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_REMINISCENCES OF A WORKHOUSE MEDICAL OFFICER._
[Illustration: Logo]
JOSEPH ROGERS, M.D.
_REMINISCENCES OF A WORKHOUSE
MEDICAL OFFICER_
EDITED, WITH A PREFACE
BY
PROF. THOROLD ROGERS
London
T. FISHER UNWIN
26 PATERNOSTER SQUARE
MDCCCLXXXIX
PREFACE.
The author of the brief narrative which I have edited, and have seen
through the Press, passed away before the printing of his work was
completed. What he wrote was composed under the presence of a mortal
disease, the issue of which he clearly foresaw. But he was unwilling to
quit life without leaving behind him some record of the evils with which
he grappled, of the obstacles which he had to encounter, and of the
changes which he strove to effect. He might indeed, and with the
acquiescence of the profession which he honoured, have claimed the
credit of those great reforms in the treatment of the sick poor, and in
the status of his professional brethren, to which the labours of his
life were directed; but he has preferred to give a narrative of his
experiences, and to leave his reputation to the members of the great and
beneficent calling which he followed, and to those among the public who
were cognizant of his zeal and perseverance.
My late brother was the descendant of three generations of medical
practitioners, who, from the first quarter of the eighteenth century,
plied the art of tending and healing the sick down to the last quarter
of the nineteenth, for his elder brother relinquished his practice only
about ten or a dozen years ago. And this was in the same locality. But
soon after my brother Joseph was qualified he went to London; and very
speedily after he came to London he began the labour of his life--the
reform, namely, of the medical relief accorded to the indigent poor. To
this he surrendered the prospects of professional success and
fortune--prospects which his professional abilities might have made
certainties; for this he sacrificed popularity, health, and all that a
vigorous constitution might have assured to him. He literally wore
himself out by his labours.
It is infinitely more difficult for a medical practitioner to urge
necessary but unpopular reforms than it is for any other professional
person to do so. The physician believes that he can succeed only by
raising no prejudice against himself. He is always tempted to be
neutral, when partizanship may seem likely to imperil his interests.
There are no safe prizes to be won in the one profession which every
one allows to be beneficent, whatever may be thought of other
professions. By a code of honour which is rigidly adhered to, the
process of a physician's treatment cannot be kept to himself. By an
equally rigid rule, the confidences reposed in him are as sacred as the
secrets of the confessional. It is no easy matter to win position and
fortune in a calling which is regulated by the strictest rules of
professional honour. It seems easy to imperil the most carefully
acquired reputation by running counter to obstinacy and prejudice. A
medical man has every motive to avoid hostile criticism. If he
determines on doing that which is unpopular, the risks which he runs are
far greater than those of any other person. Now all this was encountered
by my brother's action, and he never was allowed to forget that he had
to encounter it. He had to reckon with sordid London vestrymen, perhaps
the worst class of men with whom honest people have to deal, and with
the officials of the Poor Law Board, who were determined, as far as
possible, with rare exceptions, to shirk all responsibility. In the
pages of this volume he shows plainly what were the obstacles to his
endeavours. As might be expected from an honest man, who never counted
the odds against him when he was convinced that he was in the right,
his original manuscript commented, with no little indignation, on the
persons who thwarted his efforts, and would have baffled his ends. But
it is entirely superfluous to stigmatize such people; and I have excised
these just but unnecessary judgments. It is sufficient that the
reappearance of such persons has been made improbable, if not
impossible.
The new Poor Law of 1834 was probably a necessary measure; but it was
suddenly and frightfully harsh. The Whigs carried it, in deference to a
particular school of economists, now happily, I trust, extinct. It was
exceedingly and reasonably unpopular. The working classes had been
impoverished in the country by the enclosure of the common lands, and in
both town and country by restraints on the right of combination with the
object of raising wages. But they had always been assured that the
maintenance of the poor was a first charge on the land, and that it must
be satisfied, and should be, before the profit of the enclosure should
accrue to the landlord. When the plunder was completed the other side of
the bargain was repudiated, and the easy-going system of the old method
of parochial relief was abandoned for the new and severe provisions of
the new departure. I am old enough to remember the indignation which
the change aroused. I am sure that indignation and resentment against
the new Poor Law had a good deal to do with the political reverses of
1841, and the entire destruction of the popularity which the Whigs had
achieved by the Reform Act of 1832.
