From the seventeenth century the services of doctors, apothecaries and surgeons became increasingly available to the poor and by the following century a growing number of parishes began to establish medical services in accordance with the provision of local poor relief measures. The system commenced with the payment of bills presented to the Overseers for services rendered to paupers on a ad hoc basis but by the nineteenth century the practice was replaced by the introduction of a fixed price contract awarded annually. In the larger parishes and townships the presence of several resident doctors ensured competitive pricing and therefore minimised parish expenditure. (1)

An example of the early system applicable to Knottingley, is seen as late as April 1841 when the Select Vestry instructed the Overseer to, "…write to Mr. Dawson, surgeon of Wakefield, informing him that they do not consider themselves responsible for the Bill sent for attending upon Joseph Fozzard." (2) Fozzard being relieved at Wakefield presumably, on behalf of Knottingley Overseers.

However, at Knottingley the system of farming out the work on an annual contract basis had been adopted thus giving the Select Vestry a greater degree of control over the provision of individual medical care.

The growth in the number of resident medical practitioners at Knottingley reflects the demographic expansion of the town. At the end of the eighteenth century two doctors, William Clerk (sic) and William Gaggs, were living in the township. (3) By the 1820s the number had increased to three. Edwin Long, a scion of the family which resided at the Old Hall, next to St. Botolph’s Church, had a practice based at Cow Lane House, and Thomas Clark, probably the son and successor of William, was based at Hill Top. (4) A decade later, William Bywater and Joseph Hill were resident at Hill Top where the latter had probably succeeded Thomas Clark.

A legal document dated 11th May 1872, refers to the estate of the late surgeon, Joseph Hill, and to premises situated, "…near to the Swan Inn." (5)

The documentary detail is confirmed by a deed of conveyance of April 1883, which names the vendor as Doctor William Clark, formerly of Ladyfield, Winslow, Manchester, and then of Switzerland, whose property at Knottingley is described as standing on the east side of the canal with the town’s street, or Weeland Road, to the south and bounded on the east by property belonging to Benjamin Atkinson. (6) From this it is evident that the Hill Top surgery occupied a site between the Swan Inn and Gaggs Bridge, and identified in trade directories as Bridge House. By the mid 1830s, however, William Bywater had transferred to the Cow Lane House premises previously occupied by Dr. Long, for it is known that by 1838 Bywater had established a small brewery on the site which was later to be redesigned as the Ash Grove Surgery. (7) It was also during the 1830s that Robert Twaites established a practice at Racca House, a large detached building situated at the south side of the Weeland Road turnpike road at the top of Racca Green. (8)

Thus, by the mid nineteenth century the local population of 4,540 was served by no less than five medical practitioners. In addition to William Bywater and Robert Twaites there was John Hollingworth and Samuel Smallpage while John Hall Bywater, son of William, was practising from Bridge House. (9) Following the death of William Bywater in June 1856, the son relocated to the Cow Lane site where he remained until his death in November 1863, being succeeded by his brother, Thomas L. Bywater until early the following decade. Doctor John Hollingworth was also associated with Bridge House throughout the 1860s and may have followed John Hall Bywater when he transferred to Cow Lane in the late 1850s.

The earliest record of the annual appointment as the Town Medical Officer dates from February 1838 when the Select Vestry decreed that, "Mr. Bywater is this day appointed Town Surgeon at a salary of £15 per annum and to commence forthwith. It is to be understood that all who are receiving weekly relief from the Overseers of Knottingley have a claim upon the Town’s Surgeon and he is to attend them and also the inmates of the Workhouse for the said salary…" (10) and the following year, "Joseph Hill to be surgeon for the ensuing year at the usual salary of £15 and to attend all persons on relief and in the Workhouse."

While in February 1842, when Hill was again appointed, "…for the ensuing year beginning 1st May", indicates that by that time appointment was announced in February or March in anticipation of the commencement of duty in May. (11)

No mention is made concerning the remuneration for the post but a standard fee was paid as confirmed by the appointment of William Bywater to the post in 1844.

