Eg Phd, Mphil, Dclinpsychol

This thesis has been submitted in fulfilment of the requirements for a postgraduate degree (e.g. PhD, MPhil, DClinPsychol) at the University of Edinburgh. Please note the following terms and conditions of use: This work is protected by copyright and other intellectual property rights, which are retained by the thesis author, unless otherwise stated. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. This thesis cannot be reproduced or quoted extensively from without first obtaining permission in writing from the author. The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the author. When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given. The Roles of the Edinburgh, Kelso, and Newcastle Dispensaries in Charitable Relief, 1776-1810 Daisy Cunynghame Doctor of Philosophy School of History, Classics and Archaeology The University of Edinburgh 2020 Abstract This thesis explores late eighteenth- and early nineteenth-century British charitable medical provision through a comparative study of the Edinburgh, Kelso, and Newcastle dispensaries. It is situated within historical scholarship concerned with institutional histories, charitable relief systems, and medical therapeutics. The research draws on a range of sources, including records which have not previously been studied such as dispensary patient case notes. It also contextualises dispensary provision by studying alternative sources for medical relief for the poor in surrounding districts, including poor relief systems, infirmaries, and other charitable bodies. By adopting both statistical and narrative approaches this thesis demonstrates the variation in models of dispensary management and treatment and considers the impact on dispensary provision of local factors such as harvest failures, epidemics, and employment models. It considers the differences between the theoretical approaches of these dispensaries as presented in annual reports, newspapers, and promotional publications, and the practical realities of their provision. It also looks beyond the administrative models of the dispensaries to explore the employment, age, and gender of dispensary patients. The dispensary outpatient model of treatment often provided for a distinctly different demographic of society than other relief systems such as infirmaries and workhouses. This thesis, therefore, provides insight into sickness experiences which have previously been largely unexplored. This research considers the practical application, as well as theoretical frameworks, of medical treatment during the late eighteenth and early nineteenth centuries. By giving priority to practice over theory this thesis provides insight into the medical treatments which were commonly adopted by practitioners. In doing so it uncovers the context of these treatments, not only which diagnoses they aimed to ameliorate, but the patients’ symptoms and the identified outcomes of these treatments. This approach also enables analysis of the reception of these treatments by patients. It contributes to existing scholarship by considering ideas around patient agency and concepts of shame, particularly in relation to the diagnosis and treatment of genito-urinary complaints. 2 Lay Summary Dispensaries were established in the late eighteenth century to provide free medicine and advice to the sick poor. They were not the only institutions to do this, infirmaries and other charitable bodies were set up to provide a similar function. There were distinct differences, however, between dispensaries and these other forms of relief. Infirmaries, unlike dispensaries, had rules which made it difficult for some to access their services. Dispensaries, by contrast, were commonly open to anyone who presented themselves for treatment. As a result, a wider range of people used dispensaries than these other charities. Dispensaries frequently admitted more women, more children, and more elderly individuals. This study, by using sources such as patient case notes, provides insight into who these patients were, their occupations, their families, and their responses to the medical treatment which they were given. It shows which treatments they accepted willingly and which they did not. It also shows which medical conditions patients were ashamed to discuss and which they were not. By comparing three different dispensaries this study shows many similarities in the rules and systems of organisation which they adopted. It also uncovers significant differences based on local circumstances. The dispensary based in Kelso adapted to treating the ageing local population while another, in Newcastle, accommodated the needs of its industrialising surroundings. The third dispensary, in Edinburgh, was in a city filled with medical innovations and competition between charities and medical practitioners. 