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Reminiscences of a Workhouse Medical Officer

Reminiscences of a Workhouse Medical Officer
Title: Reminiscences of a Workhouse Medical Officer
Release Date: 2018-12-11
Type book: Text
Copyright Status: Public domain in the USA.
Date added: 27 March 2019
Count views: 48
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[Pg i]


[Pg ii]


[Pg iii]







[Pg v]


The author of the brief narrative which I have edited, and have seenthrough the Press, passed away before the printing of his work wascompleted. What he wrote was composed under the presence of a mortaldisease, the issue of which he clearly foresaw. But he was unwilling toquit life without leaving behind him some record of the evils with whichhe grappled, of the obstacles which he had to encounter, and of thechanges which he strove to effect. He might indeed, and with theacquiescence of the profession which he honoured, have claimed thecredit of those great reforms in the treatment of the sick poor, and inthe status of his professional brethren, to which the labours of hislife were directed; but he has preferred to give a narrative of hisexperiences, and to leave his reputation to the members of the great andbeneficent calling which he followed,[Pg vi] and to those among the public whowere cognizant of his zeal and perseverance.

My late brother was the descendant of three generations of medicalpractitioners, who, from the first quarter of the eighteenth century,plied the art of tending and healing the sick down to the last quarterof the nineteenth, for his elder brother relinquished his practice onlyabout ten or a dozen years ago. And this was in the same locality. Butsoon after my brother Joseph was qualified he went to London; and veryspeedily after he came to London he began the labour of his life—thereform, namely, of the medical relief accorded to the indigent poor. Tothis he surrendered the prospects of professional success andfortune—prospects which his professional abilities might have madecertainties; for this he sacrificed popularity, health, and all that avigorous constitution might have assured to him. He literally worehimself out by his labours.

It is infinitely more difficult for a medical practitioner to urgenecessary but unpopular reforms than it is for any other professionalperson to do so. The physician believes that he can succeed only byraising no prejudice against himself. He is always tempted to beneutral, when partizanship may seem likely to imperil his interests.There are no safe prizes to be[Pg vii] won in the one profession which everyone allows to be beneficent, whatever may be thought of otherprofessions. By a code of honour which is rigidly adhered to, theprocess of a physician's treatment cannot be kept to himself. By anequally rigid rule, the confidences reposed in him are as sacred as thesecrets of the confessional. It is no easy matter to win position andfortune in a calling which is regulated by the strictest rules ofprofessional honour. It seems easy to imperil the most carefullyacquired reputation by running counter to obstinacy and prejudice. Amedical man has every motive to avoid hostile criticism. If hedetermines on doing that which is unpopular, the risks which he runs arefar greater than those of any other person. Now all this was encounteredby my brother's action, and he never was allowed to forget that he hadto encounter it. He had to reckon with sordid London vestrymen, perhapsthe worst class of men with whom honest people have to deal, and withthe officials of the Poor Law Board, who were determined, as far aspossible, with rare exceptions, to shirk all responsibility. In thepages of this volume he shows plainly what were the obstacles to hisendeavours. As might be expected from an honest man, who never countedthe odds against him when he was convinced that he was in[Pg viii] the right,his original manuscript commented, with no little indignation, on thepersons who thwarted his efforts, and would have baffled his ends. Butit is entirely superfluous to stigmatize such people; and I have excisedthese just but unnecessary judgments. It is sufficient that thereappearance of such persons has been made improbable, if notimpossible.

The new Poor Law of 1834 was probably a necessary measure; but it wassuddenly and frightfully harsh. The Whigs carried it, in deference to aparticular school of economists, now happily, I trust, extinct. It wasexceedingly and reasonably unpopular. The working classes had beenimpoverished in the country by the enclosure of the common lands, and inboth town and country by restraints on the right of combination with theobject of raising wages. But they had always been assured that themaintenance of the poor was a first charge on the land, and that it mustbe satisfied, and should be, before the profit of the enclosure shouldaccrue to the landlord. When the plunder was completed the other side ofthe bargain was repudiated, and the easy-going system of the old methodof parochial relief was abandoned for the new and severe provisions ofthe new departure. I am old enough to[Pg ix] remember the indignation whichthe change aroused. I am sure that indignation and resentment againstthe new Poor Law had a good deal to do with the political reverses of1841, and the entire destruction of the popularity which the Whigs hadachieved by the Reform Act of 1832.

It is true that the Act established a central authority which shouldcontrol the action of the new Boards of Guardians. But these personswere by no means willing to check the machinery which they had erected.If the legislation of 1834 was distasteful to the country, they wereresolved to limit their responsibility to the change which they hadthemselves made in the law, and to avoid further odium. The case of thepermanent officials, who are really the departments of state, was muchsimpler. They wished to earn their salaries with as little trouble aspossible, just as they wish now, and always will wish. To importunatelycall attention to the cruelties practised under the new system was todiminish their ease, to give them trouble, and such action must beresented and discouraged. In my personal experience of the permanentstaff of the Poor Law Board I have met with officials who werepersistently resolved not to give themselves, if they could help it, thetrouble to rectify evils which were brought before their notice[Pg x] by theBoard of Guardians to which I belonged, if they could in any way find adilatory plea.

