Graham Kyle explains that a surprising benefit of the harsh Poor Law Amendment Act 1834 was that paupers in the workhouse received free medical care. Perhaps even more unexpectedly, the care had to come from qualified medical practitioners.
Near where I live near Llanfyllin in North Wales, there is a fairly well preserved workhouse that was established under the Poor Law Amendment Act 1834. A group of volunteers who worked hard to save it from dereliction also assisted the National Archives transposing the correspondence between the local Board of Governors in Llanfyllin and the Poor Law Commissioners in London.
These records are now online and give a wonderful insight into human interactions between ‘the poor’ and those charged with looking after them, as well as the relationships between the central and local governing bodies.
Before 1834, the poor were the responsibility of each parish. The 1834 Act encouraged parishes to amalgamate so that they could afford to build workhouses where people would be sent to undertake menial and boring tasks, such as oakum picking, stone breaking or bone crushing, in return for food and shelter.
This aerial view of Llanfyllin Workhouse or Y Dolydd, as it became, shows the four separate yards for men, women, boys and girls, each overlooked by the central master’s house, so that any misbehaviour could be quickly checked.
Medical care from medical men
It was policy to make these workhouses uninviting to encourage people to be self-sufficient and avoid them. The food was plain and monotonous, and the accommodation was intentionally made “less amenable than a labourer’s cottage.” Another harsh part of the regime was that families were split up.
A benefit that paupers did gain from the 1834 Act was free medical care, which previously would have been well beyond their means. The local Board(s) of Guardians, being keen to keep costs down, initially appointed men of doubtful skill or training – “lads who had worked in a druggists’ shop for a short while” to provide the health care. However, the Poor Law Commission quickly insisted that only qualified “medical men” could act as medical officers, and in 1842 further stipulated that Poor Law medical officers should have qualifications in both medicine and surgery.
Why they insisted on the dual qualification in medicine and surgery is not clear, although their report stated the reason was that “skill in one branch does not guarantee skill in the other.” This preceded a similar requirement for admission to the Medical Register by decades. Thus, the pauper had the potential for a higher standard of medical care than the general public, albeit effective therapies were few at the start.
Effectiveness of treatments generally changed especially with the introduction of vaccination for smallpox. When the Government made this mandatory in 1853, they used the Poor Law Medical System as the basis for the roll out of the programme…to use a modern idiom.
An end to the Poor Law
The Poor Law continued until 1930 when the Poor Law Board became the Local Government Board, which took over responsibility for welfare. The Llanfyllin Workhouse had become formally known as the Llanfyllin Public Assistance Institution, although a decade earlier the name had been changed to “Y Dolydd”, Welsh for “The Meadows” in an effort to soften its image. It became essentially an old people’s home, with the former workhouse infirmary providing beds for local general practitioners until the late 20th century.
Hodgkinson, R. G., Poor Law Medical Officers of England: 1834-1871. Journal of the History of Medicine and Allied Sciences, 11 (3) 1956 pp. 299-338
Graham Kyle is the President of the History of Medicine Society of Wales and a retired ophthalmic surgeon.