VICTORIAN WORKHOUSES: THE MEDICAL OFFICER

I really enjoyed the first episode of the BBC’s new series of A House Through Time, presented by historian David Olusoga. Ravensworth Terrace in Newcastle is a beautiful Georgian house and the researchers and producers have done an amazing job in uncovering the stories of the people who lived there. I was particularly interested in the surgeon/doctor Nicholas Hardcastle, who was also the medical officer at Newcastle Union Workhouse. His competence was called into question several times; the first complaint about the non-treatment of children with ‘the itch’ (scabies) was made not long after his appointment in 1854. A more serious charge was made against him in 1887 when his treatment of scarlet fever patients was criticised; this led to Nicholas’s resignation as the workhouse medical officer but did not adversely affect his career in private practice or his other role as gaol surgeon.

When I researched Life in the Victorian and Edwardian Workhouse and Tracing Your Medical Ancestors: A Guide for Family Historians, I discovered that complaints about workhouse medical officers and those who looked after the poor in the various districts were fairly common. These men were publicly accountable and whenever there was an alleged case of neglect or incompetence, the guardians of the relevant poor law union undertook an investigation to uncover the truth. As it was a matter of interest to the ratepayers, local newspapers reported on the inquiries. You can read about cases in your area by searching The British Newspaper Archive.

Applicants for the post of workhouse medical officer and district medical officer needed a diploma or degree as a surgeon from a Royal College or University in England, Scotland or Ireland. In addition, they needed a degree in medicine or a diploma or licence of the Royal Physicians of London or a certificate to practice as an apothecary from the Society of Apothecaries of London. They could also apply if they had been in practice as an apothecary on 1 August 1815 or if they had a warrant or commission as surgeon or assistant-surgeon in Her Majesty’s Navy, Her Majesty’s Army or the Honourable East India Company prior to 1 August 1826.

People Queuing at St Marylebone Workhouse, circa 190. (Credit: Wellcome Collection)

The main duty of the workhouse medical officer was to medically examine the paupers as they were admitted to the receiving ward. If any paupers were found to be ill, he had to direct the master to send them to the sick ward; the medical officer would then oversee their treatment. He also had to decide if those of unsound mind were fit to stay in the workhouse, or whether they were too dangerous to themselves and others, and therefore should be sent to a lunatic asylum. In addition to these duties, workhouse medical officers had to issue medical certificates for every sick pauper, record the death of anyone who died in the institution and keep meticulous records regarding the dietary of sick paupers

The district medical officer also had very specific duties. He was to ‘attend duly and punctually upon all poor persons requiring medical attendance within the District of the Union assigned to him, and according to his agreement to supply the requisite medicines to such persons…’ It was important that he only attended paupers ‘with a written or printed order of the Guardians, or of a Relieving Officer of the Union, or of an Overseer.’ Like the workhouse medical officer, he also had to keep meticulous records for the guardians of the medical relief he had provided and make sure he informed the relieving officer of ‘any poor person whom he may attend without an order’.

Throughout the nineteenth century and into the twentieth, the guardians of poor law unions relied on the workhouse medical officers to supply drugs for the inmates from their own salaries. This was an extremely contentious issue and medical officers often recommended extras like food and beer to provide nourishment for the sick paupers under their care. As these extras were part of the workhouse diet, they did not have to be funded from the medical officers’ own pockets.

Old Men’s Ward in a Workhouse (Credit: Wellcome Collection)

The main problem faced by medical officers for poor law unions was that they undertook their roles alongside their private practice and other posts in public service. Yet their duties were seemingly never-ending, leading to many cases of alleged neglect. For my books, I looked at the career of John McNab Ballenden who was born in Stromness, Orkney in 1813. The Medical Register records that he became a Licentiate of the Faculty of Physicians and Surgeons of Glasgow in 1847. He obtained his MD from the University of St Andrews in 1850 and became a Licentiate of the Society of Apothecaries in London in the same year.

It’s not known why John chose to settle in Staffordshire but he commenced general practice in Sedgley and raised a family there. The Medical Directory states that he had a number of additional appointments. He was a member of the Hunterian Society, a Poor Law Medical Officer, a Police Surgeon, a Certifying Factory Surgeon and a Medical Referee for the London & Liverpool Assurance Society. As a police surgeon, John was regularly called upon to offer his professional opinion about suspicious deaths and to carry out post-mortems, the results of which were reported in local newspapers.

John’s long association with the Dudley Poor Law Union began in November 1859 when he was appointed Medical Officer for the Upper Sedgley District (also known as No. 1 District). He had the difficult task of visiting paupers in their homes to administer medical relief across a wide, geographical area, at the same time as attending to patients from his own practice.

In April 1877, it was alleged that John had neglected his duties by ‘not having given proper Medical Attention to…Mary Edwards during her confinement’ and that she died as a result. The guardians suspended him while investigations were carried out. An inquest into Mary Edwards’ death confirmed she ‘died from exhaustion, consequent upon the weak state of the Heart, the laceration of the peritoneum and Vagina consequent on the cross-birth and protracted Labour’. 

John McNab Ballenden wrote to the guardians explaining his actions:

‘I prescribed some opium Pills, and gave a Saline mixture with Tartrate of Antimony, and left the case in charge of a midwife, to whom I gave the necessary directions, and told her if any alteration took place, to send for me again. Having had a very extensive midwifery practice extending over many years and amounting to about 9000 Patients, the case presented no difficulty to me, it was one requiring time, and medicine to allay irritation and help natural relaxation… During my evening Surgery hours I had been told that another Doctor was attending Mrs Edwards…’

If he had returned to attend to Mary Edwards, John had intended to carry out a craniotomy procedure, something he termed ‘breaking up the child’. He explained: ‘I would not when it is necessary hesitate to sacrifice the child to save the Mother…Any man of experience with common sense would say in such a case, use every means to increase the natural dilation and diminish the bulk of the object to be passed through’.

The guardians were satisfied with his explanation for not attending Mary Edwards a second time and his suspension was removed. He continued as the district medical officer for the First Sedgley District until 1894 when he resigned due to ill-health and infirmity, dying the following year. In his obituary, the guardians of the Dudley Union Workhouse described him as the ‘oldest officer of the union who discharged his duties very satisfactorily’.

Obituary for John McNab Ballenden, 1895 (Dudley Herald)

This will be my last post for a few weeks as I take a break over Easter. I will return to Victorian England in early May – see you then!

Please note: this post contains affiliate links.

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