Thomas Brickwell the younger was baptised aged 9 weeks on 1 January 1791 at St Mary’s, Amersham, son of Thomas Brickwell, surgeon. He pursued the same career path as his father and is the pivotal figure between the Old Poor Law and the New. His testimony about the changes is still widely quoted.
He probably qualified by the old route of apprenticeship as the Medical Directory for 1865, noting that he was the Union Medical Officer, said merely ‘in practice prior to 1815’, so acknowledging that he trained before the provisions of the Apothecaries Act of that year would apply. That is puzzling since the London & Provincial Medical Directory of 1850 (p 278) stated that he had become a Licentiate of the Society of Apothecaries in 1828.
On 29 August 1814 he married Maria Miles at St Margaret’s Westminster by banns, as reported in the Windsor & Eton Express on 4 September. On 8 September 1815, the year the Napoleonic Wars finally came to an end, their son Benjamin Arthur, who would be the third-generation Brickwell medical practitioner in Amersham, was baptised on 8 September. Catherine followed in 1817 and they had the sorrow of burying another daughter, 10-month-old Mary, in 1819. Catherine went on to marry Watkin Doyle and died suddenly on 20 August 1850, leaving 3 children The couple had married only in May 1846 in Amersham.
A Parliamentary Return of 1849 states that Thomas Brickwell was aged 59 and had been surgeon for the parishes of Coleshill, Seer Green and Penn since March 1817, a total of 32 years. His pay had averaged £55 per annum but was currently £38.[1]
He seems to have valued education since he was instrumental in bringing about the departure in 1830 from Dr Challoner’s Grammar School of the Reverends Foyster and Hickman who had been content to delegate much of the teaching to the oldest of their six pupils, aged 14.[2]
His appointment as parish surgeon began under the Old Poor Law but continued after 1834 under the new rules. He was one of the witnesses interviewed by the Poor Law Commissioners about the changes brought in and for this reason his views are still widely quoted in many of the books about the introduction of the New Poor Law.
He expressed approval of the new system in that it introduced greater accountability for both the Relieving and Medical Officers, which should result in paupers having ‘proper attendance’. He remarked that some people, whose medical bills had been picked up by the parish, had opted to become independent patients, paying the doctor directly, ‘rather than the parish know their disease’. His criticism of the new system was that medical attendants’ income would be cut: ‘I think I shall lose a guinea a week by it; in some parishes it is at present only one-third of what I have received in former years for the same time.’[3]
The new system and Brickwell’s resigned attitude to remuneration, while it sat well with the Poor Law Commissioners, did not win the plaudits of other members of his profession: ‘Like the solitary testimony of Mr Brickwell, one out of thirteen surgeons in the Amersham Union, it is brought ostensibly forward, to justify an alteration for the worse, when no alteration at all was called for by the public, and none whatever recommended by the Commission of Enquiry’.
The system caused great resentment also because it would ‘reduce medical men to the necessity of putting their skill and humanity up to sale by tender and contract, as the butcher and baker their bread and meat!’[4]
In the matter of payment Brickwell may have felt that the battle had been lost and the probable reason for that is spelt out in some detail in one of the reports submitted to a committee of the Provincial Medical and Surgical Association in 1842. Although rather lengthy it is a good illustration of the tussles which took place as Boards of Guardians strove to reduce and control costs while the medical men sought to ensure proper treatment for the paupers in return for fair remuneration. Fixed-price contracts meant that whatever drugs and dressings were needed had to be paid for by the attending doctor, who bore all the financial risk of such a deal and whose income diminished the more actively he treated his patients.
‘On the formation of the Amersham Union in 1835, the board of guardians, by the advice of the assistant-commissioner, Mr Gilbert, invited the surgeons already in attendance on the several parishes, to continue their services, on the receipt of 2 shillings for each case of illness and accident, accompanying this humiliating proposal with the usual threat of publicly advertising the Union, if it were declined. The resident surgeons protested against this proceeding and shewed by several calculations the total inadequacy of the proposed terms. One of the medical men suggested to the board a scale by which these payments might be somewhat more reasonably determined, within the limits of 2 shillings and sixpence, or six shillings and eightpence per case; the sum increasing according to the distance of parishes and the paucity of cases, though he still considered this far below a proper remuneration.
