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© The Society for the Social History of Medicine 2005, all rights reserved
Poor Law versus Public Health: Diphtheria, Sanitary Reform, and the ‘Crusade’ against Outdoor Relief, 1870–1900
Oxford Brookes University, Tonge Building, Gypsy Lane Campus, Oxford OX3 OBP, UK. E-mail: hurren{at}brookes.ac.uk
This article focuses on several high-profile, rural diphtheria epidemics of the later nineteenth century to explore the links between public health reform and disease control, and the changing character of the Poor Law. It explains that a Poor Law retrenchment policy, dubbed by contemporaries as the ‘crusade’ against outdoor relief, dominated Local Government Board (hereafter LGB) spending policies. The policy had a profound impact on all areas of local government administration. Notably, it exposed the fact that there were many over-lapping personnel, sitting as both Poor Law and sanitary officials. Holding joint offices compromised objectivity. It also encouraged administrators to cut local taxation ruthlessly. Doctors, the poor, and the LGB Medical Department objected strongly to the fact that too much financial power was delegated to self-interested ratepayers. In particular, urgently needed sanitary reform was frustrated. Large-scale investment was needed to improve drinking water, sewage supplies, and support research into preventive medicine, but few ratepayers were prepared to foot the bill, unless compelled to do so. This situation was further exacerbated by the permissive, rather than statutory, nature of public health legislation. Curiously, both historians of medicine and the Poor Law have under-estimated the extent to which the ‘crusade’ ethos dominated national and regional government spending. This article shows that studying rural diphtheria outbreaks can begin to uncover the degree of central government collaboration with ratepayers for Poor Law cost-cutting reasons, to the detriment of national public health reform in late Victorian England.
Keywords: death; diphtheria; epidemic; Local Government Board; Medical Officers of Health; paupers; Poor Law; public health sanitation; water analysis; welfare
1 There is an extensive historiography in this field. See especially, A. Briggs, ‘Cholera and Society in the Nineteenth Century’, Past and Present, 19 (1961), 76–96; R. Lambert, Sir John Simon, 1816–1904 (London, 1963); R. Hodgkinson, The Origins of the National Health Service: The Medical Services of the New Poor Law, 1834–71 (London, 1967); E. C. Midwinter, Social Administration in Lancashire, 1830–60: Poor Law, Public Health and Police (Manchester, 1969); M. Flinn, ‘Medical Services under the New Poor Law’, in D. Fraser (ed.), The New Poor Law in the Nineteenth Century (London, 1976), 45–66; U. R. Q. Henriques, Before the Welfare State: Social Administration in Early Industrial Britain (London, 1979); M. A. Crowther, The Workhouse System (London, 1981); M. Callott, ‘The Challenge to Cholera: The Last Epidemic at Newcastle Upon Tyne’, Northern History, 20 (1984), 167–86; A. Hardy, The Epidemic Streets. Infectious Disease and the Rise of Preventative Medicine, 1856–1900 (Oxford, 1993); C. Hamlin, What Becomes of Pollution? Advisory Science and the Controversy on the Self-Putrefication of Rivers in Britain, 1850–1900 (New York, 1987); C. Hamlin, Public Health and Social Justice in the Age of Chadwick, Britain 1800–54 (Cambridge, 1988); G. Finlayson, Citizen, State and Social Welfare in Britain, 1830–1900 (London, 1994); V. Berridge, ‘Health and Medicine’, in F. M. L. Thompson (ed.), Cambridge Social History of Britain, 1750–1950, vol. III (Cambridge, 1990), 171–242.
2 See, for example, M. Pelling, Cholera, Fever and English Medicine, 1825–65 (Oxford, 1978).
3 W. D. Foster, A History of Medical Bacteriology and Immunology (London, 1970); J. M. Eyler, ‘The Conversion of Angus Smith: The Changing Role of Chemistry and Biology in Sanitary Science, 1850–80’, Bulletin of the History of Medicine, 54 (1980), 216–34; A. Hardy, ‘On the Cusp: Epidemiology and Bacteriology at the Local Government Board, 1890–1905’, Medical History, 42 (1998), 328–47.
4 C. Hamlin, A Science of Impurity: Water Analysis in Nineteenth-Century Britain (California, 1990).
5 See, for example, J. K. Crellin, ‘Airborne Particles and Germ Theory: 1860–80’, Annals of Science, 22 (1965–6), 49–66; Pelling, Cholera; C. Hamlin, ‘Providence and Putrefication: Victorian Sanitarians and the Natural Theology of Health and Disease’, Victorian Studies, 28 (1985), 381–411; J. M. Eyler, Victorian Social Medicine: The Ideas and Methods of William Farr (Baltimore, 1979).
