This book had its origins in a two-day conference on “Medicine and the Workhouse” in November 2008, sponsored by the University of Birmingham and the Wellcome Trust. It drew together scholars whose current work directly addresses the issue of medicine and the workhouse. It also included a number of historians who have investigated the subject of health, illness, and the workhouse and whose names frequently appear in the references of the selection of papers that were chosen to present in this volume. The first day of the event was devoted to the Old Poor Law, while the papers presented on the second day concentrated on the New Poor Law. This structure was retained for the organization of this volume to demonstrate change and particular themes that emerged during the conference. The afterword was initially a keynote delivered at the outset of the event but has been situated at the end of the volume, given that it serves as a bridge between the two periods and offers a fitting conclusion to the subject as a whole, outlining both achievements in this area of research and some future challenges.

We wish to thank the conference sponsors, particularly the Wellcome Trust, for making this event possible and all the presenters for their stimulating papers and discussions. We are especially grateful to Steven King, Alistair Ritch, and Kevin Siena for reading through the introductory section of the volume and their many helpful comments.

The Workhouse as an “Ante Chamber of Death” in Georgian London

It is often forgotten, or overlooked, that it was in the eighteenth century, not the nineteenth century, that most London parishes built workhouses to house a proportion of their parish poor. Workhouses were new institutions in the eighteenth century, and in London at least they were large and prominent and until recently have, on the whole, been underexplored by historians. Yet virtually all suburban parishes in the metropolis operated them in the eighteenth century. Usually built in the 1720s or 1730s, they often occupied prime locations in the parish and might well dominate those locations, acting prima facie as purpose-built lodging houses, complete with sick wards for the poor, those who found themselves at the bottom of the social heap. They were often larger than London's public hospitals, sometimes twice as large; their total capacity was certainly far greater.

Despite a relative dearth of work on the subject, the student of workhouses is bound, within a short space of time, to be led into the field of medicine. Nevertheless, one might ask why there has not been more work on this subject, given that emotional responses to suffering within the workhouse led the institution to figure so prominently in popular literature of the nineteenth century, the most well-known case being Charles Dickens's Oliver Twist (1838). In any case, what is becoming ever clearer is that workhouses were not established simply to warehouse the destitute, but they had their own, often specialist, sick wards, and sickness was a common cause of poverty, as well as a common route into the workhouse. However, the stories of inmates, where they have been collected and compiled, present some common, but also very diverse, experiences. The records, when they do go into sufficient detail, present a host of diseases and afflictions, at least as broad as recorded in the earliest voluntary hospital records. They also offer concentrations of particular cases, as illustrated in a number of the chapters in this volume, encouraging what at times might be described as an early period of specialization at some institutions. Nevertheless, few medical practitioners, let alone inmates, were eager to enter workhouses, usually spending short periods there before securing more prestigious posts at voluntary and endowed hospitals.

LONDON: PORTENT OF THE FUTURE

‘In 1737 Samuel Johnson, having failed to make a very successful living hitherto, made his way to London, at the age of twenty-eight, and wrote a gloomy prognostication of his chances of survival:

Johnson had not yet visited Scotland, or he might have revised his views on the comparative safety of life in the Highlands. It was in London that he found the company that he most longed to frequent and in London that he made his career. He did not leave London often and it was in London that he died forty-seven years after his arrival, having made his famous remark that a man who was tired of London was tired of life, as there was in London all that life could afford. Most of the poem had in fact little to do with London, although it was quite correct in pointing out that the capital had its highwaymen and that the older houses occasionally fell into the street. Johnson used London to typify decadence This was, from one point of view, part of an anti-urban tradition that long predated Johnson and long outlived him.