The board hereupon made a slight advance on their first offer, namely 2 shillings and sixpence, three shillings, or 3 shillings and sixpence per case, according to the total number of patients, but refused any increased rate for distant parishes. They likewise reduced the payment per case to half the above sums for all cases removed within the first month of treatment to the Union Workhouse, for which a separate contract was to be made. The board also limited the cost of pauper attendance to the amount of the former salaries.
The majority of the surgeons, though entirely disapproving of this proposal, both on account of its inadequacy and of the unreasonable and obnoxious nature of some of its provisions, nevertheless judged it advisable to undertake the contract; but the practitioners resident in the Chesham district, which contained a population of 6,300, and extended nine miles by seven (consequently involving the longest journeys, and the greatest expenditure of time and labour) declined attending the distant parishes, unless an increased rate per case were conceded for so obvious an outlay.
The board, deaf to arguments, advertised the district, and appointed a youthful candidate from London.
Before the formation of the Union, the medical salaries amounted to £377 per annum, and the usual extra charges to more than £100.
At the close of the first year, the total payments to the medical officers were £255, being a reduction of more than £200 per annum. The payments for the distant parishes amounted to less than one-third of the former salaries. The dissatisfaction of the new medical officer was great, but that of the poor still greater.
The guardians then relinquished the payment per case, and returned to fixed salaries. But rather than abandon the gentleman whose reply to their advertisement had relieved them of their difficulties, they increased his rate of remuneration for the distant parishes — thus admitting the justice of the principle for which the established practitioners had originally contended, and for adhering to which they lost the appointment.
The subsequent conduct of the board to those gentlemen may be exemplified by the following occurrence: – At the commencement of the second year, the medical officer was taken ill, and consequently unable to attend to his duties. The parish officers were applied to, and they requested one of the established practitioners to undertake the care of the sick. Notwithstanding what had previously occurred, this medical man thought it right to obey the call, and attended the poor of the district for a week. The board of guardians, in return, refused to discharge his account for this attendance. They had the effrontery to suggest that it was usual for practitioners ‘”to assist each other gratuitously under such circumstances as a matter of course.” To crown all, they informed their unfortunate medical officer, that if payment were demanded, which they knew it might be legally, they should require it at his hands, he having undertaken the contract!’[5]
Despite the disadvantages of being bound by such contracts, the post of Medical Officer to a parish or workhouse was seen as desirable in that it carried a certain status and helped medical men establish and expand their practices. In 1844 about 2,400 such posts were available in England and Wales, with an average salary of around £69. This was considerably less than most parish surgeons had been earning towards the end of the eighteenth century in a less competitive market. It has been calculated that the medical officers often had around four or five times as many patients to treat.[6]
As time went on it became the norm for the Guardians to pay for the most expensive drugs; quinine and cod liver oil being those regularly mentioned in advertisements for Medical Officers. Midwifery cases were separately charged and fees could also be earned for vaccinations.
Boards of Guardians were permitted to appoint anyone who had a diploma or degree as a surgeon from a Royal College or University in England, Scotland or Ireland. In addition, applicants needed a degree in medicine or a diploma or licence of the Royal Physicians of London or a certificate to practice as an apothecary from the Society of Apothecaries of London.[7] Practitioners could also apply if, like Thomas Brickwell, they had been in practice as an apothecary before the new standards became the norm. This included those who had held a warrant or commission as surgeon or assistant-surgeon in the Royal Navy, the Army or the Honourable East India Company before 1 August 1826.[8]
Thomas Brickwell had embarked on his career before such qualifications became the norm. His experience allowed him to continue in practice and to become a medical officer but the Guardians had to renew his appointment every year, unlike his younger colleagues.
The Tithe Apportionment map, drawn up on 26 October, 1837, shows Thomas Brickwell occupying plot no 532, owned by Thomas Tyrrwhitt Drake. He is renting three areas of meadow grass from Ann Miles and Sarah Walker (no 1120, 1121 and 1122) and himself owns two cottages with gardens, let to Thomas Woodbridge and Thomas West ( no 1110).