6 T. McKeown and R. G. Record, ‘Reasons for the Decline of Mortality in England and Wales during the Nineteenth Century’, Population Studies, 16 (1963), 94–122; S. Szreter, ‘The Importance of Social Intervention in Mortality Decline, c.1850–1940: A Reinterpretation of the Role of Public Health’, Social History of Medicine, 1 (1988), 1–37: S. Szreter, ‘Mortality and Public Health’, in A. Digby, C. Feinstein, and D. Jenkins (eds), New Directions in Social and Economic History (Basingstoke, 1992), 136–48; S. Guha, ‘The Importance of Social Intervention in England's Mortality Decline: The Evidence Revisited’, Social History of Medicine, 2 (1989), 89–113.
7 See especially, A. Hardy, ‘Tracheotomy versus Intubation: Surgical Intervention in Diphtheria in Europe and the United States, 1825–1930’, Bulletin of the History of Medicine, 66 (1992), 536–59; Hardy, Epidemic Streets; G. Mooney, ‘The Prevention and Control of Infectious Childhood Diseases in Late Nineteenth-Century London: The Case of Diphtheria and Measles’, in R. King and M. L. Gentileschi (eds), Questioni di popolazione in Europa: una prospective geografica (Bologna, 1996), 12–27; G. Mooney, ‘"A Tissue of the Most Flagrant Anomalies": Smallpox and the Centralisation of Sanitary Administration in Late Nineteenth-Century London’, Medical History, 41 (1997), 261–90; G. Mooney, ‘Professionalization in Public Health and the Measurement of Sanitary Progress in Nineteenth-Century England and Wales’, Social History of Medicine, 10 (1997), 53–78; G. Mooney and S. Szreter, ‘Urbanisation, Mortality and the Standard of Living Debate: New Estimates of the Expectation of Life at Birth in Nineteenth-Century British Cities’, Economic History Review, XL (1998), 84–112; G. Mooney, ‘Public Health versus Private Practice: The Contested Development of Compulsory Infectious Disease Notification in Late Nineteenth-Century Britain’, Bulletin of the History of Medicine, 73 (1999), 238–67.
8 R. MacLeod, ‘The Frustration of State Medicine, 1880–99’, Medical History, 1 (1967), 15–40; R. MacLeod, ‘Law, Medicine and Public Opinion: The Resistance to Compulsory Health Legislation, 1870–1907’, Public Law (1967), 107–28 and 189–211; R. MacLeod, ‘The Anatomy of State Medicine: Concept and Application’, in F. N. L. Poynter (ed.), Medicine and Society in the 1860s: Proceedings of the Sixth British Congress on the History of Medicine (London, 1968), 199–227; R. MacLeod, Treasury Control and Social Administration: Establishment Growth and the Local Government Board, 1871–1905 (London, 1968); R. MacLeod, Government and Expertise: Specialists, Administrators and Professionals, 1860–1919 (Cambridge, 1988); R. MacLeod (ed.), Public Science and Public Policy in Victorian England (Hampshire, 1996).
9 For example, J. L. Brande, Doctors and the State: The British Medical Profession and Action in Government Health, 1870–1912 (Baltimore, 1965); D. Porter and R. Porter (eds), Doctors, Politics and Society: Historical Essays (London, 1993); A. Digby, Making a Medical Living: Doctors and Patients in the English Market for Medicine, 1720–1911 (Cambridge, 1994).
10 C. Hamlin, ‘Muddling in Bumbledom: On the Enormity of Large Sanitation Improvements in Four British Towns, 1855–85’, Victorian Studies, 1 (1988), 55–83; Hamlin, What Becomes of Pollution?; Hamlin, Science of Impunity; Hamlin, Public Health; R. Gutchen, Down and Out in Hertfordshire—A Symposium on the Old and New Poor Law (London, 1984).
11 J. Simon, English Sanitary Institutions, Reviewed in the Course of Development of Some of their Political and Social Relations (London, 1890), still gives one of the best accounts of inter-departmental LGB rivalries and their medical implications. See also, Hodgkinson, Origins of the National Health Service, for an outline of administrative tensions; C. Bellamy, Administering Central–Local Relations, 1871–1918: The Local Government Board in its Fiscal and Cultural Context (Manchester, 1981), traces the parameters of its work and funding; Hamlin, Public Health, discusses the interface between Poor Law Board and public health officials, and what funding controversies their relationships created.
