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The 1834 Poor Law Amendment Act, and the report of Royal Report that shaped it, were preoccupied with the able-bodied poor. For a number of reasons, such as ease of management and financial saving, the general mixed workhouse soon became adopted as the norm for the new system.Originally, the Report had proposed distinct institutions for different categories of pauper inmate: 'At least four classes are necessary:— 1. Thus, a single establishment had to try and provide both a severe deterrent regime for the able-bodied, and also to do what it could to accommodate the sick and aged who increasingly figured amongst its inmates.Their report, which contained statistical studies of the diseases and accommodation of the non-able-bodied poor, recommended the creation of separate hospitals for the sick poor, and dispensaries for the outdoor poor.Gathorne Hardy also consulted the President of the Royal College of Physicians, Sir Thomas Watson, who convened a committee to examine workhouse medical provision in the capital.However, this suggestion did not have the status of an official Order so had little immediate effect.
During that period, institutional medical care for the poor was transformed from a system based on often squalid workhouse infirmaries, staffed by illiterate paupers, to one which included around forty general and specialist MAB establishments, many purpose-built, staffed by well-trained personnel.A subsequent interview with Matilda Beeton, a former nurse at the Rotherhithe workhouse infirmary, revealed that 'many sick patients were dirty, and that their bodies crawling with vermin'; sheets were changed once in three weeks and soiled sheets had to be washed in the infirmary at night; there was 'a bad supply of towels used for every clean and dirty purpose'; beds were made of flock and 'maggots would crawl from them by hundreds'; the 'sick diet was a mockery — milk was not heard of'.Similar conditions were alleged at the Strand and Paddington workhouses. Hart, Anstie and Rogers, with the support of prominent figures such as Charles Dickens, set up The Association for Improvement of the Infirmaries of London Workhouses whose aims included the setting up of six thousand-bed poor law hospitals in London staffed by trained nurses, resident medical officers, and medicines financed from the rates.However, Villiers felt that the weak state of the Whig Government in the spring of 1866 made it an inopportune time for proposing new legislation upon such a controversial subject.
In June 1866, the Whig government fell and was succeeded by a Tory administration with Lord Derby as Prime Minister.
The institutions set up by the MAB came to be accessible by all the capital's inhabitants, not just the poor.