"Mr Bywater [to] be the Township’s Surgeon the ensuing year at the usual salary." (12)

Betweentime, the post had been filled by Dr Twaites as shown by a Select Vestry decision in March 1841 that, "Mr Twaites be not paid his charge for his surgical operation on John Tree." (13)

Twaites presents a fine example of the need for vigilance on the part of the Select Vestry. In May 1838 the Vestry had requested of Twaites details of paupers attended and the sources of authorisation. Twaites disregard of the demand resulted in a resolution that, "Dr. Twaites be ordered to provide the Overseer with details of medicines delivered to paupers and be desired to attend the next Select Vestry." (14)

The outcome of the affair is not recorded but an understanding must have ensued for in March 1840 Twaites was again appointed Town Surgeon. (15) However, Twaites may have been less than zealous in the execution of his duties for shortly after his appointment the Select Vestry decreed that the surgeon be asked to, "…call at the Workhouse 2-3 times per week to look at the old paupers." (16)

The method of appointing the Town Medical Officer is shown by a Vestry resolution of February 1845 that, "The surgeons of the Town be notified of tender to wait upon the Parish Poor during the forthcoming year (i.e. those in receipt of regular and casual relief). (17)

The appointment of a Town’s Medical Officer reflected the situation throughout the country in general where due to rapid population growth overcrowding in existing dwellings had promoted the construction of small cottages and terraces of houses and the conversion of larger dwellings into separate tenements to absorb the overspill. Many of the hurriedly constructed new dwellings were erected within the confines of yards and gardens which had hitherto served single units of habitation. With almost total disregard for lack of light and air, enterprising property owners crammed new dwellings into available space at all angles. Lack of adequate drainage and sewerage facilities together with inadequate and polluted supplies of water presented a huge health hazard. The situation was particularly acute in Aire Street where the existing dense habitations were supplemented by the further construction of dwellings within the courts, yards, alleys and gardens lying between the Street and the Back Lane or Croft. As the nineteenth century progressed and the area east of the township increasingly became the seat of industrial activity within the town, with its concomitant population growth, similar random building occurred, albeit with less overall density than in Aire Street due to the greater openness of the locality. Few of the town’s streets had hardcore foundations and even fewer had flagged pavements before the second half of the century. The streets, yards and areas of greatest demographic density were areas in which open gutters, cesspools and refuse heaps existed, providing a perpetual nuisance and an omnipresent danger to health and life. Periodically a sudden visitation such as the cholera epidemic in 1831-32 and again during the 1840s, provided a spur to action but such measures were always on a temporary and limited scale occurring as a reaction to events and therefore merely palliative in nature, so that even as late as the 1860s cholera outbreaks recurred. It is noticeable that the Select Vestry gave more attention to combating cholera than any other form of disease affecting the local population. The action was not solely prompted by altruism for being a water-borne disease cholera presented a greater damage to the wealthy middle class citizens with their elaborate and efficient water supply systems than did most other diseases. Following the cholera epidemic within the township during the mid 1840s the Select Vestry decided to purchase a copy of the Cholera Act. (18) It was doubtless hoped that a sustained campaign against the scourge would result in its decline on a comparable scale with that of smallpox, the other great scourge, which following Jenner’s discovery of an anti-viral vaccine in 1796 had shown a marked retreat. In the century following Jenner’s breakthrough a National Vaccine Establishment had been formed and by 1840 free vaccine was made available thus enabling the treatment of children and adults, including paupers, with periodic mass vaccinations in succeeding generations. In October that year, Knottingley Select Vestry resolved to allow the town’s medical men access to the Vaccination Act and accompanying papers for 24 hours each and thereafter, "…teat with the medical men regarding vaccination of the children residing in the township." (19)

The month following, Bywater and Twaites attended a special Vestry. Dr. Hill, unable to be present, having previously intimated that he would be bound by any agreement reached by his medical colleagues. As a result of negotiations the three doctors agreed to accept a per capita payment of 1s 6d for vaccinating the residents of the town.

The township was sub-divided into three districts of approximately equal population. The west-end, comprising the Holes, Hill Top, Spawd Bone, Longlands, Jackson Bridge, Chapel Street, Back Lane and Longwood’s shop and yard, containing a total of 1582 residents, was to be supervised by Dr. Hill. Dr. Bywater ministered to the 1494 inhabitants of the central district, beginning at the Chapel steps and along Aire Street, the Island, Marsh End and Garner Haven Brick Yard. The area assigned to Dr. Twaites had 1602 inhabitants and included Primrose Hill, Tithe Barn Yard, Cow Lane, Racca Green and the south side of Marsh End from the Cherry Tree Inn to Low Green and the eastern edge of the town. Vaccination days were to be held weekly between the hours of 9.00 and 10.00am. Monday’s – Dr. Hill, Wednesday’ – Dr. Bywater and Friday’s – Dr. Twaites (20)

A signed and sealed contract provided for 28 days notice of termination by either party, formally registered the doctors and authorised them to issue certificates to all vaccinated people. A copy of the contract submitted to the Poor Law Commissioners by the Vestry Clerk sought the issue of an order to enable the format to be used as the basis for all such contracts made by the township at any future time. (21)