12 D. Thomson, ‘Welfare and the Historians’, in L. Bonfield, R. M. Smith, and K. Wrightson (eds), The World We Have Gained: Histories of Population and Social Structure (Cambridge, 1986), 255–378, p. 373. He is critical of the lack of studies that explore the late-Victorian Poor Law experience. The most recent text in this field, A. Kidd, State, Society and the Poor in Nineteenth-Century England (Oxford, 1999), devotes just 19 pages to a discussion of the late-Victorian Poor Law, and just four pages to the ‘crusade’.
13 E. T. Hurren, Protesting About Pauperism: Poverty, Politics and Poor Relief in England, 1870–1900 (forthcoming, Cambridge, 2005); E. T. Hurren, ‘A Pauper Dead-House; The Expansion of Cambridge Anatomical Teaching School under the Late-Victorian Poor Law, 1870–1914’, Medical History, 48 (2000), 69–95.
15 Lambert, Sir John Simon, p. 526.
16 Hamlin, Public Health, p. 302.
18 Lambert, Sir John Simon, p. 526.
19 Bellamy, Administering Central–Local Relations.
20 Lambert, Sir John Simon; MacLeod, ‘Frustration of State Medicine’.
22 Williams, Pauperism, pp. 106–7.
23 P. Thane, ‘Old People and Their Families in the English Past’, in M. Daunton (ed.), Charity, Self-Interest and Welfare in the English Past (Cambridge, 1996), 113–38.
24 Williams, Pauperism, p. 99.
25 Porter and Porter (eds), Doctors, Politics and Society, p. 15.
26 Hodgkinson, Origins of the National Health Service, p. 649.
28 Ibid., p. 678, points out that, essentially, legislation failed to compel the offices of DMOP and MOH to be unified.
29 Szreter, ‘Importance of Social Intervention’, p. 25.
30 Accounts of the ‘crusade’ against outdoor relief by Earl Spencer can be found in Northampton Record Office (hereafter NRO), Spencer Ms., SOX 571, 5th Earl Spencer to John Beasley, 8 April 1872, and British Library Manuscripts Department, Althorp Ms., Albert Pell to 5th Earl Spencer, 27 and 28 March 1873, which comprises a discussion of ‘Report of my Committee on the Administration of Outdoor Relief in the Brixworth Union’. See also W. Bury, ‘Charity of the Poor Law’, Poor Law Conference Report (London, 1876), p. 44; Hurren, Protesting about Pauperism, chs 3 and 5.
31 See The National Archives, The Public Record Office, Kew (hereafter PRO), MH12/8701, Brixworth Union Guardians to the Local Government Board, 18 July 1878.
32 NRO, Spencer Ms., SOX 393, Brixworth Union Parochial Lists for Half-year Ending Lady Day, 1879: Statistics on Pauperism by order of the Board of Guardians (Northampton, 1879), pp. 1–31. PRO, MH12/8702, ‘Captain Lockwood, Senior Inspector of the Local Government Board's report on the Brixworth Union’, March 1880. Intriguingly this issue was also being debated in the neighbouring Oxford Poor Law Union. See Oriel College, Phelps Ms., Miscellaneous box, folios 182–4. Jesse Collings to the Revd L. R. Phelps.
33 A. Digby, The Poor Law in Nineteenth-Century England and Wales (London, 1982).
34 H. W. Williams, ‘Medical Acts Amendment Bill’, The Lancet, 23 February 1867, p. 5.
35 Szreter, ‘Mortality and Public Health’, p. 145.
36 British Library Manuscript Department (hereafter BLMD), Althorp MS, K324, Hichens to Spencer, 14 January 1890, reveals just how deep-seated the belief in guardians' medical expertise was at Brixworth. See also E. T. Hurren, ‘Labourers are Revolting: Penalizing the Poor and a Political Reaction in the Brixworth Union, Northamptonshire, 1875–1885’, Rural History, 11 (2000), 37–55.
37 Szreter, ‘Importance of Social Intervention’, p. 24.
38 NRO, Local Government Collection, LG 21/07, Brixworth Union Sanitary Authority 1886–9, discusses the controversy.
39 PRO, MH 12/8705, internal memoranda amongst civil servants (for example, 3–4 March 1890), discuss ‘Pell's delay in applying for a public works’ loan to fund statutory improvements' and questions whether ‘once the funds were allocated they had been redirected to the poor law union coffers’. In a memorandum of 26 April 1890, senior civil servants decided to reserve their right to interfere, since it was ‘contrary to the practice of the Board’ and would be embarrassing since they had promoted the Brixworth Union's ‘crusade’ since the 1870s.
