Intended for healthcare professionals


London’s last remaining Georgian workhouse infirmary under threat

BMJ 2007; 335 doi: (Published 20 December 2007) Cite this as: BMJ 2007;335:1312
  1. Nick Black, professor of health services research
  1. 1London School of Hygiene and Tropical Medicine, London

    From 1601 until the start of the NHS in 1948, provision of hospital care for the most destitute was a local responsibility. Initially, under the Elizabethan poor law, parishes provided workhouses, which often included some rudimentary infirmary, though little recognisable health care. The oldest one that survives in London was built in 1775-8 in Cleveland Street, Fitzrovia, by the parish of St Paul’s, Covent Garden. The elegant H-shaped, four storey, Georgian building originally had a stone relief over the entrance depicting an old man pointing to the motto Avoid idleness and intemperance.

    With the merger with six other parishes to create the Strand Poor Law Union in 1836, its role as an infirmary was formally recognised. After construction of two additional lateral blocks, it housed more than 550 people in 330 beds. Like all workhouse infirmaries, it provided half as much space per person as that designated for prisons. Longstanding concern about the care provided in such establishments culminated in two national inquiries in the 1860s.

    The Cleveland Street infirmary was notable for the contribution some of its staff played in the national campaign for reform, most notably Matilda Beeton, a nurse, and Joseph Rogers, who not only served as doctor for 20 years but also helped found the Association for Improvement of Workhouse Infirmaries and became president of the Poor Law Medical Officers’ Association.

    Reforms arrived in 1867 with the establishment of the Metropolitan Asylums Board, the first opportunity for London-wide planning of health services. The building served as an infirmary for the newly created Central London Sick Asylum District, which extended from Westminster to Bloomsbury, until 1927 when alternative provision meant it was no longer required. However, it continued as the outpatient department for its long-time neighbour, the Middlesex Hospital, until the recent move of all services to the new, state-of-the-art University College Hospital.

    While welcoming the move, we should also be preserving this building, the only remaining example of a hospital that served the poor of London for 150 years.

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