth century,
been rather more elaborate, the Surgeon being required to await the scrutiny of the Physician
and Apothecary (or other selected Governors) before performing any surgical operation, so that
they might verify its necessity and agree a price with him90. The obvious implication which
follows is that necessary surgery was subject to delays while (or until) medical officers and
governors debated its necessity and cost. Irrespective of the offence to modern sensibilities in
the notion of officers haggling over a wound, the lack of emphasis on the actual need of the patient
for such treatment indicates a certain blinkering on the Governors' part in their concentration
on financial expediency. The Governors freely acknowledged, nevertheless, that unauthorised
In fact, thi. latter stipulation was not mentioned until 1772, but presumaUy had been operating in practice
since 1751. See BCGM, 25 June 1772, fol. 359.
Sir Thomas Browne, The Work. (ad.) Wilkin, vol. iii, 481.
90 See e.g., ibsi, 24 May & 5 June 1644, 28 March 1645, 23 Nov. 1649, 24 Oct. 1656 & 19 Feb. 1674, loIs 118,
123, 189, 408, 769 & 616.
266