Medical Services under the New Poor Law
Sickness has always been a prime cause of poverty. It prevents bread-winners from earning their families’ keep, and calls for expenditure over and above the normal on drugs and the services of doctors and nurses. The more advanced the forms of social and economic organisation, the more acute the problems it raises. The Industrial Revolution, by polarising rural society, and by increasing the proportion of urban dwellers in the population as a whole, made new demands on society’s resources of social organisation. The relative decline of smaller village communities in which the closeness of personal relationships made it difficult to ignore a family’s problems arising out of sickness, and the relative rise of large, impersonal and unhealthy cities where any sense of corporate responsibility was slow to develop, intensified a problem that had always of necessity made heavy demands on social organisation.
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- Surprisingly, in view of its comparative neglect by social historians, the Poor Law medical service is one of the most fully documented aspects of nineteenth-century social administration. The Annual Reports of the Poor Law Commission from 1834 to 1846, those of the Board from 1847 to 1870, and of the Local Government Board from 1871 on provide, in addition to the texts of the relevant Orders, some basic statistics and commentary on the evolution of the service from its initiation in 1834. All these reports were printed in the normal sessional series of Parliamentary Papers. To supplement this regular series there were also, from time to time, periodic enquiries into the operation of medical relief and the state of the workhouse infirmaries. The most useful of these were the Report of the Select Committee on the Poor Law Amendment Act, P.P. XVIII (1837–8); the Report of the Select Committee on Medical Poor Relief, IX (1844); the Report of the Select Committee on Medical Relief, XII (1854); the Report of the Select Committee on the Administration of Relief to the Poor, IX (1864), and Report of Dr Edward Smith … on the Metropolitan Workhouse Infirmaries and Sick wards, P.P., LXI (1866). The Reports of the Royal Sanitary Commission, PP., XXXII (1868–9) and XXXV (1871), contain some valuable evidence about the public-health activities (or inactivity) of the guardians.Google Scholar
- The unprinted records of the central authorities — the Commission and the later Boards — embracing a vast mass of correspondence on matters relating to medical relief with boards of guardians, assistant commissioners and inspectors, are all preserved in the Ministry of Health series in the Public Record Office in London. At local level there is a wealth of archival material in the records of individual boards of guardians, most of it preserved and available for historians in County and City Record Offices. These extensive manuscript sources have as yet been little exploited by historians apart from a number of unpublished theses for higher degrees.Google Scholar
- Outside the official sphere the history of the Poor Law medical service is also well served by the publications of institutions and professional associations with a close interest in the medical aspects of poor relief. The issues of the medical journals, particularly the Lancet from 1834 and the British Medical Journal from 1856, frequently contain material of direct relevance, much of it critical, while the special report of the Lancet’s ‘Commission’ of 1865 — Report of the Lancet Sanitary Commission for Investigating the State of the Infirmaries of Workhouses (1866) — has been explicitly referred to above. After its formation in 1857, the National Association for the Promotion of Social Science published many papers on this subject in the Transactions in which its annual conferences were reported.Google Scholar
- Much information may also be found in the considerable pamphlet literature which was a principal vehicle for the campaign for reform of the Poor Law medical service. This literature is nowhere comprehensively surveyed, and it is probably most fully exploited — as are so many other areas of Poor Law pamphleteering — in the footnotes of the Webbs’ Poor Law History. The periodical reviews — particularly the Fortnightly, Macmillan’s and Eraser’s — occasionally gave space to propaganda for reform of the medical service. At the most personal and intimate level, the memoirs of medical men and workhouse visitors provide some of the most revealing glimpses of the reality of the Poor Law medical service. In this class the outstanding works are Joseph Rogers, Reminiscences of a Workhouse Medical Officer, ed. Thorold Rogers (1889), and Louisa Twining, Recollections of Workhouse Visiting and Management during Twenty-Five Years (1880).Google Scholar
- Given this wealth of source material, secondary works based on it are disappointingly few. An admirable early history of the Poor Law medical service was provided by one of the leading reformers, Dr H. W. Rumsey, in his Essays on State Medicine (1857) pp. 141–294. The Webbs’ account of the Poor Law medical service is rather scrappy and concentrates heavily on the more immediate background to the Royal Commission of 1905–9: S. and B. Webb, English Poor Law History, Part II, The Last Hundred Years, I (1929; reprinted, 1963) pp. 314–19. Of recent work, Ruth Hodgkinson, The Origins of the National Health Service: The Medical Services of the New Poor Law, 1834–1871 (1967) is comprehensive and authoritative. Its sheer bulk, however, and its remorseless pursuit of detail, makes it extremely difficult for the reader to see the wood for the trees. (The book’s 400,000 words include, for example, a single, unbroken chapter of 75,000 words — as long as many whole books!) The index — an essential guide through such a wordy labyrinth — is inadequate, and the bibliographical references are often incomplete. The value of what is potentially an important work is, therefore, much diminished, and the book is unlikely to be read widely. The loss is all the greater in that there are no adequate alternatives. B. Abel-Smith, The Hospitals, 1800–1948 (1964) — not, for example, mentioned in Dr Hodgkinson’s bibliography — offers, in contrast, a succinct account of the Poor Law infirmaries. Ruth Hodgkinson herself offers a more concise account of the ‘Poor Law Medical Officers of England, 1834–1871’, in the Journal of the History of Medicine and Allied Sciences, 11 (1956) while J. E. O’Neill, in ‘Finding a Policy for the Sick Poor’, Victorian Studies, VII (1963–4) provides a brief survey of the background to the 1867 Metropolitan Poor Act. Royston Lambert, whose superb study, Sir John Simon (1816–1904) and English Social Administration (1963) throws incidental light on some aspects of the subject, provides a useful account of vaccination under the Poor Law medical service in ‘A Victorian National Health Service: State Vaccination’, H.J., v (1962). The development of the Poor Law medical service after its transfer to the Local Government Board in 1871 is well covered by Jeanne L. Brand, Doctors and the State (Baltimore, 1965) of which chapter 5 was published previously as ‘The Parish Doctor: England’s Poor Law Medical Officers and Medical Reform, 1870–1900’, Bulletin of the History of Medicine, XXXV, 1961; also see Sir A. Powell, The Metropolitan Asylums’ Board and its Work, 1867–1940 (1930).Google Scholar