To ensure public awareness the Select Vestry ordered the printing and distribution of 150 public addresses to inform the inhabitants of the availability of the vaccine. (22) Thereafter, a public registration scheme supervised by a formally appointed official Registrar, anticipated the introduction of compulsory vaccination in 1853. A bill for £15 presented to the Vestry by the Registrar is dated November 1851 but the post clearly dates from 1840 at which date the Registrar was requested to produce his book for inspection by the committee. (23) In 1853 when Dr. Smallpage was appointed as vaccinator to the township the Registrar was Joshua Crabtree, who combined the post with the office of Registrar of Births and Deaths. (24) Following the establishment of the Pontefract Union responsibility for payment in respect of smallpox vaccination registration passed to that body for in June 1863 the Select Vestry resolved, "That Mr Crabtree be required to make full statement of all Vaccination Registrations up to the formation of the Pontefract Union and Mr Brewin or the Poor Law Board be consulted in reference to payment." (25)

Despite all precautions, however, the disease continued to ravage the townsfolk with occasional cases as late as the early twentieth century. In March 1872 the Select Vestry resolved, "That the Board of Guardians be requested by memorial to send the Inspector to examine and investigate cases of smallpox which have occurred in the Town and take such steps as may be deemed expedient." (26)

Other common contagions such as typhus, T.B., scarlet fever, and diarrhoea, were the lot of the poor and being generally associated with overcrowded and insanitary conditions were fatefully accepted and largely unremarked. On occasion, however, the authorities of the township felt obliged to make provision against such illnesses for a Select Vestry resolution of August 1849 seeks that, "The Medical Gentlemen in the Town give immediate attention to all cases of Diarhea (sic) and should the parties who are called upon be unable from poverty to remunerate them the Select Vestry hereby hold themselves responsible for all moderate charges made on their account."

At the same time the Parish Constables were called upon to give notice for the removal of all nuisances and to see that the cottages of the poor were thoroughly cleansed and limewashed with all incurred expense to be met by the township. (27) Again, in September 1853, it was announced that, "In cases of Diareah (sic) and early symptoms (sic) of cholera the destitute are requested to apply to one of the [undernamed] Medical Gentlemen."

While additionally, three ‘Inspecting Officers’ were appointed with immediate effect. (28) All costs arising from such epidemics were carefully monitored by the Select Vestry as shown by the clearance of the cholera bill presented by the Overseers in December 1850. (29)

While the implications of urbanisation were becoming increasingly apparent to individual medical practitioners during the early decades of the nineteenth century it was not until Edwin Chadwick’s Sanitary Report of 1842 and the consequent Public Health Act of 1848, that the connection between poverty, health and living conditions became generally accepted (30) and consideration given to the economic association with Poor Law administration. The 1834 Poor Law Report had assumed that the policy of less eligibility rigorously enforced would result in a vast reduction in the demand for poor relief. By the end of the decade, however, it was already apparent that sickness and disease were the prime reason for such demand. An able-bodied man struck down by illness or a death caused by bad living and/or working conditions rendered his entire family destitute and therefore a burden upon the parish rate. The town of Knottingley affords numerous examples. For instance, in August 1852, Jane Ann Claybrough, resident at Bradford, was repatriated together with her children and received into the Workhouse by the Knottingley Overseers following the death of her husband. (31) After vainly seeking to resist the resettlement, the Select Vestry were reluctantly compelled to clothe the bereaved family and allow them a subsistence allowance of 3 shillings per week. (32)

Some years earlier, in May 1849, the Select Vestry had sought to obtain an order upon the trustees of the recently deceased William Thompson in order to obtain repayment of costs incurred in the maintenance of his family. The attempt being unsuccessful, the Vestry stopped all ongoing and future payments to the unfortunate family of the deceased. (33) Again, in August 1860, the funeral fees of Joshua Heath were paid by the Overseers, who were then obliged to maintain his family from the parish rate. (34) The innumerable examples of the prefix ‘widow’ to women, both old and young, who sought entitlement to parish pay reveals both the consequence of the demise of the breadwinner and the frequency of such occasions.

Even when the growing awareness of cause and effect resulted in the introduction of preventative measures progress was piecemeal and slow and not solely because of financial constraint. The dominant psychological attitude of the age was that of the ‘freeborn Englishman’, characterised by suspicion and resentment of social interference on the par of central government and its supportive agencies. The jealous safeguarding of individual liberties were frequently underlined by a degree of self-interest, for those who were freedom’s advocates were often the owners of properties most needful of improvement.

A further consideration was lack of medical knowledge concerning epidemiology and bacteriology, hence the ‘miasmic theory’ that disease was transmitted through exposure to unpleasant smells. It is more than a little ironic that such flawed reasoning often led to remedial outcomes, albeit for the wrong reasons. Thus, the frequently issued notices by the Select Vestry concerning the removal of noxious soilheaps and similar olfactory nuisances due to their offensive smell and attendant danger proved to be beneficial to health for unperceived reasons.

