Poverty and endemic disease, by Andy Gritt

​The current global crisis is leading some people to make comparisons with previous pandemics, most notably the Spanish flu of 1918-1920. Even the historic images of that outbreak look eerily familiar with face masks becoming common and emergency hospitals set up to cope with the scale of infection. Spanish flu led to many more deaths than we have seen so far from coronavirus, with an estimated 500 million cases and 50 million deaths worldwide...

Above left: Family and their cat during the Spanish Flu, 1918.
Above right: Camp Funston, at Fort Riley, Kansas, during the 1918 Spanish flu pandemic.

It is said that coronavirus doesn’t discriminate, but there has been considerable press coverage to show that mortality rates are influenced by unequal access to medical care along racial and social lines. Indeed, welfare systems and economic inequalities undoubtedly make some people more vulnerable to infectious disease than others. Lockdown itself has exacerbated the social divide, with many low paid people either continuing to work in high risk environments and others simply losing their job. The New York Times has coined the phrase “white collar quarantine”, recognising that while many members of the middle class can work comfortably from home, that luxury is not afforded to those who work in factories, cleaners, transport workers, those who work in warehouses.

Historically this has often been the case, long before there was any scientific understanding of the causes of disease. The poor were often victims of their physical environment, especially in urban settings, where a lack of sanitation and overcrowding allowed disease to spread rapidly. Cholera, dysentery, tuberculosis, smallpox, typhus and typhoid claimed the lives of millions of people in the nineteenth century, and these diseases disproportionately affected the poor. Long-term poverty inadequate sanitation, poor housing and a diet that was deficient led to compromised immune systems, further weakening the ability of individuals to fight infection, not least secondary infections that frequently accompany viral disease.


But what of workhouse populations in the past? How prone were they to contagious disease? The detailed demographic research has not been done so it is impossible to answer this question with any degree of accuracy. However, some salient points can be made.
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The first is that many people who entered workhouses did so because of ill-health. In some cases this was due to non-communicable conditions that rendered people unfit to work but did not put anybody else at risk. However, a large number of individuals entering workhouses did so carrying a communicable disease. In the first week of January 1875, 49 cases of disease were recorded in the medical relief books at Gressenhall workhouse; at Southwell there were 89, at Guildford there were 55, at Leeds there were 428, at Ripon there were 22 and at Llanfyllin there were 46. In total there were 44,705 cases of disease in workhouses in England and Wales in the first week of January alone. (Return from Workhouses in England and Wales, January 1876, of Number of Cases of Disease, distinguishing Venereal Diseases, and of Deaths in Workhouse, 1875). The number of paupers in workhouses on 1 January 1875 was 151,930, suggesting that around 30% of inmates were recorded with diseases (Comparative Statement of Number of Paupers relieved, January: 1875 and 1876).
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Although “germ theory” was gradually gaining followers amongst the scientific community in the second half of the nineteenth century, the true nature of the causes of disease were not widely accepted until the twentieth century and many adhered to “miasma theory” until at least the late nineteenth century. Transmission of disease within workhouses, therefore, was simply not understood or accepted for most of the Victorian period.

Krazy Kat Cartoon, 1918 by George Herriman.
https://commons.wikimedia.org/wiki/File:Krazy_Kat_Spanish_Flu_1918.jpg

But these high infection rates and lack of scientific knowledge did not mean that pauper medical needs were entirely unmet. By the later nineteenth century workhouses were generally clean, with whitewashed walls, the provision of a regular diet, and rudimentary medical care. Some paupers were isolated from others, and many workhouses had dedicated “itch” wards for people presenting with scabies. This is a highly contagious condition that is spread by burrowing mites that infest human skin and as sharing beds was common practice in early workhouses scabies, and other diseases, were undoubtedly widespread amongst the poor. As the nineteenth century progressed many workhouses developed significant provision for medical care, investing heavily in infirmaries and employing qualified medical staff to care for the poor. Workhouses therefore provided many poor people with a basic quality of life that in some instances was probably far superior than conditions in poor, overcrowded housing. However, this does not take into account the psychological impact of being in receipt of institutional welfare. There are parallels here with people living in lockdown in small, overcrowded or inadequate housing with little respite from the psychological impact of such conditions.
Then, as now, bacteria, viruses and parasites did not discriminate. But society did discriminate in significant ways and the impact of disease was not felt equally across the social classes. The poor experienced the full impact of the double whammy of ill health and poverty, with one exacerbating the other leading. Compromised immune systems and the lack of a financial cushion led to a lifetime of vulnerability.  Many people across the world still experience that vulnerability.

Image credits
By Unknown author - https://www.theodysseyonline.com/seek-treatment,
https://commons.wikimedia.org/w/index.php?curid=89018757

Armed Forces Institute of Pathology/National Museum of Health and Medicine, distributed via the Associated Press
https://commons.wikimedia.org/wiki/File:Camp_Funston,_at_Fort_Riley,_Kansas,_during_the_1918_Spanish_flu_pandemic.jpg

Krazy Kat Cartoon, 1918 by George Herriman.
https://commons.wikimedia.org/wiki/File:Krazy_Kat_Spanish_Flu_1918.jpg

Acknowledgment
I would like to thank Dr Lewis Darwen for his assistance with this article

Dr Andy Gritt
Head of History, Languages and Global Cultures, Nottingham Trent University.