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!

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There were some very moving stories in last week’s episode 1 of ITV’s Secrets from the Asylum with three celebrities uncovering the records of their ancestors who all became patients in lunatic asylums. Aside from some slight over-reactions from the participants, the programme did succeed in showing how people with senile dementia, post-natal depression and general paralysis of the insane (the last stage of syphilis) were treated in Victorian times.

The concluding episode airs on Wednesday and I will be interested to see which other mental conditions are covered. To tie in with this and with Kate Tyte’s excellent recent guest post on this blog, I’d like to share part of an article from Living London about a journalist’s visit to St Luke’s Hospital for Lunatics in 1900.

He described “grimy, forbidding St Luke’s” as essentially “the twin sister of Bethlem; not so comfortable, perhaps, not with such fine grounds, but broadly a replica of the famous cure house. It receives the same class of patients, has pretty much the same rules, and has the same system of wards.”

Both St Luke’s and Bethlem looked after patients who were generally from the educated and professional classes, and art, music and literature was actively encouraged. At St Luke’s in a room housing the worst female cases were “two attendants of neat, nurse-like appearance. In one corner a woman is to be seen standing like a pillar; in another a lunatic is in the attitude of prayer – outwardly, a rapt devotee; and close by a poor deluded creature is kneeling before a box of paints, some of which she has been sucking.”

The journalist described the contrast of a middle-aged woman “sitting in listless vacuity, her head drooping, her hands clasped in her lap, fit model for Melancholia” with another in the middle of the room “striding to and fro with regular steps over a fixed course – so many forward, so many back – muttering unintelligibly and raising her arms aloft with machine-like regularity.”

 He went on to note, “How truly painful it is to study the faces of the patients in this and other rooms! The knitted brow of acute melancholia, the grotesque indications of delusion – here perplexity, misery and fear, there dignity and exaltation – the fixed look of weariness indicative of the reaction that follows acute mania, are all present, with many other characteristic expressions.”

On red-letter days such as St Luke’s Day and on festival days like Christmas, there were frequent dramatic and musical entertainments, occasional dances, billiards and other games, as well as ample reading facilities. According to the journalist, “Everything possible is done to rouse and amuse patients, and that in this the officials succeed is attested by the high percentage of cures – a percentage which, happily, increases every year.”

Lunatic patients at Bethlem and St Luke’s were the lucky ones; they were of a more superior class to those housed in county lunatic asylums and their mental conditions were such that there was always hope they would be cured and discharged.

Pauper lunatics were not so lucky. They were admitted to the workhouse to the ‘mental’ wards, which had padded rooms where the most violent cases were housed for their own safety. The journalist described the newest of these rooms as being “about three feet wide and seven feet high, and lined throughout – top, bottom, sides, and door – with perfectly smooth padded rubber, more yielding than a pneumatic tyre inflated for a lady’s weight.”

If the mental state of pauper lunatics was too serious to be treated in the workhouse, they were transferred to a county lunatic asylum. Although conditions in these institutions had improved by 1900, they were frequently overcrowded and understaffed, and their patients were too often deemed to be ‘hopeless cases’. These were the men and women who were destined to die in the asylum. Then, as now, mental illness was a tragedy not just for the patients, but for their families too.


I’ve been interested in workhouses since my university days so if I could take a trip to Victorian England, a workhouse would be on my list of places to visit. The visitors’ books of these institutions show that they were regularly visited by people like journalists, local worthies, guardians from the Board and ladies connected with charities, as well as official inspectors.  

There’s a common misconception that all Victorian workhouses were dark, depressing places in which the poor were badly treated. That is, of course, a sweeping generalisation, especially as Queen Victoria’s reign spanned sixty-three and a half years of change. By the end of the nineteenth century, workhouses had altered dramatically and there had been a considerable improvement in conditions, particularly in the larger ones.

They remained the last resort for a large proportion of the poor, although there were still regular ‘ins and outs’ who used the workhouse according to their needs. Right at the end of the Victorian period, a reporter for Living London (1901) visited St Marylebone Workhouse. His article, particularly its accompanying photographs, clearly illustrate the differences between a late Victorian and a mid- Victorian workhouse.

In the women’s ward, gone are the drab, bare walls and the uncomfortable, backless benches. There are now pictures on the walls and vases of flowers on the tables. The old ladies sit on Windsor chairs at long tables, around which they congregate and chat. There’s even a rug in front of the stove.

‘In a Women’s Ward’ from Living London (1901)

In most cases, elderly couples were separated on entering the workhouse. This was despite a ruling by the Poor Law Board in 1847 which required unions to provide separate bedrooms for couples over sixty, if requested. Many unions, especially smaller ones, were slow to provide accommodation for married elderly couples because of the additional burden this placed on the rates. 

By 1900, this accommodation was more common in city workhouses. The aged married couples’ quarters at St Marylebone consisted of “ten little tenements for as many Darbies and Joans – one room, one couple – and a general room at the end for meals, the ‘private apartments’ form a sort of miniature model dwelling that overlooks the Paddington Street Recreation Ground. Admirable is the only word for this division. The brightly, painted walls, the pictures, the official furniture including a chest of drawers and a table, the photographs and knick-knacks belonging to the inmates, who are allowed to bring in such property and arrange it as they choose – all this makes a ‘private apartment’ home-like and a delight to the eye. If an old couple must spend their last days in the workhouse, one could wish them no brighter or more healthy quarters.”

‘An Old Couple’s Quarters’ from Living London (1901)

Another improvement made from the 1880s onwards (and even earlier in London) was to house the children away from the workhouse. The workhouse unions moved towards boarding out their pauper children within the parish as a better, more humane alternative to keeping them in the workhouse.  Children were boarded out with ‘foster parents’ who were vetted by the union and paid to look after them. Other workhouse unions chose to set up ‘scattered’ or cottage homes, or district schools instead. 

The lack of children in the workhouse, unless they were casual admissions, meant that the inmates were mostly old and infirm. Many of the old men and women were ex-servants who had never had homes of their own. The journalist for Living London commented that in the kitchen  there was “a mincing machine, one of the uses of which  is artificially masticating the meat supplied to old and toothless paupers”. 

In 1900, the Local Government Board ruled that outdoor relief be given to the ‘aged deserving poor.’  If indoor relief was necessary, it was recommended that the elderly be “granted certain privileges which could not be accorded to every inmate of the workhouse”. These privileges were to include “flexible eating and sleeping times, greater visiting rights, and the compulsory provision of tobacco, dry tea (so that they could make a cup whenever they wanted) and sugar”.

‘In the Airing Yard’ from Living London (1901)

More concessions were granted to elderly inmates including the recommendation by the Local Government Board that separate day-rooms should be provided for those who had “previously led moral and respectable lives”. By the end of the nineteenth century, the majority of unions were implementing some kind of segregation on moral grounds, particularly for elderly inmates.  

For many elderly inmates, the workhouse really was a godsend, especially if they were seriously ill and needed hospital treatment. However, in spite of the increased comforts offered, becoming an inmate was a bitter pill to swallow for those who had been fiercely independent and had always been able to get by and look after themselves. The fact remained that they were likely to end their days in the workhouse and suffer that most shameful fate – a pauper burial.