Charting the course of philanthropy in the care of older people (and why it is important)

Resources from our extensive archive of geriatric medicine
Michael Denham
Date Published:
02 April 2015
Last updated: 
02 May 2015

For some years, the BGS has benefited from the research of Michael Denham, past President of the British Geriatrics Society. We asked him to tell us why he became interested in history in general and in the history of philanthropy in the British Isles in general.

On your imaginary forces work…think when we talk of horses that you see them…
Shakespeare: Chorus to Act 1 Henry V

I was attracted to history at school when I was taught about the Peninsular War. I ‘devoured’ the books of C. S. Forester and the stories of Hornblower. I thoroughly enjoyed reading Lord Macaulay’s History of England. Clinical activities dominated later years but my interest reignited when I researched the death of my grandfather who was killed in the last days of the Passchendaele campaign. Now his memorial is one of almost 35,000 names of officers and men on the wall at Tyne Cot ‘to whom the fortune of war has denied a known and honoured burial’.  This fired a desire to visit other battlefields mainly of the First and Second World Wars.

I let my ‘imaginary forces’ work, for example, when with eyes half closed I stood on the walls of Troy and visualised the forces of the Greeks and Trojans.  Similarly, when standing on the Lion’s Mount at Waterloo it was possible to ‘visualise’ the fighting, the noise, the smell of gunpowder and the carnage.  I experienced other emotions when standing on the Dunkirk beaches and ‘saw’ the lines of men standing patiently in the sea awaiting pick up.  Quite different sensations occurred when sitting in the corner of the front row of the prisoners’ pew in the main court in Nuremberg, which was where Herman Goering had sat. It is difficult to express my feeling when I stood exactly where Hitler stood on the saluting dais in Nuremberg and visualised those massive disciplined ranks of Nazi troops, so well seen in Leni Riefenstahl’s 1935 film ‘Triumph of the Will’. Then there was Churchill’s funeral procession. As it passed me in the Strand on that very cold day of January 30th 1965, I was aware that history was passing by. 

How did I acquire my interest in the history of the care of older people?  It began for two reasons.  The first resulted from visits I made as a seconded member of Health Advisory Service teams.  At Joyce Green hospital in Dartford, Kent, you could see the remains of the wartime emergency wards, the tramway for horse drawn ambulances used to transfer patients from the riverside Long Reach hospital to Joyce Green, and the stalls for the horses. At Dorchester, I was shown the gateway of the workhouse through which Tess of the d'Urbervilles would have passed. The rear of the Old Windsor hospital was the site of the work area of the workhouse. Along one side was a wall with holes for a grill. It was here that men had to break up large stones to a size to pass through the grill to earn their hammock and food for the night. On the other side of the area were the outhouses where the hammocks were slung from hooks in the rafters, which were still visible. In East Anglia, old workhouses still exist and in one case were used for young chronic sick patients. The old workhouse at Gressenhall, near East Dereham, is now a museum and gives an idea of the life inmates experienced in Victorian times. My second reason for interest resulted from my work for a PhD on The history of geriatric medicine in England. I enjoy researching and reading while attempting to write concise clear English and avoiding ‘management speak’: if only I could emulate the prose of Lord Macaulay! 

Disquiet about inadequate care of older people goes back many years and early legislation is probably well known. Suffice to say that in the very early times people had to work until no longer able to do so and, if ill, would use home remedies, visit the local herbalist or seek assistance from the local monasteries. The latter ceased in the 1530s when Henry VIII experienced his dynastic problems.  Pressure to resolve the situation led to the passage of the Poor Law Act in 1601. Outdoor help and indoor relief, via almshouses and/or workhouses, were provided. In 1834 the Poor Law Act was amended, outdoor relief was curtailed and smaller parish workhouses were amalgamated into larger unions.   

The general approach in the Victorian era was to discourage admission by making the buildings and regime very grim. Indeed some workhouses looked like prisons, although eminent architects, such as Sir George Gilbert Scott, did design more attractive accommodation. Once admitted, the new inmates found that sexes and families were separated. Their clothing was removed and disinfected. All had to wear the workhouse uniform, which had a red or blue cloth badge with the letter P together with the initial letter of the parish. The daily routine meant getting up at 6 a.m. in summer and going to bed at 8p.m. The meals consisted mainly of gruel, bread and cheese with meat only provided twice a week.  Discipline could be quite severe for those who broke the rules. The stigma of admission was emphasised when, following the birth of a child, the registration address was given as the workhouse. This requirement ceased in 1904, when an innocuous street address was substituted. If a resident died and there were no next of kin to organise a funeral, the authorities arranged a pauper’s funeral. The body would be wrapped in a cheap sheet and placed in an unmarked grave, sometimes in non-consecrated ground. It was no surprise that Beatrice Webb, the great social reformer, declared that few objects attracted such universal hatred and hostility as the old workhouse. Admission was the solution of last resort.

