Scandal and the reform of London workhouse infirmaries 1864-1872

Abstract

The 1834 Poor Law Act was framed with the able-bodied pauper in mind and the workhouse system was designed as the ultimate test of destitution. But workhouses soon filled with people for whom they had not been intended - the sick and chronically ill, the mentally afflicted, children and parturient women. Yet until the 1860s the poor laws had provided medical relief more by accident than design. Despite the attempts of medical reformers, the medical service had evolved more in response to internal forces within the legislative and administrative structures than to pressure from without. By the late 1830s concern about the lot of ’worthy* paupers had spread to a small group of philanthropists who did much to publicize the issue. The efforts of medical reformers and philanthropists came to nothing until the well-publicized deaths of two paupers in London workhouses erupted into scandal in 1865. The reformers effectively utilized the sensibilities of an outraged nation and for the next eight years poor law reform took on a new momentum. After two years of intense campaigning by small but influential groups of medical men, politicians and philanthropists, the Metropolitan Poor Law Amendment Act passed through Parliament easily in 1867. This Act was the first explicit acknowledgement of the need for central government intervention in the health care of the poor. It was, however, a partial solution dictated by the confused philosophy of the poor laws, resistance to central government expansion, the complexities of financing state aid to the poor and the predominant perceptions of poverty. The fundamental weakness of the 1867 Act can be traced to the difficulty of mitigating existing evils in the poor law system while maintaining the less-eligibility principle. Implementation of the Act and its subsequent amendments over the next five years was largely dictated by the Poor Law Board’s reaction to ratepayers’ objections to increased expenditure and by the emergence of the Charity Organization Society in 1869. The end result was a policy which attempted to restrict access to poor relief while improving poor law institutions. In this atmosphere, the reformers lost the initiative they had held so briefly. Ironically, separate infirmaries - the ideal of the 1860s reformers - became a means to the abolition of outdoor relief and the strict enforcement of the workhouse test. In this cycle of reform many of the most scandalous material inadequacies of the poor law medical service were eradicated from London workhouses. But the "economical and social advantages of free medicine to the poor" were lost sight of in the determined effort to instil in the poor the virtues of personal responsibility and thrift. The reforms of the 1860s had been launched because the increased humanity of the age would not tolerate the wholesale way in which paupers were herded together in workhouses. The same humanitarian impulses then saw a need to restrict access to these improved facilities in order to save the poor from themselves: that is, dependence upon the state. The medical treatment of the poor did not resurface again in the nineteenth century as a matter of major public or professional concern. In this process of reform the interplay of public opinion, the professional concern and pride of medical men and the formalization of a government bureaucracy provide the essential subject matter. Show more