Allied to shortcomings in medical knowledge were deficiencies in technical aspects of civil and sanitary engineering. Problems of liquid waste disposal and the bilk movement of water for domestic use, water purification and treatment of sewerage inhibited the general introduction of piped water and the adoption of water closets and adequate drainage systems so that progress, however desirable, waited upon technical development. Within Knottingley, for example, the periodic opening of the town drains under the supervision of the Constable, was a feature of town life into the closing decade of the century by which time the use of glazed drain pipes and the incorporation of pipes of varying diameter in systems constructed following their local introduction in the 1860s, had replaced the more primitive drains of an earlier period.

It was against this background that the township’s medical officers were appointed. The payment and something of the conditions of the post are seen from a Vestry notice of February 1845 that, "Notice be given to the Surgeons of Knottingley to let them attend once upon the poor by tender. All persons to be considered paupers who receive either casual or regular relief from the Overseers and reside in the Township…", while a comparable notice dated March 1852 states that a salary of £25 in respect of such attendance and including midwifery and all surgical cases. (35) The £25 would appear to have been a retainer for there are, additional instances of medical practitioners submitting bills to the Select Vestry in respect of services rendered. A Vestry resolution of September 1844 records, "That Thomas Down’s Doctor Bill be paid - £1-6-6." (36) and again, some years later and in more pathetic circumstances, "That Raymond Shaw’s child be interred and the Doctor’s charges paid by the Overseers." (37) Conversely, in August 1842, "The Doctor’s bill of James Leach’s wife be not paid." (38)

Nor was the latter an isolated example for all bill were carefully scrutinised. Apart from the refusal to pay Dr. Twaites bill quoted earlier, in January 1846 it is recorded, "Widow Beckett’s Doctor’s Bill be not paid", and there are several other examples. (39) Sometimes, where an element of doubt occurred concerning the necessity for the doctor’s attendance or assistance, a compromise was offered by the Select Vestry. For example, in May 1843, "Widow Frank to have ½ her Doctor’s Bill paid." (40)

The Select Vestry were always the arbiters and no doubt their position of patronage ensured the acceptance of its decision by the medical men and whilst the resolution that, "Askham & Stead have only ½ a crown each for attending to Geo. Turton", may be for non-professional care, it indicates the arbitrary power of the Vestry. (41)

Appointment to the post of Town’s Medical officer undoubtedly provided an opportunity for the holder of the post to present inflated bills for services rendered and for medicines and surgical supplies. In this respect Twaites was the chief offender. A bill presented by the Town’s doctor in 1851 was queried by the Select Vestry, prompting a demand for further particulars concerning attendance and medicines dispensed during the recent cholera outbreak. After a delay of two months it was finally resolved, "That Mr Twaite’s Bill be paid deducting from it the Accts. for William Darnford & John Shillito under protest that even then the Bill is too large in the opinion of the Select Vestry." (42)

Likewise, in September 1859, "Mr Smallpage have £4-0-0 instead of £5-0-0 for the case of Mr Blackburn." (43)

And again in November 1844, we find "John Mann’s Medicine Bill be not paid." (44)

To obviate the necessity for such measures, the Vestry sought to anticipate the need for consultation and treatment and give prior approval. Thus in April 1838, "An agreement be made with Dr Bywater to attend Samuel Parker’s wife’s confinement", and again in 1848, "Joseph Cawthorn’s wife to have the Doctor for her delivery and two sheets and two shifts." (45)

In July 1852, "William Land be examined by the Doctor of the Township", and again, two years later, "John Heap be visited and the Doctor’s instructions attended."

Likewise, in January 1861, "That Dr Bywater be called in to examine Mary Cawthorn and report thereon." (46)

Sometimes the approval concerned the extent of medication as in December 1845 that, "John Wood have allowed two bottles of medicine at Mr Bell’s" (47) and again in November 1852, "John Hanley have some cod liver oil." (48)

On occasion, treatment was denied as in May 1853, "John Downing have no medical aid." (49)

The most common example of surgical provision, of which there were numerous instances, is of Select Vestry approval for paupers to be fitted with a truss. (50) Such a recommendation was cost effective as it enabled recipients to undertake strenuous manual labour and thus ensure an economic return for money expended by the parish. There is even on instance of a pauper, John Dixon, being fitted with a double truss. (51)