Of course a reformer is always odious to a large number of persons.There are people who profit by the abuse or malpractice which he triesto remove, and such persons are naturally indignant at hismeddlesomeness. There are others who acquiesce in the existing state ofthings from sheer indolence, and are impatient only at being disturbed.There are others who hold that all reforms cost money, and are alarmedat the expense which they may incur; while the fact is that all reformswhich are wise and true save money in the end and diminish cost. Tobuild a proper hospital for the sick poor, to supply it with properlyqualified nurses, and sufficiently paid medical officers, one must incurinitial expense, which is in the end constantly overpaid by eventualeconomies. My late brother constantly predicted that the changes whichhe counselled would relieve the rates in the end, and his prediction wasconstantly verified. The reader will find these facts illustrated in thepages which follow. A genuine reform is a sensible saving. But even ifthis result did not follow, the system which he found and attacked was ascandal to humanity and a dishonour to civilization. The Londonvestrymen did not see this; but Londoners[Pg xi] have found out at last thatthe average vestryman is unteachable and incurable.

The courage which will attack abuses such as were found in thoseworkhouses near forty years ago is rare indeed. The person whoundertakes the unpopular task has to come to close quarters with suchGuardians of the Poor as are described below, and such governmentofficials as are resolved to wink at abuses. Not but that, even in theworst days, the Poor Law Board and the Local Government Board were ofgreat public service. They could be squeezed in Parliament. A judiciousand temperate question has often discomfited the most corrupt official,and stirred the most lethargic. I am pretty sure that nearly all thereforms which have been achieved in the administration of the law forthe relief of the poor, have been derived from persistent questioning inthe House of Commons. Much indeed remains to be done, but much has beendone; and my brother was exceedingly fortunate during his lifelongefforts in the advocates which he obtained among Members of the House.

It must not be forgotten that a medical reformer is apt at first to beunpopular with his brethren, or at least to be discouraged by them. Themore fortunate members of the profession are apt to feel a serene[Pg xii]indifference to the purposes which he avows. I do not think that thereform of those evils with which my brother concerned himself has hadmuch assistance from the more wealthy and influential among thephysicians. As Arnold said, contemptuously and justly, of Isaac Walton,that "he fished through the civil wars," so these good people held, as arule, severely aloof from the struggle. To the poorer members of theprofession, who had to make every effort for a livelihood, and wereconstrained to give their services for nominal sums in order to get astatus in their calling, it seemed more practical to get them better payand not to give offence. In the end this was part of the result of mybrother's labours. He was able to assert, towards the close of hisactive career, that he had added £18,000 a year to the incomes of thePoor Law medical officers in the Metropolis, and to allege that thechange, with others, had saved ten times that amount in the Metropolitanrates. I am convinced—having once been a Guardian of the Poor in thecity where I live—that the adoption of the policy which he recommendedhas effected a still greater saving.

The first reform which my brother undertook, persevered in, and speedilysaw achieved, was the prohibition of intramural interment. He had goodreason[Pg xiii] to make efforts in this direction, for he had abundant evidenceof what came from the old practice in the experience of his profession.Most of the Metropolitan clergy were very hostile to this reform, andfor obvious reasons. But it came gradually, finally, and thoroughly. Thepresent generation in London has a very inadequate conception of theabominations, in the midst of which their fathers and mothers lived, andnot a few of them were born. The abandonment of intramural interment,and the drainage of London, imperfect as the latter is, have turned oneof the unhealthiest cities in the civilized world into one of thehealthiest. One of the first churchyards closed was that of St. Anne's,Soho, the parish in which my brother lived for many years.

His next efforts were directed towards obtaining a mortuary in theparish. Every one admits how serious are the evils of overcrowding, andhow difficult a problem it is to supply the London poor with decenthomes at moderate rents. A century ago, as I know very well, house-rent,even in London, took a small part of the workman's scanty earnings; nowhis earnings are sometimes very little better than they were a centuryago, and his rent absorbs from a fourth to a half of what he earns inpoorly paid labour. At best his home is crowded and [Pg xiv]unhealthy enough,but when death occurs in the family the condition of things isintolerable. It cost my brother three or four years of incessant effortand pleading to obtain this concession from the Vestry of St. Anne, andfor a long time this was the only London parish which made thisnecessary provision.

The next mischief which he attacked was the window tax. His experienceas a physician proved to him that lack of light and air intensifieddisease and rendered recovery difficult. There was a plea for the windowtax. It seemed to bring a fair charge on large houses, which an assessedtax notoriously does not. In assailing the tax his principal

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