London Journal of Primary Care 2013;5:49–50

# 2013 Royal College of General Practitioners

Published 7 April 2013

Editorial

Reflections on Charles Dickens Marini Edwards MRCGP West London

I have always enjoyed reading Dickens’s writings – for his wonderful use of the English language as well as for his concern for social issues. His descriptions of doctor and nurse in his novel Martin Chuzzlewit are reminders of the vast improvement in the attitudes and skills of both doctor and nurse over the past 200 years. As a medical student in Cambridge, I was told that the old geriatric hospital had been a workhouse before the National Health Service (NHS) was founded. A reminder of the workhouse where Oliver asked for more food in Dickens’s novel Oliver Twist. A recent episode of the television serial adapted from Jennifer Worth’s book Call the Midwife – about the experiences of a community midwife in the East End of London in the 1950s – showed the sad consequences of life in the workhouse and the incredible impact of the establishment of the NHS for one former workhouse inmate. At times of change, it is useful to reflect on and, hopefully, learn from the historical development and the effect of the NHS, especially in primary care. 2012 was the 200th anniversary of the birth of Charles Dickens – one of the best-known English novelists. Born on 7 February 1812, in Portsmouth, his writings were mainly about London where he lived most of his life. He died outside London, at his last home, Gad’s Hill Place, near Rochester in Kent on 9 June 1870, when he was 58 years old. On 10 June 1870, the Daily News stated, ‘He was emphatically the novelist of his age. In his pictures of contemporary life posterity will read, more clearly than in contemporary records, the character of nineteenth century life.’ Dickens lived in a time of great change – the Industrial Revolution. ‘During the nineteenth century, London expanded to meet the needs of a huge immigration of people from the rural areas.... In the generation between the 1820s and the 1850s ... the population of London rose from one and a half million to two and a half million – sixty per cent.’2 Much was a consequence of immigration from rural England. Dickens chronicled the society that existed in his lifetime – his observant descriptions of places and people convey vivid images of the past. By illustrating social ills, he used his writing to encourage social

changes that would improve society. One of his main themes was the life of the poor in his times, such as in his descriptions of workhouse life and debtors’ prison. He also described the consequences of illegitimacy and poverty for children. He supported reforming social ventures, such as the Foundling Hospital in Coram Street. From 1837 to 1839, he lived near the hospital at 48 Doughty Street and he frequently attended the hospital chapel. The Foundling Hospital provided for destitute infants who were abandoned by their usually single mothers who were unable to provide for them. Dickens founded a ‘home’ for ‘fallen women’, Urania Cottage, in Shepherd’s Bush in 1847. He believed that girls with ‘wretched histories’ might have better lives if they were given ‘education and example’. Dickens’s own early life gave him the opportunity to experience first-hand the horrors of child labour and a lack of education. By the early nineteenth century, child poverty, child labour and child prostitution were rife, especially in London. In Dickens’s times, there was very little state provision for the poor. The poor were dependent on charitable organisations or individuals and the workhouse. Workhouses were first set up following an Act of Parliament in 1601, the Elizabethan Poor Law – this made each parish responsible for its own poor, accountable to annually appointed overseers who would decide on how much each ratepayer would have to pay the parish for the care of the poor. There were alternatives, for those poor individuals who could work. For example, if a farmer had work, he could employ the unemployed poor who were able to work and their wages were subsidised by the parish. The elderly and sick were lodged in workhouses. Workhouses would also provide work for those who were able, but this was not a requirement to obtain poor relief. By the beginning of the nineteenth century, the cost of providing poor relief had increased considerably (as had the number of poor) from around £2 million in 1784 to roughly £7 million in 1832. The Poor Law Amendment Act was passed in 1834 – the underlying belief was that the poor were poor because of their improvidence/fecklessness/other bad habits. This amendment established that all those who were able to

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work and asked for poor relief would be given it but only within the workhouse. Conditions within the workhouse were to be made ‘less eligible’ than those of the poorest labourer – so that those that were admitted had ‘passed the workhouse test ... and only the truly destitute would accept relief’.3 By 1838, 1300 parishes were organised into 573 Poor Law unions supervised by a central body of three Poor Law commissioners acting through assistant commissioners and the number of union workhouses increased. Dickens describes the lives of workhouse paupers in his novel Oliver Twist published in 1838. Dickens had not lived in a workhouse but, when his family lived at 10 Norfolk Street (now Cleveland Street) he lived near one. The Cleveland Street workhouse belonged to the parish of Covent Garden and was built in the 1770s on land that the parish had purchased from the Duke of Bedford. Behind it was the pauper burial ground. Outside the workhouse gate was the parish of St. Pancras and across the road was the parish of St. Marylebone. This led to difficulties for the poor of this area because each parish was responsible for its own poor and the poor would have to go back to their parish for help, including medical help. The last workhouses finally closed in 1930. The Cleveland Street workhouse was purchased by the Middlesex Hospital and became its outpatient department. The hospital was demolished a few years ago, but the workhouse is now a listed building. In 1830, the Middlesex Hospital was on Charles Street, now Mortimer Street, near Cleveland Street. It was a voluntary hospital founded in 1745 on Windmill Street, for people who could not afford private care. Voluntary

hospitals were charitable institutions dependent on private charitable ‘voluntary’ donors. They ‘took in treatable casualties and those whose ailments were considered potentially curable ... the chronic sick, the infirm, the mentally ill, and the dying poor were turned away’.5 Those refused treatment at the hospital could only rely on the parish doctor and the parish workhouse infirmary/hospital. St. Marylebone parish workhouse opened a separate infirmary in 1881 in Rackham Street and this became St. Charles Hospital in 1930. Dickens was extremely observant and had a talent for descriptive writing. There is no doubt that his graphic descriptions of the terrible existence for the poor, particularly in London, had a considerable effect on his readers and promoted social change. The effect his writing had on society reflects the power of the written word as a means of facilitating social change. REFERENCES 1 Ackroyd P. Dickens. London: Vintage, 2002. 2 Clark P. Dickens’s London. London: Haus Publishing, 2012. 3 May T. The Victorian Workhouse. Oxford: Shire, 2009. 4 Mitton L. The Victorian Hospital. Oxford: Shire, 2008. 5 Richardson R. Dickens and the Workhouse. Oxford: Oxford University Press, 2012.

ADDRESS FOR CORRESPONDENCE

Marini Edwards, MRCGP Email: [email protected]

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