Taking the Long View of Contagion, Compassion and Community Response

Temporary Spanis Flue hospital 1918 ii
Temporary hospital during the Spanish Flu pandemic, 1918

In these unsettling times it might seem as though history has little comfort to offer us. When we look back for reassurance, we tend to light on the scale of the Spanish Flu pandemic, the horrors of the Black Death, or the ravages of smallpox through the ages. Yet despite the hardships and, for some, personal tragedies that have followed in the wake of Covid-19 it is important to maintain a sense of perspective, and one way we can do this is by recognising just how resilient and resourceful we are, and always have been, in the face of epidemics and communicable diseases. From the early modern period onwards, we have built on empirical observations and experimental science to understand the best ways to mitigate and even halt the spread of deadly diseases; but, individually and collectively, we also have a rich history of compassion and public spiritedness when  it comes to protecting vulnerable groups and supporting those most affected by epidemics. Nowhere are all these tendencies clearer than in the stories that emerge from the correspondence to the Poor Law Commissioners across the 19th century.

Hampstead Smallpox Hospital ii
A Ward in the Hampstead Smallpox Hospital, 1871

In 1893, for example, Charles Wills, the medical officer of health for the Southwell Rural Sanitary Authority, wrote to the Local Government Board that a case of smallpox had been discovered at the union workhouse. The affected man, Henry Jackson, had tramped from Manchester (where he was believed to have picked up the disease) and arrived on the 27 January. The authorities swiftly determined that he had shared the vagrant ward that night with a further 18 men, and this was communicated to the Local Government Board with an account (as far as possible) of their ongoing movements. The ward was then closed, and Jackson was placed in isolation with another male inmate to act as his nurse. His companion was chosen specifically because he had previously survived the disease and was therefore assumed to be immune. The Guardians took further measures to stop the spread of the disease by vaccinating or re-vaccinating all inmates over the age of 10 who would allow it. As a result of their swift action, Jackson’s was the only recorded case on this occasion: he seems to have recovered by late March, and his ‘key worker’, Robert Rushton, who nursed him for a full seven weeks, was later given a guinea by the Guardians as a reward for his efforts, which enabled him to discharge himself from the workhouse. In a postscript to the case, the Medical Officer, Charles Wills, wrote that there were many isolated cases of smallpox in Derbyshire and Yorkshire at the time, and that it was bound to be exported to neighbouring districts. In response, he proposed that some semi-detached cottages should be built on property adjacent to the workhouse in order to improve facilities for isolation if it reached Southwell again (it is not known whether the Board chose to act on his recommendation in this instance)  (TNA MH 12/8544, 9547).

If all of this sounds remarkably familiar, then it’s hardly surprising: the very fact that epidemics were a constant threat before the refinements of modern medicine meant that rapid responses and empirical methods of containment were at the forefront of everyone’s mind, and many of the public health measures that were instigated from the 1830s onwards were, of course, specifically aimed at achieving this outcome. Crucially, the newly centralised and bureaucratised structures of the poor law were an ideal forum for applying these measures. So it was that when Richard Pugh, the clerk to the Watford Union, reported in 1849 that there had been a fatal case of cholera in the town, the Guardians were well placed to put in train a series of measures to ensure that it was checked at source. These included a house-to-house visitation of infected localities, and when a case was discovered in the Workhouse Infirmary it involved daily testing and examination of all workhouse inmates to ensure that timely treatment could be applied as soon as symptoms manifested themselves (TNA MH 13/197).

Indeed, large parts of daily workhouse practice were specifically aimed at stopping the encroachment of communicable diseases from gaining a foothold in these institutions, and from spreading more widely if detected. The oft-noted practice of removing a person’s clothes for ‘purification’ (usually by boiling) when they were admitted and replacing them with workhouse dress was done for precisely this reason. It is a subject that has often caused controversy in the literature, because contemporaries, and most historians, have chosen to interpret it simply as a way of enforcing a degrading uniform; but, in fact, it was a very effective way of checking the spread of disease. As the president of the Poor Law Board explained to Parliament in 1849, “the rule now in force [was] introduced on considerations suggested by the necessity of securing cleanliness,” and he added that “by enforcing it, the cleanliness and health of the establishments [has] been very materially promoted” (Bath Chronicle, 28 June 1849). When common sense measures such as these were not followed, paupers themselves were the first to complain. In 1867, for example, J. Smith, an inmate at Bethnal Green workhouse, wrote that the nurses from the sick wards were carrying their dirty washing through the day rooms, which were used predominantly by elderly and infirm inmates, and that this laundry was likely to be contaminated from contact with infected patients. He complained that it was a practice which was “injurious to health and not to be tolerated,” and he suggested that the only reason nurses were not allowed to go the “proper way” to the laundry was because the Master was fearful lest his own children “should catch a disease, as they would have to pass his apartments” (TNA MH 12/6854).

This focus on the workhouse poor brings us back full circle to the situation we face today with Covid-19. Thankfully, here in Britain, as in many countries where it has made such rapid progress, things have begun to stabilise and, though obviously still of great concern, the overall number of cases and deaths seems to have plateaued. One of the areas of increasing anxiety, however, relates to care home residents, and we still have little understanding of just how devastating it will turn out to be for the institutional care sector as a whole. Clearly, many of the practical measures outlined above were specifically designed to protect workhouse populations from mass outbreaks. But the authorities were also acutely aware that other measures that we are now becoming all-too familiar with could make a crucial difference in preventing institutional tipping-points. So, for example, when Widow Granger, a resident at Barnet workhouse, asked permission to go out and visit her dangerously ill granddaughter, the Guardians “refused [her request] in consequence of the complaint being the small pox” (G. Gear (ed.), The Diary of Benjamin Woodcock: Master of the Barnet Union Workhouse 1836-38 (Herts. Record Society, 2008), p.98). This entry tells us that Widow Granger would, under normal circumstances, most likely have been allowed out on compassionate grounds; something that, in itself, challenges many of the standard narratives about workhouse life. But it also tells us that officials in the 19th century were constantly grappling with the competing needs – emotional, psychological and medical – of those under their charge in exactly the same way as those who are currently trying to manage the spread of Covid-19 in care homes. The question of how to protect the physical welfare of vulnerable residents, while ensuring that they are not denied the life-affirming contact and support of loved ones, is clearly not a new one.

These are extraordinary times, unprecedented for most of us: but alongside the uncertainty and inevitable anxiety that comes with a situation like this, we also have the opportunity to reflect on the great sacrifices that ordinary people – from key workers to coordinators, and from community volunteers to self-isolaters – are making for the public good. It is, perhaps, some comfort to know that we have such deep reserves of selflessness and rapid response to draw on. This last example, from the Board of Guardians’ Minutes of Mitford and Launditch Union in Norfolk during the last great epidemic of smallpox in 1871, is a wonderful case in point (TNA MH 12/8484).

The attention of the Guardians was particularly directed to the case of William Cory, of Great Dunham, Labourer, who, with his Wife and family of six children, had recently been deprived of their usual Harvest earnings by reason of the state of Quarantine imposed upon them, for 5 or 6 weeks, in consequence of the existence of Small Pox in a Cottage adjoining his Dwelling house and under the same roof: And it being shewn to the satisfaction of the Guardians that this insulation of Cory and his family has tended to prevent the spread of the disease but that he had thereby incurred a loss of Five pounds and upwards, it is unanimously resolved that he be allowed the sum of Five Pounds, either under the provisions of the Sanitary Acts, or by way of gratuity under the special circumstances as the Local Government Board may approve.

 

 

 

 

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