In 1841 the Brickwells can be found living next door to the Crown Inn, with their daughter Catherine, while their son Benjamin, already a surgeon, was lodging in Burleigh Street, Westminster. Ten years later the couple are still on the High Street, probably at The Gables, now no 27 but living on their own with one servant. Thomas Brickwell was 62 and gives MRCS and LAC as his qualifications. Benjamin had returned to Amersham and is raising his own family further along the High Street. Maria died on 8 December 1859. It they lived for some time at The Gables, now 27 High Street.
In the Autumn of 1856 Mr Brickwell ordered his gardener William Rolfe to dig up part of the garden where for many years damson and filbert trees had been growing. A skull was unearthed, then the rest of the skeleton it had been attached to. An inquest was held at which Mr Gray and Mr Brickwell both stated that it was a woman’s skeleton and likely to have been there for 50 or 60 years. It had not been buried in a coffin and the two surgeons made it very clear that there were no signs of the body having been used for dissection. Brickwell stated that he had occupied the house for the last 2½ years but had known it for some 60 years and that the previous occupants had been Mr Weller in succession to Mr Pearson and Mr Velander, none of whom had been medical men. The jury could only bring in a verdict of unexplained death and so the mystery remains.[9]
Like the other surgeons Thomas Brickwell was called to testify at a number of inquests. On one occasion he examined a child from Henley who had died without having being seen by a doctor. Brickwell’s professional opinion was that death was due to inflammation. The jury however preferred to bring in a rather more traditional verdict — ‘Died by the Visitation of God’. It would be interesting to know what the surgeon might have said about a label commonly used for sudden death from no known cause being preferred when he had gone to the trouble of putting forward a more scientific explanation.[10]
Maria Brickwell’s death on 18 December 1859, aged 71, was noted in the Bucks Herald of 1859. Thomas Brickwell died on 1 May 1873, leaving an estate valued at under £100. His death notice appeared in The Times on 5 May, p 1:
‘On 1st, at Amersham, where he had practised as a surgeon for upwards of 60 years, Thomas Brickwell, Esq, in the 87th year of his age. Friends will please accept this intimation.’ The following day’s issue had a paragraph marvelling that the obituary column had reported the deaths of seven people whose combined ages totalled 608 years and adding that one of them had practiced surgery in Amersham for over 60 years. Quite a few newspapers then went on to repeat some of the information in the same anonymised form.
Benjamin Arthur Brickwell continued in practice in Amersham, was also a medical officer, and lived at Broadway House (no 50, High Street) He died in 1888.
[1] Return of the Names, Ages, Designation of Office, &c., of Officers whose Incomes are paid from the Poor Rates, p14.
[2] N Salmon & C Birch, Yesterday’s Town: Amersham, 1991, p 50
[3] First Annual Report of the Poor Law Commissioners for England and Wales, 1835, pp 263-4
[4] ‘Poverty, its Evils and their Remedies: Parochial Medical Relief’ in Medico-Chirurgical Review and Journal of Medical Science, January 1840, p 118
[5] The Administration of Medical Relief to the Poor under the Poor-Law Amendment Act, 1842 pp 11-12. This included reports submitted by members of the Provincial Medical and Surgical Association. The chairman of the Association’s Sick Poor Committee was Henry Wyldbore Rumsey (1809-1876) of Chesham. He was extremely influential and appeared before two Select Committees of the House of Commons, in 1838 and 1844. One of his friends was William Farr, the medical statistician employed by the Registrar General. Rumsey moved to Gloucester and later retired to Cheltenham, having been granted a Civil List pension for his services to the State as an adviser on medical services for the poor.
[6] Irvine Loudon, Medical Care and the General Practitioner 1750-1850, 1986, p 239. For more details of their duties see the Poor Law Commission’s Consolidated General Order, 1847, Articles 205 to 207.
[7] The Apothecaries Act of 1815 required apothecaries to serve a formal apprenticeship and to demonstrate their knowledge. From then on apothecary-surgeons had to be instructed in anatomy, botany, chemistry, materia medica, physic and in addition have six months practical hospital experience. It marked the beginning of formal regulation for medical practitioners and was followed eventually by registration.
[8] See the Poor Law Commission’s Consolidated General Order, 1847, Article 168
[9] Windsor & Eton Express, 29 Nov 1856, p 3
[10] Bucks Herald, 3 Dec 1853, p 3