It is true that the Act established a central authority which should
control the action of the new Boards of Guardians. But these persons
were by no means willing to check the machinery which they had erected.
If the legislation of 1834 was distasteful to the country, they were
resolved to limit their responsibility to the change which they had
themselves made in the law, and to avoid further odium. The case of the
permanent officials, who are really the departments of state, was much
simpler. They wished to earn their salaries with as little trouble as
possible, just as they wish now, and always will wish. To importunately
call attention to the cruelties practised under the new system was to
diminish their ease, to give them trouble, and such action must be
resented and discouraged. In my personal experience of the permanent
staff of the Poor Law Board I have met with officials who were
persistently resolved not to give themselves, if they could help it, the
trouble to rectify evils which were brought before their notice by the
Board of Guardians to which I belonged, if they could in any way find a
dilatory 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 tries
to remove, and such persons are naturally indignant at his
meddlesomeness. There are others who acquiesce in the existing state of
things from sheer indolence, and are impatient only at being disturbed.
There are others who hold that all reforms cost money, and are alarmed
at the expense which they may incur; while the fact is that all reforms
which are wise and true save money in the end and diminish cost. To
build a proper hospital for the sick poor, to supply it with properly
qualified nurses, and sufficiently paid medical officers, one must incur
initial expense, which is in the end constantly overpaid by eventual
economies. My late brother constantly predicted that the changes which
he counselled would relieve the rates in the end, and his prediction was
constantly verified. The reader will find these facts illustrated in the
pages which follow. A genuine reform is a sensible saving. But even if
this result did not follow, the system which he found and attacked was a
scandal to humanity and a dishonour to civilization. The London
vestrymen did not see this; but Londoners have found out at last that
the average vestryman is unteachable and incurable.
The courage which will attack abuses such as were found in those
workhouses near forty years ago is rare indeed. The person who
undertakes the unpopular task has to come to close quarters with such
Guardians of the Poor as are described below, and such government
officials as are resolved to wink at abuses. Not but that, even in the
worst days, the Poor Law Board and the Local Government Board were of
great public service. They could be squeezed in Parliament. A judicious
and temperate question has often discomfited the most corrupt official,
and stirred the most lethargic. I am pretty sure that nearly all the
reforms which have been achieved in the administration of the law for
the relief of the poor, have been derived from persistent questioning in
the House of Commons. Much indeed remains to be done, but much has been
done; and my brother was exceedingly fortunate during his lifelong
efforts 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 be
unpopular with his brethren, or at least to be discouraged by them. The
more fortunate members of the profession are apt to feel a serene
indifference to the purposes which he avows. I do not think that the
reform of those evils with which my brother concerned himself has had
much assistance from the more wealthy and influential among the
physicians. As Arnold said, contemptuously and justly, of Isaac Walton,
that "he fished through the civil wars," so these good people held, as a
rule, severely aloof from the struggle. To the poorer members of the
profession, who had to make every effort for a livelihood, and were
constrained to give their services for nominal sums in order to get a
status in their calling, it seemed more practical to get them better pay
and not to give offence. In the end this was part of the result of my
brother's labours. He was able to assert, towards the close of his
active career, that he had added £18,000 a year to the incomes of the
Poor Law medical officers in the Metropolis, and to allege that the
change, with others, had saved ten times that amount in the Metropolitan
rates. I am convinced--having once been a Guardian of the Poor in the
city where I live--that the adoption of the policy which he recommended
has effected a still greater saving.
The first reform which my brother undertook, persevered in, and speedily
saw achieved, was the prohibition of intramural interment. He had good
reason to make efforts in this direction, for he had abundant evidence
of what came from the old practice in the experience of his profession.
