Under the Old Poor Law, parishes paid for medical attendance on a fee-forservice basis, but by the early nineteenth century, many found it more convenient to contract with a medical practitioner based on an annual salary. The latter arrangement was cemented after the Poor Law Amendment Act (1834) when the Poor Law Commissioners authorized boards of guardians to appoint medical officers for the provision of outdoor medical relief and for the attendance on sick inmates in workhouses. Consequently, guardians treated medical officers on the same basis as other officers or servants employed by them. For instance, William Sturrock, workhouse medical officer in Birmingham in 1900, complained that he was allowed only three weeks’ annual leave, whereas other first-class officers had four. He claimed that this “seems like a slur on Medicine that its representative should be ranked with subordinate officers.” Immediately after the New Poor Law, guardians appointed the doctors by utilizing the tendering process, usually choosing the lowest submitted. This arrangement was abolished after the General Medical Order of 1847 required a salary decided by the guardians to be stated at the time the post was advertised. Medical officers were usually appointed on an annual basis, despite the order directing that tenure should be permanent. It also required them to be qualified as surgeons and apothecaries. This was modified by an order in 1859 to require qualifications to practice medicine and surgery in England and Wales, thereby ensuring that poor law medical officers were better qualified than practitioners in private practice. However, the dual requirement could be circumvented if a doctor lived outside the district of his responsibility. Although salaries were set by guardians prior to appointment, they remained very low, varied greatly, and were a cause of frequent complaint. Despite this, medical officers were the one common denominator within a patchwork of welfare practices and fundamental to medical welfare.

This chapter will consider the conditions under which the workhouse medical officers of Birmingham and Wolverhampton labored and will provide an estimate of their workload. The questions it attempts to answer include to what extent the New Poor Law influenced the institutional medical care of paupers and how the development of infirmaries affected medical staffing.