Photo: Perspective view of a workhouse for 300 paupers from Wellcome Library, London

The Beveridge Report was published 70 years ago this week.  This was the report which led to the formation of the modern Welfare State in Britain, so there’s been a lot of discussion about the ‘state of welfare today’, and what Beveridge would have made of the current system of benefits, including a BBC Radio 4 Programme, and many blog posts.  What’s tended to be left out is the fact that attempts to create a rational ‘scientific’ system of welfare in Britain are actually 180 years old – the Royal Commission of Inquiry into the Operation of the Poor Laws was formed in 1832 to consider the best way to deal with the problems of poverty in Britain. The result was the infamous Victorian Workhouse, an institution which attracted a lot of moral and political criticism, but which was particularly attacked by doctors and statisticians, who repeatedly appealed to mathematics and medicine to prove that the workhouse was inefficient and deadly.

By 1832 it was clear that the 431-year-old system of welfare, the Elizabethan Poor Law could not cope with the size, density and poverty of the new industrial cities of England. After periods of serious social disturbance, and an extension of the right to vote through the Reform Act of 1832, the British government asked lawyer Edwin Chadwick to lead the Royal Commission.  Basing their evidence on a survey with only a 10% response rate, the Commissioners recommended a series of reforms, which were made law in 1834 when the Poor Law Amendment Act was passed.

The Commissioners were particularly worried about abuse of the Poor Law system; for example that support for children would encourage poor women to behave “immorally”, or that in an era of low wages a “life of idleness” on Poor Law relief might be more attractive than hard work to poor men.  This was the reason the Commissioners recommended a shift from traditional ‘out-relief’ (clothes, food or other help provided direct to the poor) to institutional ‘in-relief’ in workhouses.  It also explains the harsh regime of the workhouse, which was designed around a principle known as ‘less eligibility’ – in other words that life on welfare had to be made worse than life at work in the slums.

Families were separated, food and facilities kept basic, and arduous physical labour required of those who could manage it. Those too sick to work, or the very elderly, were to be housed in workhouse infirmaries (hospitals) – although few were built, and in many cases the ‘infirmary’ was simply a separate room in the workhouse.  Doctors were quick to criticise the limited medical facilities in the workhouses.  Most vocal was Thomas Wakeley, general practitioner, Radical MP for Finsbury, and founder/editor of the medical journal ‘The Lancet‘.

In 1841 Wakeley wrote a blistering editorial about the Workhouses, calling them “ANTECHAMBERS OF THE GRAVE”.  He claimed that the gruel dietary, and the sheer mental depression of imprisonment and shame meant that inmates were vulnerable to diseases that the limited workhouse medical facilities then failed to treat effectively. This disease could leak out into the community, as “several epidemics appear to originate in the workhouses, as they did in the prisons of old”.

Other doctors agreed.  In 1840 the Scottish physician William Pulteney Alison published his survey of life and death amongst the poor in Observations on the Management of the Poor in Scotland (Scotland had a separate welfare system: a Commission of Enquiry was only set up in 1843, and a reform law passed in 1845). In this he argues that although poverty alone cannot cause disease, it can increase the speed and severity of an outbreak of epidemic and contagious disease, and make it more likely that such diseases would appear in the first place.  This was due to ‘deficient nourishment’ and ‘mental depression’.

Chadwick’s own inquiry into the issue, the Report on the Sanitary Condition of the Labouring Population published in 1842 claimed that the dirt and filth of city living, and the unhygienic and immoral habits of the poor were the true causes of disease and death.

 the various forms of epidemic, endemic, and other disease [are] caused, or aggravated, or propagated chiefly amongst the labouring classes by atmospheric impurities produced by decomposing animal and vegetable substances, by damp and filth, and close and overcrowded dwellings

This interpretation, Chadwick’s ’sanitary principle’ set the terms for future Victorian public health reforms – which would build great sewers, cleanse the slums, provide clean water to the poor, and regulate polluting industries. These are reforms we celebrate yet the flip-side of Chadwick’s attitude towards disease – that it was caused by dirt and not poverty – was the workhouse system itself.

It can be misleading to line up the past and the present too neatly.  These were specific reforms and specific beliefs caused by a particular set of circumstances.  Yet there are clearly resonances for today: the overwhelming political concern about cost, efficiency and ‘scrounging’, and the stigma of the welfare system are common to both 1832 and 2012.  Likewise there’s the double difficulty of ideological conflicts and ‘scientific’ data that can be interpreted in several ways; was Chadwick right that dirt caused disease, and disease caused poverty? Or was Alison right that poverty, hunger and depression were the fundamental causes that needed to be tackled?

Doctors were not involved in the design of the first British welfare ‘system’, so they attacked and criticised it from outside.  Wakeley particularly appealed to doctors to step in and campaign against workhouses as ‘they know the poor; they have witnessed their sufferings’.  In the modern welfare context, doctors and other healthcare professionals are much more involved, and it is hard to read Wakeley’s words without being reminded of much more recent campaigns – perhaps last week’s report by the Care Quality Commission about the neglect of some vulnerable recipients of ‘in-relief’, or the criticisms doctors and others of the new Work Capability Assessment system. Wakeley asserted back in 1841 that;

We earnestly entreat the Medical Profession throughout the country to exert themselves to the uttermost at the present crisis…Let them, then, in the name of GOD, and of common humanity, with one voice, call upon the Legislature for deliverance from the fatal workhouse system: it is their office to stand between the destroyed and the destroyer.

About the Author: Vanessa Heggie is a Teaching Associate on the Wellcome Trust Generation to Reproduction Project, at the University of Cambridge; she will take up a University Fellowship at the University of Birmingham in February 2013.  Vanessa works on the history of modern medicine and science.  This piece is adapted from a post that appeared in the Guardian.