Most of the Metropolitan clergy were very hostile to this reform, and
for obvious reasons. But it came gradually, finally, and thoroughly. The
present generation in London has a very inadequate conception of the
abominations, in the midst of which their fathers and mothers lived, and
not a few of them were born. The abandonment of intramural interment,
and the drainage of London, imperfect as the latter is, have turned one
of the unhealthiest cities in the civilized world into one of the
healthiest. 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 the
parish. Every one admits how serious are the evils of overcrowding, and
how difficult a problem it is to supply the London poor with decent
homes 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; now
his earnings are sometimes very little better than they were a century
ago, and his rent absorbs from a fourth to a half of what he earns in
poorly paid labour. At best his home is crowded and unhealthy enough,
but when death occurs in the family the condition of things is
intolerable. It cost my brother three or four years of incessant effort
and pleading to obtain this concession from the Vestry of St. Anne, and
for a long time this was the only London parish which made this
necessary provision.
The next mischief which he attacked was the window tax. His experience
as a physician proved to him that lack of light and air intensified
disease and rendered recovery difficult. There was a plea for the window
tax. It seemed to bring a fair charge on large houses, which an assessed
tax notoriously does not. In assailing the tax his principal helper was
Lord Duncan, at that time one of the Metropolitan Members. The tax went
at last in 1851. The repeal of this tax took nearly twenty years'
agitation, the first physician who attacked it on sanitary grounds
having been Dr. Southwood Smith.
My brother commenced his practice in London in 1844. In 1855 there was a
serious visitation of cholera in St. Anne's, Soho, and he became a
supernumerary medical officer in the district. Cholera had a very
serious effect on his private practice, as he states himself, and nearly
twelve years after he had taken up his abode in London, he concluded to
become a candidate for the function of medical officer to the Strand
Workhouse. He was to receive a stipend of £50 a year, and find all
medicines for the sick. It may be doubted whether he knew what he was
undertaking: certainly they who appointed him and the officials who
confirmed his appointment at the Poor Law Board had no conception of
what they were doing. The character of his duties, and a description of
the place in which he had to perform these duties is to be found at the
commencement of his narrative. For its condition it is hard to decide
whether the Guardians of the time, or the central authority were most to
blame.
The Strand appointment was the beginning of those systematic labours on
behalf of the sick poor and the medical profession which thenceforward
became the principal business of his life, to which he sacrificed such
leisure as he had, health, and money which he could ill spare. He gave
also what was more important--undaunted courage, and accurate
information. Thus in 1861 he gave evidence before a Select Committee of
the House of Commons, on the subject of the supply of drugs in Workhouse
infirmaries, such a supply being as essentially part of the Guardians'
duty as the purchase of food and clothing are. His views were adopted by
the Committee and pressed on the Department. What he advocated was the
germ of the Workhouse infirmary.
During the last few months of his life he lived at Hampstead, in the
hope that the air might help him. At the back of his new home there was
built one of those great hospitals for the sick poor which it was the
principal aim of his labours to render general, and to see constructed
in such a way as would give the fairest prospect of recovery for the
patients who were treated in them.
The practice of the Poor Law Board at this time was to assert on paper
the supremacy of the medical officer in his own department, to give him
no personal support when he did his duty, to visit on his head all the
consequences of their own negligence or dilatoriness, and, right or
wrong, to support the Guardians when they took offence at
conscientiousness and zeal. Now, in 1865, a scandalous case of neglect
led to an inquest, to an exposure of the facts, and to very severe
comments by the Press. Shortly afterwards the proprietors of _The
Lancet_ newspaper--a medical journal which has, during a very long
career, been distinguished alike for its zeal in maintaining the honour
of the medical profession and for its advocacy of humanity in dealing
with the sick and destitute poor--resolved on investigating the
condition of the London workhouses and their hospitals. Among other
places, Dr. Anstie visited the Strand Workhouse, in Cleveland Street,
and made his own report on what he saw in the columns of the paper which
he represented. The report was candid, graphic, and by no means
flattering to the Guardians, to their management, and to their
officials. But it was entirely accurate, for the Strand Union and its
Guardians at that time were probably the worst examples of a thoroughly
bad and vicious system. Of course the Guardians were as angry as they
could have been if they had been known for the best of characters and
motives and had been grossly defamed.
