Adapted from Joan E. Marshall’s presentation,and used with her permission.

Ms. Marshall is the retired director of “Group Homes for Children, Inc.” a not-for-profit agency that provided care in a family-like setting to help meet the needs of children in crisis who must be away from their own homes.  She is the author of several scholarly articles related to the care of children, the poor and the sick in Tippecanoe County in the periods prior to the Social Security Act of 1936.  These were published between 1994-2000 in Social Service Review or the Indiana Magazine of History.  See also the article about Ms. Marshall in the Lafayette (Indiana) Journal and Courier, p. C3, March 11, 2001.

County Poor Relief

In Tippecanoe County

In the Early 1840’s

Joan E. Marshall

 Presentation given at TIPCOA meeting

October 14, 1998

            I have been going through the old county documents saved from the courthouse attic that are stored in banker’s boxes at the Tippecanoe County Historical Association (TCHA) and pulling out anything to do with poor relief.  I hope to reconstruct aid for the poor as it really was before federal programs like Medicaid, Medicare, unemployment insurance and aid to dependent children.  Tonight, I’m going to tell you what I’ve found out about county relief for the sick poor in the early 1840’s.

            But first the background—In 1840 the nation was in the middle of a deep depression and the situation in Indiana was exasperated by the huge debt engendered by the collapse of the state internal improvement plan.  Tippecanoe County, which had a scattered population of less than 1400 that was mostly engaged in agricultural pursuits, was hit hard by low prices for farm goods causing farm foreclosures and by a currency shortage that made barter a way of life.  But these harsh realities were tempered by an overwhelming optimism because of the coming of the Wabash-Erie canal.  The county’s 1842 Fourth of July celebration embodied this optimism.  The civic committee planned a celebration that would unite all the citizens.  Businesses closed for the day and celebrants met at the public square to form a procession to Stockton’s grove accompanied by the music of the fife and drum corps and the Lafayette and Dayton Bands.  The Laborers who were digging the canal, Irish immigrants, marched in a group; other groups in the procession described as “a moving spectacle” included Sunday schools, revolutionary soldiers in carriages, and 26 young ladies representing the states of the union

            This optimism in the county’s future was well placed.  In September 1843—six months after the canal was open to the lake—Lafayette was described as a bustling commercial center with streets clogged with wagons, hotels crowded, housing scarce, jobs plentiful.  But the positive prospects brought by the canal did not alter the fact that bad luck in the form of sickness or accidents could still floor anyone, making them possible candidates for county poor relief.

Poor relief recipients in Tippecanoe County’s first decade from 1827 through 1837 were primarily the sick and disabled who had no money, no family, no resources.  Because of the increasing costs of boarding the sick poor, in March 1837 the county commissioners purchased property six and a half miles west of Lafayette near Montmorency to serve as a county poor farm.  And the very next year in May they created the position of county physician.  Tippecanoe County was among the first of Indiana’s counties to have a physician for the poor.  The commissioners had no precedent for their action. 

            Why did the county commissioners establish the position of county physician?  Their position was not motivated by a need to minimize professional medical costs, because poor relief expenses for doctors and medicine were small and stable.  Neither were they motivated by a humanitarian concern for the sick poors' welfare.  If the sick poor could choose, they would probably select boarding with nursing in a home environment, rather than a doctor’s care in an institutional setting.  In the pioneer period medical care was a mostly family affair with the sick being cared for at home by family members who followed their common sense and used home remedies; physicians were called in as a last resort, if at all.  Doctors were held in low esteem because medicine lacked scientific knowledge of disease and had few effective therapeutics.  The heroic medicine commonly practiced by physicians relied on harsh remedies thought to rid the body of disease and restore its natural balance.  Those remedies, which included bleeding, cathartics, and emetics often did more harm than good.  Physicians also lacked authority owing to the absence of educational or licensing requirements.  Almost anyone could call himself a doctor and start a practice.  This led to an oversupply causing most doctors to need to supplement their income.  The need for more work made the sick poor of great interest to physicians who saw them as potential patients.  The sick poor were prime candidates for both a doctor’s treatment and public poor relief since the majority were single men with no family to nurse them and no home for shelter. 

