Dickens, Rogers and Miss Nightingale

Portrait photo of Dickens in 1868, aged 56As a result of his work at the Strand Union Workhouse, Joseph Rogers founded two important organisations. The first was the Poor Law Medical Officers' Association - which endeavoured to organise a collective medical voice to support doctors and their patients against the ingrained neglect and/or victimisation operating under the Poor Law administration. Such an organisation was very necessary at the time. Those involved had to combat official policies which set doctors to compete against each other in offering the lowest possible cost of care, and against the shameful Poor Law rule which deducted the cost of all prescribed drugs from the doctors' own salary.

The Lancet Commission on the Strand Union WorkhouseRogers, for example, was originally paid the miserable salary of £50 a year - less than £1 a week, not much more than Bob Cratchit - and as we have seen, he was expected to care for a rolling total of hundreds of patients. He was always out of pocket. Not all workhouse doctors could do as Dr Rogers did, and lose their salary entirely. Some, perhaps many of them, simply gave patients coloured water - even when they were suffering the excruciating pain of cancer or other terrible conditions. The Poor Law Board knew that such salaries would breed such conflicts of interest. It was long before the policy was changed.

The second organisation Joseph Rogers established was the Association for the Improvement of Workhouse Infirmaries, a dedicated pressure-group which began with a metropolitan focus and eventually spread nationwide.

Its success was due in part to a great change in public opinion, fostered by an extraordinary investigation - the Lancet Sanitary Commission of 1865-6. This specially appointed commission of three eminent doctors visited the major London workhouses, and published its findings in the pages of the famous medical journal, The Lancet.

Miss Nightingale's suggestions for workshouse nursingThe squalor and misery the Lancet commissioners witnessed were a fundamental public indictment of the governance of the entire Poor Law system, after thirty years of operation. The accounts of the medical eye-witnesses were reported and commented upon widely in the press. At the Strand Union Workhouse, the Commission found - for example - that 556 people shared 332 beds. Elsewhere doorless latrines faced into the workhouses wards, and had no toilet paper or washing facilities.

So shocking were the Lancet's exposures, that the Government instituted its own inquiry, and found them to be substantially accurate. The revelations generated a sea change in public and parliamentary opinion. In the long term, reforms were instituted which embodied Florence Nightingale's idea, that sickness transformed a person from their normal existence to the status of a patient, and that meant they deserved proper nursing care.

Miss Nightingale's conclusionsThe Lancet report of the first meeting of Rogers's Association for the Improvement of Workhouse Infirmaries, March 1866After Miss Nightingale's work in the Crimea, 'Nightingale' reforms to hospital nursing had already begun in the charitable hospitals of London and elsewhere, but until the Lancet Commission was formed, the workhouse system had avoided scrutiny, even though workhouse infirmaries housed thousands more sick than the charitable sector.

The Association for the Improvement of Workhouse Infirmaries was founded by Rogers in 1866, and launched at a big public meeting. Charles Dickens sent a letter of apology to Dr Ernest Hart of the Lancet, who had invited him to attend, enclosing a donation of money to help the organisation get started. At the inaugural meeting, the following splendid letter from Dickens in support of the new organisation was read out loud by Dr Joseph Rogers, as Secretary, to cheers from the audience:

My Dear Sir,
My knowledge of the general condition of the Sick Poor
in workhouses is not of yesterday,
nor are my efforts in my vocation to call merciful attention to it. (Cheers)
Few anomalies in England are so horrible to me
as the unchecked existence
of many shameful sick wards for paupers,
side by side with a constantly recurring expansion
of conventional wonder
that the poor should creep into corners to die,
rather than fester and rot in such infamous places. (Cheers)

The government eventually agreed a policy of separating the sick poor from the well, and - having to provide separate infirmaries - began a dedicated programme of hospital-building, on sites around the then outer periphery of London, and other cities. These later served as the core sites for National Health Service provision when that new national healthcare organisation came into being in the mid-20th century. Many still serve in the same capacity today.

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