The time was plainly come for concerted action, and one of the Strand
Guardians, a Mr. Storr, a gentleman of very different character from
most of his colleagues, convened a meeting at his own offices, in order
to discuss the situation. It was at first suggested to call a public
meeting; but my brother pointed out that even if the meeting were a
success its effect would be ephemeral. It was determined, therefore, to
create an association under the title of the Workhouse Infirmaries'
Association, Mr. Storr offering to find £100 towards its preliminary
expenses. But his generous offer was not needed. As soon as it was
known that the Association was in process of formation, names and money
poured in upon the scheme. New evidence about the Strand Union came out,
and was forwarded to Mr. Charles Villiers, then President of the Board.
An inquiry was held, and, as usual, the permanent officials strove to
throw the blame on the medical officers, and to exonerate the Guardians.
Now, to counteract this, my brother called a meeting of all the
Workhouse medical officers in London. The object of this meeting was the
formation of an Association for the protection of the character and
interests of these officials, and for supplying information to the
public as to the manner in which their best efforts were hampered and
thwarted. This was the nucleus of the Poor Law Medical Officers'
Association, an organization which has extended itself to the three
kingdoms. Of this my brother was, as long as his health allowed, the
president and principal administrator.
In 1867 Mr. Gathorne Hardy, now Lord Cranbrook, was President of the
Poor Law Board, and in this capacity introduced the Metropolitan Poor
Bill, some of the provisions of which were the establishment of
Workhouse hospitals and dispensaries, and the supply of all medicines
and medical appliances at the charge of the Guardians. The President
frankly acknowledged that he owed much of the information which he had
acquired from my brother. It was unfortunate that the provisions of the
Act were not made general, throughout England at least. But London at
last got an instalment of Poor Law Reform, and on rational lines. The
administration of the Poor Law is far from perfect; but the best part of
it is that of the sick poor. Even here officials for a long time
obstructed the will of the legislature and the objects of the law, but,
on paper at least, the ancient abominations described in the earlier
part of my brother's reminiscences were swept away.
In the eyes of the Strand Guardians, or rather of a majority among them,
his offences on behalf of justice and humanity were unpardonable. He had
to be got rid of. In this the officials of the Poor Law Board, then
under Lord Devon, agreed with the Guardians. The Guardians picked a
quarrel with him, the Poor Law Board instituted an inquiry, and
apparently instructed their Inspector as to what he should report, and
the President gave solemnity to the farce by removing him from his
office. The ground on which he was dismissed was that "he could not get
on with the Board of Guardians." Of course he could not. No man of
sense, honour, humanity, decency, and conscientiousness, could get on
with them, or, in those evil days, with the Poor Law Board either; for
the President and his officials, perhaps unconsciously, leagued with the
Guardians in the maltreatment and oppression of the poor.
It is a common trait in mean and malignant natures to think, if they can
injure in fortune or character an advocate of justice and right dealing,
that they can arrest his efforts and discourage those of others. Many
experiences will occur to those who have any knowledge of public affairs
which will illustrate this policy and its failure. It always fails with
such men as have any character at all. They disregard the loss or the
insult, and redouble their efforts after the object which they have put
before them. I do not remember that my brother ever dwelt with any
peculiar acerbity on the circumstances of his dismissal; but he gave
himself more than ever to the self-imposed task which became the
business, and eventually the success, of his life. He spoke, indeed,
with bitterness, and wrote with bitterness of the crew who had sought to
injure him, but for the reason that they were prolonging the miseries of
the poor, and for that reason only.
Of course my brother had the sympathy of his profession and the support
of the medical papers. But he resolved to perfect and extend the
organization which he had founded. The result was the formation of the
Poor Law Medical Officers' Association. In order to give strength and
stability to this agency he visited most of the principal towns in
England. He made several journeys to Ireland, the infirmary system of
which he highly commended, and went once at least to Scotland, where
indeed reform was greatly needed. And in these places he inculcated the
important truth, that where medical relief was abundantly and generously
accorded by the Guardians, pauperism decreased and rates were lessened.
