To the Hospital or the Workhouse? The Provision of Medical Care for the Poor in Eighteenth-Century London

Abstract

Parishes’ medical obligations under the Old Poor Law were considerable. Paupers unable to afford private medical care often relied on their parish for relief. When cases of sickness or injury were serious enough to warrant institutional care, parishes frequently arranged to get paupers into city hospitals. This study looks at the admissions registers of St. Thomas’s Hospital in the 1770s and 1780s to gauge the hospitalisation practices of London’s 155 parochial units. It shows that such practices differed significantly based on whether parishes operated workhouses. The medicalisation of workhouses, by which parishes established sick wards within them, had a powerful impact on parochial reliance on St. Thomas’s Hospital. Parishes that lacked workhouses were nearly four times more likely to send patients to the hospital. The scarcity of paupers coming from parishes with workhouses sends a powerful signal that considerable medical care must have been operating at the local level. The collective medical capacity of London workhouse infirmaries may have thus equalled or even surpassed that of its hospitals. The article further considers the impact of workhouse medical provision on hospitalisation practices in the wider provincial environs of London to speculate on workhouse medicalisation there.