3 Table of Contents Declaration of Authorship 6 Acknowledgements 7 List of Figures 8 Abbreviations 10 Introduction 11 Identifying the Practitioner, the Patient, and the Disease 15 Introduction to the Sources 25 Methodology 30 Aims and Objectives 32 Chapter Synopsis 34 1. The Local Context of Medical Poor Relief 37 1.1 Infirmaries: the Finance of Exclusion 40 1.2 The Geography of Inclusion 44 1.3 Moral and Medical Criteria 47 1.4 The Poor Law Context 49 1.5 The Role of the Workhouse 55 1.6 Conclusion 60 2. Dispensary Origins and Administration 62 2.1 Founding the Dispensaries 66 2.2 Funding and Accommodation 72 2.3 Patient Admissions and Medical Provision 80 2.4 Dispensary Management 85 2.5 Staffing the Dispensaries 89 2.6 Conclusion 91 3. Admissions and Demographic Context 93 3.1 Occupations of Patients Admitted 94 3.2 Gendering Admissions 106 3.3 Provision for the Young 113 3.4 Provision for the Old 119 3.5 Conclusion 125 4. Body and Mind: Changing Approaches to Medical Diagnosis 127 4.1 Classifying and Identifying Disease 129 4.2 Physical Examination of the Patient 134 4.3 Verbal Examination of the Patient 137 4.4 The Patient’s Narrative 140 4.5 Conclusion 147 4 5. Diseases, Conditions, Disorders, and Complaints 148 5.1 An Overview of Disease Categories 149 5.2 Genito-Urinary Diseases 153 5.3 Diseases of the Digestive System 163 5.4 Conclusion 172 6. Treatments and Outcomes 174 6.1 Hygiene and Regimen 176 6.2 Physical Methods 179 6.3 Medicinal Methods 184 6.4 Medical Outcomes 190 6.5 Conclusion 198 7. Public health 200 7.1 The Origins of a Public Health Movement 201 7.2 Addressing Public Health 205 7.3 Inoculation and Vaccination 212 7.4 Infection and Contagion 217 7.5 Conclusion 223 Conclusion 225 Appendix 238 Bibliography 242 5 Declaration of Authorship I, Daisy Cunynghame, declare that this thesis has been composed solely by me, the work presented is my own, and it has not been submitted for any other degree or professional qualification. 6 Acknowledgements I would like to thank my supervisors, Professor Stana Nenadic and Dr Gayle Davis for their guidance and encouragement without which this thesis would certainly not have developed as it has done. I would also like to thank Professor Adam Fox for acting as my temporary supervisor and Professor Michael Anderson for his invaluable guidance regarding statistical analysis. I would also like to thank the staff at the Lothian Health Services Archive, Tyne and Wear Archives, the Edinburgh City Archives, the Centre for Research Collections at the University of Edinburgh, and the National Records of Scotland. Particularly, I would like to express my gratitude to Dr Louise Williams of the Lothian Health Services Archive whose expertise has been invaluable to me in my research and whose patience has been very much appreciated. I am also very grateful to Iain Milne and Estela Dukan, my colleagues at the Royal College of Physicians of Edinburgh, who have been extremely understanding throughout my work on this thesis. Without their flexibility and tolerance this thesis would certainly not have been completed. Finally, I would like to thank my mother, Penny Cunynghame, for her unending love, support, and encouragement, Laura Magner, for the same, and my partner Chris Buckham, for being there. 7 List of Figures Figure 1.1. Patient admissions at the Edinburgh infirmary, by admission category, 1770-1810 (p.42) Figure 1.2. Reasons given for pension payments in Edinburgh’s Canongate parish, 1785-1805 (p.53) Figure 1.3. Recipients of relief from the Edinburgh Charity Workhouse in June 1774 (p.56) Figure 1.4. Recipients of poor relief in the city of Newcastle in 1803 (p.58) Figure 2.1. Patient admissions at the Edinburgh infirmary, Newcastle infirmary, Edinburgh dispensary, Newcastle dispensary, and Kelso dispensary, 1780-1810 (p.63) Figure 2.2. Kelso dispensary, Roxburgh Street (p.75) Figure 2.3. Newcastle dispensary, St. John’s Lodge (p.76) Figure 2.4. Elevation and plan of the Edinburgh dispensary, Richmond Street (p.78) Figure 3.1. Occupational categories, where given, of patients admitted to the Edinburgh dispensary, 1778-1790 (p.97) Figure 3.2. Surgical, casualty, and slight cases admitted to the Kelso dispensary and Newcastle dispensary, as a percentage of total admissions, 1780-1810 (p.103) Figure 3.3. Number of surgical cases admitted to the Kelso dispensary, by diagnostic category, 1790-1810 (p.104) Figure 3.4. Gender composition of patients at the Edinburgh, Kelso, and Newcastle dispensaries, as a percentage of total admissions, 1776-1805 (p.108) Figure 3.5. Gender composition of patients at the Edinburgh infirmary, as a percentage of total admissions, 1770-1810 (p.110) Figure 3.6. Gender composition of patients at the Newcastle infirmary, as a percentage of total admissions, 1779-1787 (p.110) Figure 3.7. Age range of patients at the Edinburgh, Kelso, and Newcastle dispensaries, as a percentage of total admissions, 1776-1805 (p.114) Figure 3.8. Age range of patients at the Newcastle infirmary, as a percentage of admissions where age is recorded, 1779-1787 (p.123) 8 Figure 5.1. Breakdown of diagnostic categories of patients admitted to the Kelso dispensary, as a percentage of total admissions, 1780-1805 (p.151) Figure 5.2.

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