40 NRO, Brixworth Rural and District Council Archive, BHB/46, Revd T. S. Hichens to LGB, 20 February 1885.
41 NRO, Brixworth Rural and District Council Archive, BHB/47, LGB, 10 March 1885, reply to Revd T. S. Hichens.
42 PRO, MH 12/8705, LGB memos on Brixworth Union drains provision, dated 1889.
43 For a well-documented example, see PRO MH12/8705, John Jebb Wykes to LGB, 6 July 1890.
45 The clearest account of the controversy coming to a head may be found in PRO, MH12/8701, ‘Petition from Walgrave Village Residents’, 1889.
46 PRO, MH12/8705, 14 September 1889. A list of diphtheria deaths and case studies of families from East Haddon, Northamptonshire.
47 Gaylor was also the relieving office for the poor. The two offices were amalgamated to save salary costs in 1873–4. For an understanding of the full complexity of this issue, see PRO, MH12/8701, ‘Southam, Lambert and the President’, 3 January 1879.
48 Northampton Mercury, 5 September 1889.
49 Hodgkinson, Origins of the National Health Service, gives valuable background context. For an ‘exhaustive’ account of Bruce Low's unpublished report, see The Lancet, 7 September 1889, p. 575.
50 Hardy, ‘Tracheotomy versus Intubation’, pp. 536–59; Hardy, Epidemic Streets, ch. 4, ‘Diphtheria’, pp. 80–109.
51 Hardy, Epidemic Streets, pp. 90, 102.
53 Ibid., p. 90; Lancet, 14 September 1889, and ibid., 19 October 1889.
54 Morning Post, 17 August 1889.
55 The Lancet, 17 August 1889.
56 The Lancet, 24 August 1889, 31 August 1889.
57 The Lancet, 22 September 1889, pointed this out in an editorial, p. 613.
58 PRO, MH 12/8705, petitions from ratepayers dated 20 September 1889, and 30 June 1890, confirm their criticisms and his reactions.
59 PRO, MH 12/8705, LGB ref. 83400/89, 19 September 1889. Request for report. Ibid., 10 September 1889, Reply of Poor Law Medical Officer to LGB. See, also, in the same file, ‘Petition from churchwardens, overseers and ratepayers of East Haddon to the LGB’.
60 PRO, LGB ref. 84079/89, 20 September 1889.
61 The Lancet, 21 September 1889, p. 613.
62 The Lancet, 4 January 1890, pp. 47–8; British Medical Journal, 7 August 1889, p. 575, also reported the case, though in a more matter-of-fact manner.
63 See here ‘Report of Dr Bruce Low on Diphtheria Outbreak at East Haddon’, The Lancet, 4 January 1890, pp. 47–8.
64 PRO, MH12/8705, ‘Full Report on the East Haddon Drainage Scheme from the Brixworth Union’, January 1890, p. 13.
65 The Lancet, 4 January 1890, pp. 47–8.
66 PRO, MH12/8705, Memorandum discussion of Brixworth diphtheria controversy, 17 February 1890, 3 March 1890, and 14 March 1890.
69 Northampton Daily Chronicle, 10 September 1889; NRO, Brixworth Union Minute Book, 1889.
70 Northampton Daily Chronicle, 10 September 1889.
71 The Times, 6 December 1889.
72 PRO, MH 12/8705, ‘Full Report on the East Haddon Drainage Scheme’, p. 13, dated January 1890.
73 L. Bellamy and T. Williamson (eds), Life in the Victorian Village, The Daily News Survey of 1891, vol. II (London, 1999).
74 ‘Death in our Villages (From Our Special Commissioner)’, Daily News, 9 October 1891.
76 Daily News, 15 October 1891.
77 The quotations are taken from ‘Special Commissioner Editorial’, Daily News, 15 October 1891. See, also, letter from Revd P. H. Case, Daily News, 16 October 1891.
78 The redefinition of poverty by the early 1890s is well documented in D. Englander and R. O'Day (eds), Retrieved Riches: Social Investigation in Britain, 1840–1914 (London, 1995); R. Humphreys, Sin, Organized Charity and the Poor Law in Victorian England (Basingstoke, 1995) and L. Hollen-Lees, The Solidarities of Strangers: The English Poor Law and the People, 1700–1948 (Cambridge, 1998).
79 Daily News, 17 October 1891.
80 Hurren, Protesting about Pauperism, ch. 11.
82 See, for example, Crowther, Workhouse System; J. V. Pickstone, Medicine and Industrial Society: A History of Hospital Development in Manchester and its Regions, 1752–1946 (Manchester, 1985); P. Thane (ed.), Maternity and Gender Politics: Women and the Rise of European Welfare States, 1880s–1950s (London, 1991); H. Hendrick, Child Welfare: England 1872–1989 (London, 1994); F. Crompton, Workhouse Children (Stroud, 1997).
83 Thomson, ‘Welfare and the Historians’, makes this point forcibly.
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