            To understand the commissioner’s creation of an official county medical professional one must examine the belief of early Americans in individualism that colored attitudes regarding health, poverty, and medical care.  The belief that individuals were responsible for their own circumstances led to a judgmental attitude toward both poverty and sickness.  It was thought that weakness of character and deviation from moral behavior predisposed the poor to sickness or disability, causing the worthiness of the sick poor to be questioned.  The sick poor were often viewed with suspicion and blamed for their own plight.  Were they deserving of county poor relief?  Were they ill or just pretending?  Were they well enough to work on the farm?  A county physician could be a check on the worthiness of the inmates, as well as a check on the superintendent’s judgement, which could be clouded by practical matters.  A county doctor could monitor conditions at the farm and act as a gatekeeper.  An influential early report about poor relief, the Quincy report, published in Massachusetts in 1821, divided the poor into the able-bodied and impotent (those wholly incapable of work) and discussed the difficulties in discriminating between these two groups.  A gatekeeper with medical knowledge could make that discrimination and serve the commissioners’ interest.

            The hypothesis that the county physician would serve the commissioners as a check on both inmates and the superintendent, as well as serving the physicians themselves by increasing their authority in the community and raising their income is supported by the reports of Dr. Isaac H. Wright, the poor farm physician from 1842 to 1844.  Doctor Wright shared the county commissioners’ political affiliation (Whig) and they appointed him after becoming familiar with his work in some fill-in professional visits to the poor farm in 1841.  Perhaps his contact with Commissioner Samuel Grey as a fellow Presbyterian trustee helped secure this appointment, which paid an annual fee of $150 for attending the inmates once weekly, as well as the Fairfield Township paupers when called upon by the overseers of the poor.  To put that fee in perspective, $550 would be an acceptable annual income for an Indiana physician at that time and $150 would pay for two days a week ministering to the poor.

            To reach the farm, Dr. Wright had to cross the river and travel more than six miles on poor roads.  The inmates lived with the superintendent and his family in a one-story log structure that had one large room with six beds for men on the east end of the building, with women (usually a small minority) housed at the opposite end.  The average daily occupancy from 1842 through 1844 was five inmates, though actual occupancy varied from 2 to 16.  Most inmates were sick single men without the resources for treatment of choice—nursing at home.  They were wage laborers without the cushion that those that worked for themselves might have accumulated.  Dr. Wright’s patients at the poor farm suffered from a variety of ailments; about a third suffered from ague, a malaria-type illness very common in the Wabash Valley.  Other complaints included dropsy, pneumonia, bilious fever, consumption, dyspepsia, and insanity, as well as broken bones and sore legs.

            The day-to-day care of the sick inmates was in the hands of Superintendent Isaac Best and his family.  The county commissioners appointed Best, a fellow Whig, in January 1841 because he submitted the lowest bid—an offer to rent the farm for $150 a year and to board the paupers each for a per diem of $1.75 a week.  Best, a 45-year-old farmer who had come to Tippecanoe County in 1837, had his own land close to the poor farm and was a respected farmer in the county.

            Best and Wright shared a similar history; both were born in Pennsylvania and moved to Ohio before settling in Tippecanoe County.  But Best, being a good deal older and a county citizen longer than Dr. Wright probably was less than open to Wright’s professional authority.  Best was a second-generation pioneering farmer.  His family background along with his own pioneering experience made he and his wife well suited to the poor superintendent’s life.  They had the heritage, the firsthand knowledge, and the abilities to handle the many aspects of pioneering farming, giving them a confident know-howness that would not easily bend to a doctor’s expertise.  The Bests did not comply with Dr. Wright’s request to move inmates because of overcrowding, even though (as Dr. Wright put it) ten were “compelled” to lodge in one room, some two to a bed “in a state loathsome to themselves and to all in the House on account of Disease, so much so as to render the room almost intolerable when entered.”  However, when the commissioners [supported] Wright’s recommendations, they did respond.

            Wright served the commissioners well by keeping an eye on the conditions at the farm.  He reported positives (e.g. adequate provisions) as well as making suggestions for improvements, such as the need for plaster and whitewash for the male inmates’ room in order “to sweeten it before the hot season commences.”  But his most constant concern as the gatekeeper was the legitimacy of the inmates’ claims to county support.  He believed that the self-interest of the inmates and the self-interest of the superintendent weighed in against the county’s interest, of which he was the champion.  Wright asserted that inmates well enough to support themselves had been allowed “to exercise their own pleasure as to the time of their dismissal, and that pleasure in most cases was not hastily exercised.”  As Superintendent Best’s income was derived from the number of paupers and the length of their stay, he was not necessarily in a hurry to have them leave.

