A brief history of healthcare provision in London


Whilst the voluntary hospitals could choose their patients, the Poor Law hospitals had to accept everyone.  The original infirmaries were rooms in workhouses, usually with no heating and no furniture apart from iron beds and thin mattresses.  Patients were not charged for treatment and received very basic care, but admission to an infirmary carried a social stigma.

Separation of workhouse and infirmary began around 1867, after the death of an Irish inmate due to neglect in 1860, and following pressure and complaints from the medical profession about the standard of care.  The earliest infirmaries built as separate buildings from their workhouses were at St Pancras, St George-in-the-East and Wandsworth.  The infirmaries were huge and had to accommodate a large number of chronically ill patients (mainly the aged and infirm).  They also had substantial maternity wards but, because of the shame of being classed a pauper, birth certificates for children born in infirmaries to deserted or unmarried women tended to use the street address only, such as 19 Tewson Street, for St Nicholas' Hospital in Plumstead.  (Poor Law infirmaries gradually improved and, by 1900, many patients preferred the better standard of care offered in an infirmary.)

The government introduced a new Poor Law bill to improve the "management of the sick and other poor in the metropolis".  It was believed that health care could be more economical if handled by an organisation with large resources, with fewer and better equipped institutions.  The Metropolitan Poor Act became law on 14th March 1867, and all the Unions and parishes in London were designated as the Metropolitan Asylums District.  The District would be managed by the Metropolitan Asylums Board (MAB), a new central administrative body tasked with providing the first organised hospital system for the poor.  The Board comprised 45 elected Guardians and 15 appointed members.  It had its first meeting in June 1867, with Dr William Henry Brewer appointed as its Chairman.

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Longmate N 1974 The Workhouse.  London, Temple Smith.


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