There is no doubt that local problems arising from overcrowding and deficiencies in drainage and sanitation were exacerbated by disease ‘imported’ by sailing vessels and their crewmen. In 1844 the Local Government Board issued emergency regulations in respect of a cargo of rags imported from Marseilles and Toulon because of an outbreak of cholera there, placing an embargo on the movement of the goods until cleared by the Town Medical Officer. (52) As late as 1902 John Garlick, erstwhile Chairman of the Knottingley Urban District Council, contracted smallpox from a cargo of rags imported into the town by a vessel, resulting in his death some months later and, incidentally, a legal dispute with the Council. (53) On a more mundane level, much illness arose from the effect of drunkenness. While the labouring class element of the town sought temporary relief from the grimness of working class life in the bottom of a beer mug, it may be worthy of consideration that the dubious quality of the town’s water supply made recourse to alcohol minimally less dangerous and certainly more pleasurable. (54) As late as April 1892, an outbreak of diphtheria within the town which caused mass sickness and resulted in the deaths of three children of Captain and Mrs Arnold within a three week period, caused Dr Percival, the town Medical Officer, to publicly state that well water at Knottingley would not bear the test of scientific analysis. (55)

Of the many nuisances within the township which drew the attention of the Surveyors of the Highways one of the more frivolous may be mentioned here. In May 1847, the Select Vestry authorised the Surveyors to complain to the local magistrates of the nuisance caused by Mr Thomas Jackson winnowing his corn to the "injury of the health and comfort" of nearby inhabitants. (56)

A further cause for concern within the town was the presence of moles. The much maligned creatures who in addition to being suspected of causing T.B. and other respiratory infections, by their burrowing undermined the roads and pathways and thereby endangered man and beast, existed in such profusion that it was necessary to "hire a mouldcathcher." (sic)

In February 1840, John Monkman, a ‘mold catcher’ was engaged by the Select Vestry, "…to take the moulds (moles) of the township."

The engagement appears to have been undertaken on an annual basis with Monkman being paid 11/2d for the first year and 1d per acre in succeeding years. (57) However, the work appears to have been undertaken intermittently, being dictated by the availability of money to pay for the work. There are indications that the town guardians sought to eschew financial responsibility for a resolution of late 1842 states, "The Mould (sic) Catcher’s Bill be paid by the occupiers of the land." (58)

The landowners, however, clearly and apparently successfully, argued that pest control was the responsibility of the Select Vestry for a decision of 30th November that, "The Mould Catcher’s Bill be paid", (59) indicates acceptance of the responsibility by that body. By 1852, the Select Vestry appear to have made the task of mole-catching a regular occupation but there are still indications of financial constraint in the decision of November that year that, "The Mould Catcher have only £4 per annum." (60)

In April of the year following, a resolution was passed, "That no more money [is] to be paid for catching moulds out of the Poor Rates", (61) and although it was mooted in September 1855, "That we now pay for mould catching", the record is silent thereafter. (62)

Not withstanding the ire engendered by submission of his allegedly inflationary bills, the system of irregular rotation applied to the annual appointment of the town’s Medical Officer saw Dr Twaites appointed to the post again in March 1853. (63) It may not have been entirely coincidental that at the time of Twaite’s reappointment the Surveyors were given the additional responsibility for scrutinising the midwifery and surgical accounts submitted to the Select Vestry. (64) At that date the surgeon’s duties are defined as, "…attending all the regular and casual poor, including all midwifery and surgical cases." (65)

For this responsibility Dr Twaites was paid an annual salary of £25 but the scale of remuneration was either tendered for or discretionary in nature for the following year when Dr Smallpage was the Medical Officer, the annual payment was only £20 and likewise in 1855. (66) In 1853 when Twaites was the Medical Officer, Smallpage was appointed as vaccinator for the township (67) a position held by Dr John Hall Bywater in 1859 at roughly mid point between being town’s Medical Officer, which post he held in 1857 and 1861, with Smallpage again being appointed as M.O. in 1858. (68)

The frequency of epidemics which resulted in the annual appointment of a Medical Officer had also engendered the Disease Prevention Acts of 1848 and 1855. Betweentimes, as a result of the passing of the former Act, a Board of Health had been established at Knottingley on the 23rd September 1853. At a specially convened meeting, the Board, consisting of the entire membership of the Select Vestry, together with the Surveyors, clergymen of the town and all the medical men, was formed. Any five of the above formed a quorum and the Board was scheduled to hold twice weekly meetings, Monday’s and Thursday’s at 7.00pm and had the power of co-option. (69) The twice weekly meetings were not adhered to, however, for by 1856 the Board of Health met at fortnightly intervals. (70) One permanent and beneficial outcome of the establishment of the Board, however, was the initial appointment of three Public Health Inspectors with the duty to enquire into all reported cases of illness or health hazards, thus ensuring prompt action in cases of contagious disease. (71) The establishment of the Board of Health in no way changed the established method of appointing the town’s Medical Officer and Vaccinator, nor despite the considerable increase in the number of paupers, did it result in an increase in the remuneration of the office holders. When, in 1861, Dr John Hollingworth was named as Town Doctor for the ensuing year and requested an increase in salary, the Select Vestry considered the application before deciding that, "…taking into consideration the depreciated state of the Township deem it not advisable to increase the salary of the Medical Officer." (72)

The issue was rather academic in nature for the following year the responsibility for appointing the Medical Officer was transferred from the Select Vestry to the newly established Pontefract Poor Law Union.