In my frequent communications with him, I urged him to insist on this as
a matter of principle and a matter of fact. Generous relief to the poor,
if it be discriminating and founded on a few intelligible rules, is the
truest economy in the end. Owing to his efforts, many towns voluntarily
adopted the principle of the Metropolitan Act, and with the best
results. In the earlier years of his campaign he obtained great
assistance in Parliament from the late Dr. Brady, Member for Leitrim,
and from Dr. Lush, Member for Salisbury.
Four years after his expulsion from office in the Strand Union, he was
elected to a similar office in the Westminster Union. His career here
was not one of incessant and unavailing remonstrance. The Poor Law
Board, subsequently the Local Government Board, began to awake to a
sense of its duties, and to see, though reluctantly and haltingly, that
Boards of Guardians sometimes need supervision. But soon his troubles
recommenced. The inferior officials were harsh, violent, and dishonest,
and they were abetted by a majority of the Guardians. The inevitable
consequences followed. My brother undertook the cause of the poor, and
the Guardians and their tools or accomplices turned on him. They tried
their old trick of suspending him, in hopes that the Poor Law or Local
Government Board would endorse their ruling. My brother employed his
enforced leisure in extending the organization which he had founded. In
due course he was reinstated by the Department, and his enemies were
baffled.
The mismanagement of the Workhouse by these Guardians, and the
outrageous misconduct of the master, at length roused the wrath of the
ratepayers. An influential committee was formed, which recommended a new
list of Guardians to the electors, and the whole of the old gang were
ejected from office by overwhelming majorities. I have reason to know
that the atrocities perpetrated by the master roused the anger, and
secured the unobtrusive but effective co-operation of a very exalted
personage. The resentment which affected this total change was not the
act of one section of society or of one party only, and it is just to
say that my brother had the assistance of eminent persons in both
political parties. I mention this the rather, because my brother made no
secret of his political opinions, and never omitted any opportunity of
inculcating them. He belonged, as all his brothers did, to the advanced
Liberal party.
During the remainder of his active life he was in perfect accord with
the Board of Guardians. He had the good fortune to see that what he had
laboured for, and had been persecuted for, was now acknowledged to be
humane, politic, and economical. He even had the opportunity of checking
reckless and unwise expenditure. He had done great services to the poor,
though his clients were unable to express more than their personal
gratitude to him. He had recognized and secured the co-operation of some
among those excellent women who have worked so energetically and
unobtrusively on behalf of the poor destitute. He had done great
services to his own profession, and had secured them a little of their
due; for, I repeat, there is no class of persons who do so much, from
whom so much is expected, and who are more scantily remunerated than
medical practitioners among the poor. Some of these practitioners in
1884 determined to offer him some recognition of his lifelong services.
There was nothing in his whole career which he dwelt on with more
satisfaction than on the rout of the Westminster Guardians, in 1883, and
on the testimonial of 1884.
Two years afterwards he was attacked by heart disease, and became
conscious of the organic mischief against which his naturally strong
constitution struggled for nearly three years. His incessant labours had
literally worn him out. His disease rapidly increased on him, and with
great pain and effort he wrote out, in the intervals of his trying
disorder, the reminiscences which follow. Had he been in better physical
health, they would have no doubt been fuller, for his memory was exact
and tenacious. That which is printed will show what manner of man he
was. But it will be seen that he dwells but little on his own unwearied
labours. During his sickness he was attended by many physicians who knew
him and valued him: chief and most untiring among them was Dr. Bristow.
I can say, without consciousness of partiality, that my brother's life
was one of incessant devotion to a noble object. They for whom he
laboured were the poor and helpless; who could make him no recompense,
could, perhaps, hardly understand his purposes. He was met by obstacles
which would have daunted a less resolute man; but he was sustained by
the rectitude of his aims, and by a firm belief in their wisdom. Such
men change the face of the world, as far as their own sphere goes. Their
reward is generally the approval of their own consciences, and sometimes
evidence accorded in their lifetime as to what has been the fruit of
their labours. Thousands of our fellow-countrymen have been saved from
suffering and misery by the lifework of Joseph Rogers.
JAMES E. THOROLD ROGERS.
OXFORD,
_April 10_.
CONTENTS.
CHAPTER I. PAGE
THE STRAND 1