Thomas Spence and the Call for State Medicine

Spence Book Cover

I’ve posted a series of articles recently on the late 18th- early 19th century radical reformer, Thomas Spence. In his books, pamphlets and correspondence, Spence argued that Britain should be transformed into a federation of autonomous parish communes. These would each take into their ownership the land surrounding them, which would then be rented out to various companies and industrialists. The money thus raised would be spent on a series of public works, such as roads and canals, as well as schools, relief for the infirm and unemployed, and medical care for the sick. Any remaining money would be paid out every quarter day to every single one of the communes’ inhabitants, including women and children.

Although the NHS was set up in 1948 after the victory of the Labour party in the post-War election, there had been demands for a system of state-supported hospitals going back to the Levellers in the 17th century. Tom Paine also demanded the state provision of medical care in the late 18th century. Thomas Spence too demanded the establishment of a system of state hospitals to serve the poor in a letter of October 24th, 1800. The 18th century saw the emergence of a number of public hospitals, beginning with the Bristol Royal Infirmary. These were funded by a group of individual subscribers, and patients were only admitted after they had gained the approval of the subscribers and satisfied them that of their good character. Spence was highly critical of this system, because of the way it turned away sick people, who could not provide the subscribers with the required guarantees that they were worth admitting. Spence wrote:


The management of hospitals for the sick being of the greatest importance to the public, nobody can be blamed for endeavouring to improve their state. And though they are of very great public utility, as at present conducted, yet I think they may be of much greater, by allowing an unbounded latitude and ease of admittance.

Is it not wonderful that subscribers or governors, as they call themselves to such institutions, should so far stand on punctilious, as to require application from the poor weak patients for letters of recommendation, before they can be admitted.

The difficulties attending the procurement of these recommendatory papers, and the time and strength wasted about them, are often of the most hurtful tendency to poor creatures labouring under the accumulated burdens of disease and poverty and are certainly the cause of many a death. The grievance and anxieties suffered on such occasions are incomprehensible to such as have not tasted of the bitter cup. As to out-patients, their usage is shameful to an extreme, by the uncertain time of medical gentlemen’s attendance, and makes it more to a patient’s advantage if his time be of any value, at all, to pay for his medicine elsewhere, than to fret so many hours away in waiting.

Why then in the name of humanity, should all these disagreeable repugnances be thrown in people’s way? It is doubtless to deter as many as possible from applying to such places for relief, and induce them to apply to the faculty elsewhere, rather than dance such distressing attendance.

So much then for the medical gentlemen working together for the benefit of their craft. They should therefore be looked strictly after and made to attend more punctual to their appointed time, at all such places of medical relief, for surely the time of one individual cannot be more precious than that of the many unhappy, and useful sick, who are waiting for them.

But what is the strangest of all in this melancholy business, is that the very subscribers should wish to come in for a share of this pitiable attendance, and at the most critical time too. Good God! Can it be to squeeze a little homage from such suffering creatures, or is it to take such a sure opportunity as this to mortify, and let them know their dependent condition? They will not dare to avow such mean motives.

Well then Citizen to remedy all these evils I would have the hospitals open for the admission of the sick of every description, every day of the week, without previous application. For as in cases of sickness there can be the least chance of imposture, we may safely trust the detection of cheats to the sagacity of the faculty who should admit all applicants immediately without making them wait for a particular day of the week as for the moving of the waters. I say, let all immediately be admitted either as in or out-patients, as the cases should require. No questions should be asked about circumstances or security for funerals, neither should maladies of any description be rejected, but only for want of room in which case, if the patient require to be taken in, he should be told to apply to such other hospital as they knew to have vacancies, that no time might be lost.

By such speedy relief and encouraging invitation the most happy effects would accrue to the public. Every disease would be taken in such due time, as to render the cure almost certain, and those of an infectious nature would likewise be prevented from spreading…

But now Citizen, methinks I hear you say, what will become of such of the faculty as have not places in the hospitals for they would be ruined if such free and easy access were permitted to such institutions?

I answer that I was not studying for the interest of any particular set of men, but for the public good. But supposing there were hospitals sufficient for all the people when sick, and that there were no other medical men employed than were placed in them, I cannot apprehend that the state of mankind would be worse. And suppose further that hospitals were all supported by county rates, instead of private subscriptions that we might get rid of paying such distressing homage to subscribers and governors, it would certainly be a great improvement.

H.T. Dickinson, The Political Works of Thomas Spence (Newcastle-Upon-Tyne: Avero 1982) pp. 89-91.

The NHS has certainly been far more effective in the prevention and treatment of disease that the private medical care that preceded it. It is also far more efficient than America’s private medical care, no matter what the Republicans say about the supposed evils and inefficiencies of socialised medicine or Obamacare. Unfortunately, this is now being undermined and privatised by the Coalition. If this goes ahead, then it will result in the lack of medical care for the poor that was prevalent in Spence’s day, and which is still true of the American system. Spence in his demands for state medicine anticipated and helped contribute to the foundation of the NHS in 20th century. With their privatisation of the NHS, the Coalition are doing their best to drag us back to the 18th.

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