It is interesting to note that the overall growth in the size of the town and its population during the first half of the nineteenth century resulted in an increase in the number of medical practitioners and yet appears to have afforded them comfortable livelihoods. In addition, it also provided supplementary business opportunities for at least two of the general practitioners. For almost two decades from the 1830s, William Bywater adopted the additional profession of common brewer. (73) Likewise, Robert Twaites had a business interest as a brick and tile maker from the 1840s. (74) It is perhaps significant that both doctors suffered from financial hardship during the latter years of their lives and not improbable that the financial setbacks occurred from over extension of capital liabilities outside the sphere of their primary profession, for the period 1842-1858 witnessed several adverse trade cycles. During the latter part of that time the previously expanding town population suffered a temporary decline. In the decade from 1851 the number of residents fell by 3.6% and by 8.4% during the following decade before commencing a rapid upward trend from 1871 as new industries such as glass and chemical manufacture were introduced into the town. The town Valuation List of 1857, (the year following the death of William Bywater, and the year preceding Twaite’s death) reveals the extent of the loss suffered by each. (75) In the case of Twaites the signs of financial stress were evident from an early date. In July 1843, the Select Vestry had threatened to issue a distress warrant for arrears of rates and again, in November 1851, Thwaites was earmarked for the same offence. (76) The following year the Select Vestry renewed the threat and added the rider that, "Robert Thwaites be not in future employed as Town’s Surgeon." (77)

Although as shown above, the resolution was not enforced, Twaites financial decline continued (despite his allegedly excessive charges for attendance upon the paupers of the town) and by the summer of 1856 he was forced into bankruptcy. At Pontefract Magistrates Court on the 9th August 1856, the Justices ordered the Knottingley Overseers to allow Samuel Twaites 6 shillings per week and at the Vestry meeting on 14th August the decision was confirmed and in addition it was decreed, "That under Mr. Robert Twaites present circumstances the Select Vestry agree to allow his parents 6s per week until Mr Twaites’ affairs be rounded up." (78)

Following deferred consideration of the Twaites case the Select Vestry decided on the 25th September 1856 that, "Mr & Mrs Twaites pay be stopped and to come into the House." (79)

Thus, by a fateful irony, the parents of Robert Twaites were condemned to spend their declining years as pauper inmates within an institution, the residents of which had but recently been served by their doctor son – sic transit gloria mundi. (80)

Two policy decisions by the Select Vestry illustrate the increase in social mobility arising from the development of the railway system and the penny post and telegraph services by the mid nineteenth century and the introduction of health care in an effort to combat disease and injury engendered by urban and industrial squalor. In March 1851 the Select Vestry decided to make an annual subscription of two guineas to the Leeds Infirmary, thus enabling serious or problematic medical cases to be referred to the medical practitioners at Leeds for diagnosis and treatment. (81) Patients had been referred to Leeds Infirmary before the subscription date, albeit infrequently.

In 1831, "The Overseers to obtain recommendations to Leeds Infirmary for George Brook’s son", and again, in 1846, "That W. Acres be placed in the Infirmary", (82) but not surprisingly, the record shows more frequent recourse to the facility after the subscription was taken out. In July 1860, "Sarah Ashcroft to have 2s 6d [and] a few journies (sic) to Leeds", and again, the following year, "Sarah Ashcroft 2s 6d to pay her fare to Leeds Infirmary." (83)

Clearly, Sarah’s condition, whilst unstated, was of a protected nature. Four months later, in July 1861, we find, "Reynard Shaw’s wife [to] have her fare to Leeds Infirmary." (84)

The social factors which gave rise to the provision of medical aid funded by voluntary subscriptions also engendered the rise of spas such as those at Scarborough, Harrogate and Buxton. From the mid eighteenth century the vogue for bathing and partaking of the mineral waters of such towns had led to the establishment of companies to promote the fashion and exploit the commercial advantages arising therefrom. Two minor watering holes within a short distance of Knottingley were those at Boston Spa, near Wetherby, and Askern Spa, near Doncaster, the latter being particularly favoured by the industrial, social and civic organisations located in south-west Yorkshire. (85) By the early nineteenth century the Knottingley Overseers were sending selective paupers to take the waters at Askern Spa. The earliest reference dates from July 1826 when the Assistant Overseer was instructed to take out subscriptions to Askern Spa and Pontefract Dispensary. This was followed a month later by two applications for treatment at the Spa which were approved. Plus expenses, by the Select Vestry, although one applicant was told, "...not to trouble the Town again." (86)