In the mid-1840s, scandals were reported in workhouses of which those at Andover and Huddersfield were the most infamous. Little good seems to have resulted from published accounts, because in 1866 the Lancet launched its own Sanitary Commission. This stated that state hospitals in workhouses were closed to observation and contravened the rules of hygiene. The fate of the ‘infirm’ inmates of crowded workhouses was lamentable in the extreme because they led a life, which was like that of a vegetable, were it not that it preserved the doubtful privilege of sensibility to pain and mental misery. Further, if all the infirm were medically treated, many would recover. 

The government set up a Royal Commission on the Poor Laws and the Relief of /Distress in 1905. The Minority report, largely written by Sidney and Beatrice Webb, assisted by a certain William Beveridge, envisaged the creation of a welfare state.  Although largely ignored by the then Liberal government, it proved influential in the long term with the founding of the Labour party, the launch of the Beveridge report and foundation of the NHS.  George Lansbury, a member of the Minority Report, became a Labour politician, wanted to see the end of the workhouse with more generous poor relief and later edited the Daily Herald. 

The chorus for change intensified. Edwin Chadwick, a lawyer, contributed to the 1834 Poor Law Amendment Act and published The Sanitary Conditions of the Labouring Population in 1842. He demonstrated a direct link between poor living conditions with disease and life expectancy, which led to the 1848 Public Health Act. This established the general Board of Health with Chadwick as the first director. Local Boards of Health were encouraged to appoint a Medical Officer, to provide sewers, inspect lodging houses and check food offered for sale.  

Others took up the cudgel. Charles Booth described working class life in London at the end of the 19th century. He was a cousin of Beatrice Webb and worked with Seebohm Rowntree helping to improve conditions for his employees, establish old age pensions and free school meals for the poorest children. Lord Shaftesbury found that the condition of inmates in some lunatic asylums was worse than the vilest workhouses and targeted reform of the Lunacy laws. He also campaigned to improve the life of poor children by reducing their working hours, preventing them climbing chimneys and improving their education. Jeremy Bentham believed in relief for the poor and that everyone should be free from starvation. Working should be more attractive than not to work. Dr Joseph Rogers crusaded to improve medical care in workhouses.  At that time, medical officers working in workhouses had to pay out of their own salary for the medicines they prescribed to patients. Florence Nightingale advocated improvements in the care of the sick poor.  

Conditions in lodging houses around the 1900s concerned Lord Rowton, a lawyer and Benjamin Disraeli’s long serving private secretary. The unhealthy and squalid character of the common lodging-houses gave him the idea of a new form of a poor man's hotel, where accommodation, tiled washrooms with hot and cold water, footbaths, washing troughs, drying facilities, large dining room, a library and clean sheets on the beds would be offered at the lowest price. He used £30,000 (equivalent to over £3 million in present day money) of his own resources to create this new accommodation. George Orwell, who stayed in a Rowton house in 1933, gave them his seal of approval. 

Religious organisations added their energies. The Society of Friends or Quakers set up workhouses to provide accommodation for aged Friends, employment for wearers and education for children. The Salvation Army, founded by Catherine and William Booth, set up short term accommodation for the homeless, which provided food and shelter including ‘penny sit up’, ‘two penny hang up’ and the intriguing ‘four penny coffin’. Their present day philosophy states that the older generation ‘deserve to be treated with dignity, have a say in what they want, to receive care when they require it and to have the opportunity to retain as much independence as possible’.  What more needs to be said!

Reformers with literary/artistic talents used them to good effect. For example, Charles Dickins wrote Oliver Twist.  Anthony Trollope published Jesse Phillips: a tale of the present day, which described scenes in the workhouse.  George Sims composed Christmas Day in the workhouse in 1879. It proved popular, although vigorously attacked, as ‘a mischievous attempt to set the paupers against their betters’! Much later George Orwell published his essay The Spike in 1931. Sir Hubert von Herkomer painted several canvases portraying life in the workhouse particularly Eventide: A Scene in the Westminster Union a (workhouse) in 1878 and Hard Times in 1885. 

This slow inexorable march of democratic forces, which targeted the abolition of the workhouse and the institution of a welfare state, almost achieved success with the 1929 Local Government Act, which was introduced to Parliament by Neville Chamberlain. It abolished the Board of Guardians, who administered workhouses, and transferred their responsibilities to local authorities, who were expected to develop a hospital service as part of an integrated public health service. Furthermore, they were encouraged to take over Public Assistance Institutions (the old workhouses), which is how Marjory Warren came to start her life’s work.  

Perhaps it is fair to say that this was ‘the end of the beginning’.  Full abolition of the workhouse had to wait until after the Second World War when philanthropy would play a powerful but different role. 

Michael Denham
Past BGS President and Historian

For our series charting the events which have led to a kinder society, see our section of intensively researched articles written by Michael Denham

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