            As gatekeeper, Dr. Wright had the authority to decide upon the time of dismissal, but he also wanted to be able to decide on the merits of those admitted to the farm.  Unfortunately, this was in the province of the township overseers of the poor.   In early Indiana, poor law did not acknowledge the need for a medical doctor’s special attention.  The responsibility for the care of sick poor lay in the hands of the township overseers of the poor [1818] who were to investigate those “lying sick or in distress without friends or money” and give them temporary relief if they could not be removed to place of settlement.  The overseers had the flexibility to decide what form that relief might take.  Dr. Wright complained to the county commissioners about the overseers, saying that they were “not sufficiently careful in reception of applicants,” and rewarded the unworthy by not taking the “pains or trouble to ferret the real nature of the case.”   In addition to denouncing the overseers’ inattention to worthiness factors, Dr. Wright did not hesitate to put in his two cents in areas that have little to do with medical expertise.  He criticized the overseers for not taking the care necessary “to prevent non-residents from being a county charge” in the first place.  While Wright was putting down the overseers, he was hoping that they would work with him and “grant him the privilege” to examine the applicants for poor relief, declaring himself "very willing to take the trouble.”

            The primary overseer of Fairfield Township at the time of Dr. Wright’s tenure was Abraham Fleek, who had been reelected on the Whig ticket in April 1842.  In the one-year period from June 1842 to June 1843 Fleek worked 60 days as overseer at a dollar a day.  His clientele was the desperate sick.  He buried 16 paupers buying shrouds from Hanna & Nelsons, coffins from Mulford and Scudder, and having graves dug by Meeks & Garrett.  He bound out two new orphans as apprentices.  He arranged boarding for 12 people.  For a couple of these boarders, he also provided provisions and shoes.  For most of the sick poor Fleek attended, he chose the poor farm option, sending 33 paupers there during the 12 months. 

Fleek’s decision making, as overseer of the poor appears to be pragmatic, and more related to ease than economics or politics.  As an elected official, the overseer was not dependent on the county commissioners, and in addition had no motive to economize on poor relief costs since these expenses did not come directly out of town revenues.  Boarding took more time to arrange than placing at the poor farm.  For a busy carpenter, the poor farm alternative, Best’s most frequent choice, was appealing, giving some credence to Dr. Wright’s complaints of poor investigation practices.

            Once the paupers were inmates of the farm, Dr. Wright considered decisions as to their future as being in his hands.  But this was a gray area.  While Dr. Wright did have medical authority over the inmates as his patients, the overseers still had legal authority over the inmates as county charges.  Dr. Wright claimed his medical authority by stepping right into areas that were legally the overseers’.  He frequently sought other boarding alternatives for inmates—ones that would be cheaper and/or more appropriate than the poor farm.  These alternatives he presented to the commissioners in ways that would ingratiate him with them.

            Although Dr. Wright denigrated others for their self-interest, he was constantly tooting his own horn.  In his application for reappointment in 1843 he described his job performance as going beyond the physician’s role, saying he acted as an “Agent of the Board.”  A glaring omission in all his presentations was any consideration of the effectiveness of his medical intervention.  It was as if the actual treatment of the paupers and how they fared was of no matter.  In asking to be reappointed in 1843, Dr. Wright pleaded for an increase of salary to $200, which would be “only as an act of justice to him.”

            Dr. Wright was reappointed in February 1843, but he got no increase in salary.  He did, however, receive a boost to his medical authority regarding gatekeeping at the farm.  His new annual agreement stated that he shall “attend to examination of paupers and accept or reject them as he thinks their several cases require.”  So, his actions had resulted in the official acknowledgement of a doctor’s authority regarding the physical conditions of the sick poor, giving the county physician the power of gatekeeper for the poor farm, on paper at least.  However, the overseers of the poor were not required to abide by the commissioners' order regarding the physician’s authority and could ignore the doctor if they wished.

            Although Dr. Wright did not reap the rewards he sought from the position of Tippecanoe County physician, he did shape that position into something of a medical police officer who ruled on the worthiness of the sick poor, rather than simply a medical professional who ministered to them.  The other two Tippecanoe officials, overseer Fleek and poor farm superintendent Best both benefited from their work with the poor.  Abraham Fleek was not reelected in 1844, but his overseer experience had provided him with contacts useful for his expanding business.

            Isaac Best did not reapply for the superintendent’s job at the end of his three-year term.  In his three years, Mr. Best netted $1482 from per diems.  This money enabled him to purchase 80 acres of prime land in Grand Prairie.

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