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

by Joseph Rogers

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.