Joseph Rogers, M.D.: Reminiscences of a Workhouse Medical Officer

by Joseph Rogers

"A return of the mortality from general causes in the three portions of the United Kingdom, and of preventable mortality."

That return exhibited the following: That whilst one in every 43 died yearly in England, one in 44 in Scotland, only one in every 60 died in Ireland; and whilst in England zymotic, or preventable diseases, constituted one-fourth of the total mortality, or one in 190 of the population, Scotland one-fourth, or one in 194 of the population, in Ireland it was one-fifth of the total mortality, and one in 308 of the population; the fact being this, that in England and Scotland there existed the same miserable system of medical relief, whilst in Ireland, after the potato famine and the fever which followed it, calamities which swept away a large portion of the inhabitants, the Medical Charities Act was introduced, and led, by its efficient working, to the beneficial changes which had taken place in the health of the country.

The views I advanced met with much favour, and were commented on and approved by many general, as well as by all the medical journals. Having sent a copy of the paper I read at a meeting of our Association to Mr. C. P. Villiers, that gentleman wrote to me stating that he had derived much pleasure from its perusal, and that I had thrown more light on the causes of pauperism, and devised better measures for its diminution, than any previous writer on the subject. Subsequently, through the influence of Mr. Corrance, then M.P. for East Suffolk, I was invited to address the Central Chamber of Agriculture, which I did, when a resolution, couched in very flattering terms, was adopted, and further it was moved that a copy of the Chamber's approval of my address, and the principles contained in it, should be sent to the Poor Law Board, coupled with the request that the attention of all the provincial Chambers should be called to the subject. Subsequently I was invited to address the Worcester Chamber on the same subject, as well as that of Suffolk.

At a very early period of the presidency of Mr. Goschen, several of the provincial Poor Law Inspectors were directed to make inquiry into the question of medical relief to the poor, and the desirability, or otherwise, of establishing dispensaries, modelled on the principles contained in the Irish Medical Charities Act. One of the most able and exhaustive reports was sent in, as might have been expected, by Mr. Farnall, who thus proved true to the views he held in his interview with me some ten years before; whilst the very feeblest of these was that preferred by Mr. R. B. Caine, who manifested the same lack of heartiness here as he exhibited earnestness some years before in upsetting poor Richard Griffin's statistics, of which he boasted to me during his conduct of the inquiry at the Strand Union in 1866.

One of the results that sprang from my visit to Ireland was the establishment of a good understanding between our Association and that of the Irish Dispensary Medical Officers, of which the late Dr. Toler Maunsall was the honorary secretary. Dr. Maunsall was the most indefatigable secretary I ever knew. His appetite for work, and his skill in getting up statistics was remarkable. He was most valuable to me, as he assisted in getting out dry figures for my use, which would have given me infinite trouble. Poor fellow! like many others of my fellow-workers, he was destined to die early, and I sustained a great loss by his premature death. Unfortunately, too, he died badly off. I started a subscription in England for the benefit of his widow and children, which helped to swell the sum that his friends got together in Ireland.

During my stay in Ireland it was arranged between us that we should mutually help each other, and consequent on that, when the Irish Association strove, under the leadership of the late Dr. Brady, M.P. for Leitrim, to obtain superannuation allowance for dispensary and workhouse medical officers, I called attention to the subject in the medical journals, and induced the members of our Association not only to petition, but to interview members in their respective localities, in favour of the Bill. Dr. Brady, having succeeded in carrying this measure, essayed the next year to do the same for England and Wales. The success of the appeal we had made to members in the general election of 1868, facilitated the passing of the measure most materially, as we had promises of support from upwards of eighty gentlemen who were subsequently elected. Prior to the second reading of our Bill, I interviewed several members, and got promises to attend the second reading and vote for the measure. Some of these gentlemen, having intimated their desire to speak in its support, and having asked to be supplied with information on the subject, I coached them up. To one of the ablest of our supporters, who asked me to provide him with facts, I said that I was opposed to superannuation on principle, as I held that every one should be able during the working days of his life to provide for the exigencies of his old age—but then it was necessary if he held an office that the pay should be such as would enable him to do so. Now it was notorious that the pay of the medical officer was based on such a starvation principle as to render it impossible for him to save anything. This argument, reproduced very much as I have written it, in the House assisted a great deal in the success of the Bill. At the time this occurred I was out of office, and had not the most distant idea I should ever again be a workhouse medical officer. I did not know what was again in store for me, nor that I was destined to have another fourteen years of it; that I should be again suspended, restored to office, and eventually, through broken health, compelled peaceably to resign and to be myself a pensioner.

After the Bill had become law Dr. Brady most generously bore tribute to my efforts, and stated that he never could have carried the Bill without my help. The Lancet published this statement of Dr. Brady's, and I for the time gained from my Poor Law medical brethren credit for what was, at that period, absolutely disinterested labour.

About this time I was invited by a leading physician in Edinburgh to visit that city and address a meeting at the College of Physicians on the subject of Poor Law medical relief in Scotland. Although I was aware that the condition of things in that country was worse even than it was in England, yet I had not studied the subject so completely as to justify me in asserting it. Consequently I declined what was a very great compliment. Some years afterwards I went and delivered an address. It took place at the time when the annual meeting of the British Medical Association was last held there, when a highly complimentary resolution was adopted at that meeting in reference to that visit and address of mine. After occupying the position of president for a brief period only, during which time the Department was administered most vigorously and successfully, Mr. Goschen was transferred to another office in the Government, and Mr. Stansfeld was appointed President, the effect of which became immediately apparent, for the leading permanent officials, whose influence had been checked during Mr. Goschen's presidency, came directly to the front again.

One of the first measures introduced by Mr. Stansfeld was the conversion of the Poor Law into the Local Government Board. This was carried out by the absorption of the Public Health Department of the Privy Council in the destitution element of the Poor Law Board—a most disastrous act of policy, as it subordinated the Health Department, which had done its work so well to the discredited section of the Poor Law Board as exhibited in the permanent officials of the Board, who had always been obstructive, and had neither carried out, nor permitted any one else to carry out, any reform whatever.

This was early made apparent, for at the first deputation to the President, at which I was present, after his appointment, I saw Mr. H. Fleming and Mr. Lambert sitting together with the President, whilst Mr. (only just recently made Sir), John Simon and his staff, who were the only intellectual element of the new Board, were relegated to distant seats in the corner of the room.