In September 1841, when Richard Addy was sent to Askern Spa by the Select Vestry it is clear from the casual nature of the record that such visits were already well established. (87) A resolution of July 1842, decreed that, "Robert Martin be not sent to Askern Spa again this season", (88) and a proposal in August 1843 that, "William Osman be sent a second time to Askern", (89) reveals a system of regular attendance and implies the belief of the authorities in the efficacious benefits of such attendance.

Payment of an annual subscription enabled the Select Vestry to send pauper patients to the Spa, pro rate. However, a resolution of June 1857, that, "Elizabeth Butterfield be sent to Askern Spa", is the last of its kind, suggesting perhaps, that as a result of the payment of an annual subscription visits to the baths became so commonplace that the Overseers were able to refer people without obtaining the specific approval of the Select Vestry, previously required on grounds of cost. (90)

No details are available concerning the nature of illness or disability suffered by those sent to Askern Spa but one may assume that the cure would be sought by paupers with rheumatic and skin conditions. Whatever the condition, the authorities must have been satisfied with the overall results for the records show the renewal of the annual subscription over a series of years. (91) In passing it is interesting to note a Select Vestry resolution in January 1839 that, "A few [boxes] of rheumatic pills be sought for medicine immediately." Clearly, an instance in which patient medicine was used for palliative effect, probably in the hope of defraying greater expenditure such as treatment at Askern Spa. (92)

As mentioned above, an annual subscription was paid to Pontefract Dispensary as early as 1826 for treatment to paupers. Non paupers had to pay for themselves. The financial strain of so doing is evident from the case of Sarah Gill who in October 1828 applied to the Select Vestry on behalf of her daughter, Caroline, "…to have something allowed towards keeping her in the Dispensary", and was allowed, "2 shillings per week until she is better." (93)

The growth of the local population and urban development resulted in the expansion of the local dispensary at Pontefract in May 1880. Thereafter, Knottingley and neighbouring townships collected funds on a casual and voluntary basis throughout each year, holding an ‘Infirmary Sunday’ to round off the annual effort at which the sum collected was announced and disbursed between the Pontefract Dispensary and Leeds Infirmary. (94)

The preceding decade was marked by an almost complete change in the resident medical practitioners within Knottingley. John Hall Bywater had died in 1863 and although his younger brother, Thomas G. Bywater, continued the established practice for a few years, he too had ceased practising by the end of the decade. (95) By 1871, a new medical dynasty, the Percivals, had taken up residence within the town. Thomas Percival succeeded Dr. Bywater at the newly named ‘Ash Grove’ surgery situated at Cow Lane, and a generation later his son. Arthur, commenced practising from the Bridge Court premises, Hill Top, previously used by the town’s doctors. (96) Contemporary with Thomas Percival was Dr. Erasmus Stone, who lived at ‘The Mount’, to the south of Hill Top, who seems to have practised within the town until the mid 1880s. (97) Other general practitioners of whom little is known, were Francis Bayly Hannan, who was resident in the Low Green area of Knottingley and may have had connections with the practice formerly held by the unfortunate Dr. Twaites. Dr. Thomas Johnson was also resident at Bridge House in the ‘eighties and may have succeeded Dr. John Hollingworth there. (98)

An incident of a somewhat bizarre nature which occurred in the early 1880s reveals the degree of social prestige which had by that time accrued to the post of Medical Officer of Health for the district. In September 1882, Dr. Erasmus Stones tendered his resignation from the post and in the course of discussion by the board of Guardians concerning his successor, the name of Dr. Percival, who had taken over Stone’s practice, was mentioned. (99) At the subsequent meeting of the Board, however, Dr. Thomas Johnson was elected Medical Officer. Dr. Percival took offence and upon meeting Dr. Johnson a little later, assaulted him with his riding whip, an action which resulted in an unseemly court case before the local magistrates. (100)

In common with infirmaries and dispensaries, asylums for the mentally ill were increasingly founded during the second half of the eighteenth century and were widely established by the start of the following century under the title of ‘lunatic asylums’, a designation which reveals much about the ignorance concerning the nature of mental illness in the nineteenth century and the general attitude of the society of that time such ignorance engendered. Nevertheless, in common with other areas of health provision, the State undertook an increasingly paternalistic attitude to mental health, enshrined in national legislation. The County Asylum Act of 1808 made the interment of the mentally disturbed compulsory if considered dangerous following examination by local magistrates. However, as asylums were dependant upon benefactions, subscriptions and donations for their maintenance, the mentally ill were usually provided with outdoor relief or where home care was impractical, admitted to the workhouse unless adjudged to be dangerous, and only referred to the County Asylum at Wakefield when presenting a clear or potential threat to society. (101)

