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Middlesex Hospital Outpatients Wing/the Strand Union Workhouse.

* Although the |Trust Hospital' may be considered a novelty, like it or not, it is built upon much older foundations. Present day hospital |trusts' draw heavily upon the public service ideals of the post-war National Health Service, a tradition which itself evolved and was buttressed by the statutory and charitable care of the sick poor which predated 1948.

Our point of entry is the Middlesex Hospital Outpatients' Wing, in Cleveland Street, London. The building, on the eastern flank of the main hospital, is rather a dull-looking place. Many people pass it by, indeed even work there, without giving its past a thought. Yet this building has a remarkable history. In the mid-nineteenth century, far from being an appendage to its more illustrious neighbour, it was an institution in its own right: the Strand Union Workhouse.

The core of the building is eighteenth century in origin. It was first built as a workhouse in the 1780s for the Parish of St Paul, Covent Garden, on the site of an old burial ground for the poor of that parish. With some alterations and additions the building became the workhouse for the Strand Union of parishes, under the Poor Law of 1834. The Victorian Poor Law became the largest civil organisation in the country, with over 700 such institutions. Workhouses were designed to fulfil two main functions: to incarcerate the dependent poor, and to deter others from applying.

The Cleveland Street portal of the workhouse featured a stone relief of an old man, pointing to a stone drapery with the motto: |Avoid idleness and intemperance'. The inscription encapsulates the Poor Law attitude to poverty. In order to receive financial assistance from the parish, personal belongings were sold and homes were broken up. Families were separated, husbands from wives, and both from children. Even into the twentieth century, siblings were separated and sent to the colonies. Workhouses were known as |bastilles' because they effectively imprisoned the sick, the unemployed, the disabled, the insane and the old.

The old portal has now disappeared, and the workhouse building has been modernised and remodelled internally at least twice since the mid-nineteenth century. Yet it is substantially the same building to which a young provincial doctor was appointed Medical Officer in 1856. Hospital care of the sick had recently been much in the news, but it was to prove a long time before the lessons of the Crimean War were applied within its walls. Had Dr Joseph Rogers not recorded his experiences, few familiar with Cleveland Street today could have imagined what scenes of real misery passed within its walls.

Rogers was acquainted with poverty from his work as a general practitioner in Soho. In the 1840s the neighbourhood was still one of mixed trades and fortunes, and Rogers had established a thriving practice. Much of the housing stock dated from the rebuilding of London after the Great Fire, and was in poor condition by Rogers' day.

While caring for a patient with blood poisoning, Rogers noticed that her living room wall was exuding |a highly putrid fluid'. Enquiries on the other side of the wall in the churchyard of St Anne, Soho, revealed an appalling state of affairs. The ground was over full, and earth and bodies were piled up against neighbouring buildings. Rogers' campaign to prevent further burials there helped raise public awareness of the problem of overcrowded churchyards, and of the need for new cemeteries for the urban dead. St Anne's was among the first of the metropolitan burial grounds to be closed, in 1849.

Soho was badly affected by the cholera epidemics of the 1840s and 1850s. The Broad Street pump, whose poisoned waters were famously stopped by Dr John Snow, was at the heart of Rogers' catchment area. Paying patients either died or moved away from an area which now had an unhealthy reputation. It was the loss of his paying clientele which drove Rogers to apply for the job at the workhouse.

Despite his local knowledge, Rogers seems to have been completely unprepared for what he found. In his Reminiscences, he described the Strand Union Workhouse when he started work there:

|a square four-storied building fronting the street, with two wings of similar elevation projecting eastwards from each corner. The necessary laundry work of the establishment, which never in my time fell below five hundred inmates, was carried on beneath the entrance hall [which] was filled with steam and the odours from washing the paupers' linen. On the right side of the main building was a badly paved yard, which led down to the back entrance from Charlotte Street; on each side there was first, a carpenter's shop and a dead house, and secondly, opposite to it, a tinker's shop with a forge and unceiled roof. This communicated with a ward with two beds in it, used for fever and foul cases, only a lath and plaster partition separating it from the tinker's shop.'

Like many workhouses, the one in Cleveland Street was ruthless in its separation of the sexes, but much less careful in the segregation of medical cases. It had no separate infirmary, and no trained nurses. Only two of its twenty wards were designated for the sick. However, because illness, insanity and old age were the primary causes of poverty, Rogers found himself responsible for sick and dying patients throughout the building. Only 8 per cent of inmates were held to be |able bodied'. An official inspection in 1866 revealed 556 people sharing 332 beds. Overcrowding meant ventilation was |exceedingly defective'. Cubic space per patient was half that specified for the prison population, and a quarter of that for barracks. In the post-natal ward this figure was halved again. There were no facilities for the adequate separation of acute, chronic, dying or infectious patients.

Most workhouses at that time were unable to cope with urgent cases - there being no ambulance service, no provision for the reception of casualties and no surgical facilities. Some Boards of Guardians paid subscriptions to large charity hospitals like Guy's and St Bartholemew's for the care of their acutely sick. To keep costs low, the Strand Guardians of the Poor kept tight control of Rogers' referrals, only allowing them under really exceptional circumstances. Amid overcrowding so dreadful that patients could only get out at the end of their beds, Rogers had to tackle epidemics of measles and fevers in which there were more deaths than recoveries. The Middlesex Hospital, where Rogers had been a prize student, stood just around the corner from the scene of his labours: yet he was not allowed to refer his needy patients there.

Under his contract of employment, all medication for the hundreds of sick people in his care was funded from Rogers' salary of only 50 [pounds] a year. He was later to appear before a Parliamentary Select Committee, to argue this method of financing be abandoned, since even dying. patients under less conscientious doctors received no medication, or placebo treatment only, such as coloured water.

For twenty years Rogers battled to improve the care of the sick poor. He established a dispensary so as to be able to treat sick people in the community, without their having to enter the workhouse as inmates. He eventually got the laundry moved to the workhouse yard, which removed a source of steam and damp inside the workhouse itself, and freed space for a canteen in the basement, and some ward space. He won the right to end the |starvation diet' for single mothers, devised by the Guardians themselves as |a deterrent against the use of the workhouse as a place in which to be confined'. It took him a decade to end the practice of carpet-beating in the yard outside the male sick ward, which filled the workhouse with noise and noxious dust. To the Guardians the work served as pauper |training', and served as a valuable source of revenue-generation.

The expenditure implications of Rogers' improvements met repeated resistance and hostility from the Strand Guardians. Rogers' Reminiscences make clear that Oliver Twist offers no exaggeration of the pinching parsimony which governed these institutions. A severe breakdown of relations was the eventual result, and Rogers became a cause celebre in the Poor Law medical world. He founded the Association for the Improvement of Workhouse Infirmaries, and later became President of the Poor Law Medical Officers' Association, both of which organisations promoted reform nationally. He wrote for the medical press, and received support from politicians and reformers such as Charles Dickens, Lord Shaftesbury, Louisa Twining and George Godwin.

Rogers' national campaign for better Poor Law health care helped change attitudes, and promoted the great workhouse infirmary building boom of the 1870s-80s, which happily he lived to witness. At Rogers' death in 1889, his obituarist observed: |A prince has fallen out of our ranks. His life's work was a long series of reforms in sanitary law and administration, and in wringing from tardy Bumbledom justice for its ministers.' The infirmary architecture promoted by his efforts still forms the core of many of the country's hospitals.
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Title Annotation:London, England building
Author:Richardson, Ruth
Publication:History Today
Date:Sep 1, 1993
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