History of geriatric medicine in the UK: Joseph Rogers and the 1867 Metropolitan Poor Act and emergence of state hospitals
In the early 1800s, medical advice/treatment was unsatisfactory. Furthermore the public could find it difficult to distinguish properly qualified physicians from ‘quacks’: a problem not resolved until the 1856 Medical Act.
Prominent amongst the non-medical fraternity offering guidance was John Wesley, the Methodist preacher, who wrote the successful manual: Primitive Physick (1747). He gave advice on sensible life style and suggested herbal medicines for specific conditions.
Medical input in the Victorian workhouse was mediocre and improvements waited until activists like Dr Joseph Rogers (1820-1889) were appointed. He became an outspoken, passionate social reformer who carried his convictions to some of the highest in the land.
He began his clinical practice with his brother in Soho, London in 1844. There he found a patient dying from sepsis in a room where putrid material from the adjacent graveyard was seeping through the walls. He visited other graveyards, found very unpleasant conditions, successfully persuaded Lord Palmerston to close similar council burial grounds and campaigned for the opening of suburban burial grounds. Later he crusaded successfully for the repeal of the window tax.
Unfortunately, an outbreak of cholera in Soho in 1854 destroyed Rogers’ practice and in the following year, he became medical officer to the Strand Workhouse, whose entrance had the motto ‘Avoid idleness and intemperance’.
Starvation diets as a deterrent to sin!
He found much to criticise - poor medical and nursing care plus such gross overcrowding that residents had to get out at the ends of beds rather than the sides. The Board of Guardians allocated starvation diets for single pregnant women to act as a deterrent. Workhouse medical officers lacked executive power and had to use their meagre salary to pay for patients’ medication.
In the 1860s, Rogers became increasingly politically active. In 1861, he appeared before a select committee of the House of Commons, to discuss the supply and payment of drugs in workhouse infirmaries. In 1866, he founded the Association for the Improvement of London Workhouse Infirmaries where he was supported by Charles Dickens. In 1868, he was dismissed by his Board of Guardians due to his continued outspoken criticisms. The same year he established the Poor Law Medical Officers' Association to improve their prospects and conditions of work. His campaigning did not deter the Westminster Union workhouse who made him their medical officer in 1872.
Its Board may have regretted their ‘impetuosity’ because, once again, he exposed shortfalls in management. History repeated itself: he was suspended although later reinstated. He retired in 1886, viewing himself ‘as a child of the New Poor Law’ and published Reminiscences of a Workhouse Medical Officer.
Arguably, Dr Rogers’ most significant actions involved the passage of the 1867 Metropolitan Poor Act. He had given decisive evidence to the 1866 Lancet Sanitary Commission on the state of Victorian workhouses. Its report, together with workhouse scandals, pressure from medical organisations, activists like Florence Nightingale and Louisa Twining, strengthened the influence of the President of the Poor Law Board as he urged the passage of the enabling Bill. The Act influenced services nationally, led to the separation of the medical and welfare roles of Poor Law system and the creation of the first state hospitals. It established the Metropolitan Asylums Board (MAB), which provided new facilities for patients with infectious diseases. The 1891 Public Health (London) Act authorised these hospitals to become the first free-state hospitals.
The major challenge for the MAB was endemic smallpox, which caused major outbreaks. The 1871-72 epidemic killed over 50,000 people in Britain and Ireland. The MAB developed a strategy of swift isolation and prompt vaccination. Unfortunately, local residents resisted building new smallpox hospitals ‘in their back yard’, while parents ignored compulsory vaccination of their children. Nonetheless, by 1877 the MAB opened two new smallpox hospitals, one in Fulham (later named the Western hospital) and the other in Deptford (later the South Eastern hospital). When these proved inadequate, two old wooden battleships (Atlas and Endymion) were converted to medical use, moored at Greenwich before moved to Long Reach near Dartford. When these in turn proved insufficient, a tented camp for smallpox patients was established at Darenth (near the M25 Dartford crossing). A permanent smallpox hospital, Joyce Green hospital, replaced the hospital ships at a site adjacent to their moorings. Two more temporary hospitals to be built adjacent to Joyce Green, the Long Reach and Orchard hospitals, following another smallpox epidemic in 1901-2. Interestingly, when a motorway was planned across the smallpox burial grounds, constructors were banned for fear of disturbing the lethal virus.
Outbreaks of scarlet fever and cholera prompted building of other fever facilities: the North Eastern, Brook, Fountains, Grove and Park hospitals. The MAB appropriated accommodation and built hospitals outside London to treat tuberculosis. Thus, the old Westminster Union’s infirmary was converted and reopened as Colindale hospital in 1920. Two years later the new purpose built King George V Sanatorium, Godalming, was opened. Many of these hospitals are now housing estates.
The MAB other duties included care of children, the mentally ill, vagrants, and providing an ambulance service. The arrangements for children included offering naval training of pauper boys, treatment units for ringworm, ophthalmia, and general illness. The MAB managed ‘imbeciles’, the feeble minded and those with learning difficulties by building asylums north and south of the Thames. Other accommodation became training centres or colonies for epileptics. In 1912, the MAB took over care of vagrants who had previously been admitted to special workhouses wards for overnight stay. The Board reduced these 24 wards to six and created a central clearinghouse linked with the Salvation and Church Armies. The MAB established a land and river based ambulance service. The former was horse drawn until replaced by petrol driven appliances.
Neville Chamberlain abolished the MAB in 1929 with the Local Government Act, which transferred control of workhouses (now called Public Assistance Institutions) to local authorities. In 1935, the West Middlesex Hospital took over the adjacent Institution, previously administered by the Middlesex County Council, invited Marjory Warren to assess its 874 residents, and so began another saga.
BGS Archivist and Historian
and Past President (1992 - 1994)