In June 1838, the Constable was detailed, "To take Jane Almond to the Magistrate for examination [and] to take her in a cart", the mode of transport presumably being considered most appropriate to her condition. (102) Again, in June 1857, the Select Vestry decided, "That John Dove’s daughter be examined by the Magistrates as to her sanity", following which it was concluded that, "John Dove’s daughter be not sent to the Asylum yet." (103)

The decision of the magistrates’ was doubtless a relief to the Vestry for once accepted as insane, mentally ill paupers became long term charges upon the parish and the expense involved in the maintenance of the committed was particularly heavy. Consequently, although the Select Vestry minimised such expense by paying an annual subscription to the asylum, only the worst cases were referred. (104) When such a step was deemed necessary the local authorities sought to minimise the expense incurred by attempting to make a patient’s family bear part of the cost. This in February 1826 when George Wright was committed to the Asylum, the Overseers were instructed to receive his [benefit] club money and continue to pay subscriptions on his behalf during his absence. (105)

In June 1848, "John Grindle’s wife be sent by us to the pauper Lunatic Asylum on condition that he repay to us, which he now agrees to." (106)

When John Spence was committed in April 1841, it was decreed that, "…all expenses incurred in the removal of John Spence to the Asylum be paid by himself", even though as a result of his misfortune, Spence’s 11-year-old daughter, Ann, had to be admitted to the workhouse. (107)

The Select Vestry seem to have been quite determined to recover their costs, for in November 1841, it resolved, "That John Spence shall pay charges respecting him." (108)

A more resolute example from 1859 concerns the wife of George Pawson. The township having paid half the bill for Mr. Pawson’s admittance to the asylum resolved that, "Mrs Pawson be made to [pay] up the account due to her husband’s Asylum account." (109)

Following non-compliance of this demand the Vestry decided, "That Mrs Pawson be summoned for money given as relief to her husband, now an inmate in the Asylum." (110)

Legal opinion was therefore sought, "…as to whether or not we can obtain the expenses incurred by the Township in maintaining [Pawson] at the Asylum", and in January 1860, it was confirmed that Mrs Pawson would be prosecuted for recovery of money advanced by the Select Vestry. (111) At the following Vestry meeting it was further decided to issue a summons to compel Mrs Pawson to maintain her husband who was still incarcerated in the County Asylum. (112)

Given the high costs involved and the inability or unwillingness of those charged not to pay, one can understand the reluctance of the local authorities to seek committal, an attitude exemplified in the decision of July 1848, "That in the opinion of the Select Vestry it is not necessary to send Thomas Secker to the Asylum." (113)

Necessity often dictated the course of events however, as in 1847, "The Select Vestry request the Magistrates’ to commit Isaac Clegg’s wife", (114) and again, in May 1851, "That George Gill be carried to Wakefield [Asylum]." (115)

Also, in March 1854, "That Mary Smith be sent to the Asylum", (116) and in October 1860, "Steps be taken to carry Saml. Austwick to the Asylum." (117)

Patients thus confined were closely monitored by the Select Vestry which for economic reasons sought their release at the earliest opportunity, hence the decision almost one year after George Gill’s committal that, "From the information recd. (sic) the Overseer write to Dr. Carrelli requesting if George Gill may be dismissed from the Asylum", (118) following which action a resolution was passed, "That George Gill be taken out of the Asylum." (119)

It was not until five months later, however, that the Overseer was instructed to, "…fetch George Gill from the Asylum into the Poor House." (120)

Similar instances are recorded. On the 18th June 1857, "George Pawson’s friends be allowed to take him out of the Asylum", (112) and a resolution of June 1844 records that, "Thomas Hodgson be removed out of the Asylum", (122) revealing that George Gill’s case was not unique. Nor was the Select Vestry averse to acting on behalf of a patient’s family when to do so promoted its own interest, as shown by a resolution of 6th October 1859, that, "…enquiry be made respecting Mrs Adams who is now confined in the Asylum, as to whether it is possible to obtain her release according to her husband’s wishes", and in further pursuance of this objective some months later, "To enquire about Adams now at the Asylum." (123)

One would like to believe that a humanitarianism accompanied such actions but is, alas, drawn to the conclusion that the involvement of public funds made economic considerations the prime motive.

©2005 Dr. Terry Spencer