Medicine and Poverty: A Study of the Poor Law Medical Services of the Leicester Union, 1867-1914

This thesis presents a micro-study of the poor law medical services provided by a large provincial union in a rapidly growing industrial town during the central phase of poor law administration. The poor law medical service has been perceived as a second-class service that stigmatised and exploited both medical staff and patients. Working conditions for medical officers were arduous and unrewarding and sick paupers either received limited outdoor medical relief or were treated in institutions that were designed and managed on principles of deterrence and economy. Yet posts were competitively sought after by doctors, who often remained in the service for many years, and it could be argued that sick paupers at least received medical treatment that would otherwise have been denied them. This thesis focuses on local detail and personalities within the Leicester union to provide an insight into the reality of the service as experienced by the medical staff and patients. The thesis begins with a review of the historiographies of the social history of nineteenth-century medicine and the new poor law. Chapter 2 provides the context of the study by explaining the national framework of the poor law medical services and describing the social and economic circumstances of Leicester and its union. The remaining chapters present a thematic exploration of the medical care and treatment provided. Chapters 3 and 4 offer a detailed assessment of the working conditions and practices of the medical officers. Poor law nurses undertook the daily care of workhouse patients, and Chapter 5 explores how nursing developed at this union during this lengthy period. Having considered the providers of medical care, Chapters 6, 7 and 8 examine the perspective of the recipients: the general patients, children, and insane and epileptic patients. Chapter 9 focuses upon the transition at the beginning of the twentieth century from the workhouse-based infirmary to a purpose-built modern separate infirmary. The final chapter concludes that the stereotypical image of poor law medicine has been confounded by some of the evidence offered in this thesis which has revealed a more nuanced and balanced view than previously of the benefits and deficiencies of the poor law medical services.