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A thesis submitted to the University of Birmingham for


History of Medicine Unit

School of Health and Population Sciences

University of Birmingham

November 2014

University of Birmingham Research Archive

e-theses repository

This unpublished thesis/dissertation is copyright of the author and/or third parties. The intellectual property rights of the author or third parties in respect of this work are as defined by The Copyright Designs and Patents Act 1988 or as modified by any successor legislation.

Any use made of information contained in this thesis/dissertation must be in accordance with that legislation and must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the permission of the copyright holder.

ABSTRACT This study of the medical role of the urban workhouses of Birmingham and Wolverhampton after the New Poor Law addresses the following questions: what were the standards of medical and nursing practice and what treatments were used to alleviate inmates’ suffering? It considers the nature of illnesses encountered covering acute non-infective illnesses, infectious disease and chronic disability, and highlights the important role the workhouse played in providing institutional care, especially in the isolation of epidemic diseases. Birmingham workhouse had a well-developed medical service prior to the New Poor Law and this continued until the midnineteenth century. By comparison, Wolverhampton workhouse did not meet satisfactory levels of medical and nurse staffing until near the end of the century. The study provides a new perspective on medical care in workhouse infirmaries by showing how standards varied over time within the same institution and how medicalisation of the workhouse began in the early years after the New Poor Law.

Medical care in workhouses has been viewed as important only in the context of the development of the National Health Service, but this study demonstrates that it provided significant, and at times high quality, medical treatment for the poor.

i CONTENTS List of Tables page iii List of Appendices vi Acknowledgements vii Abbreviations viii Chapter 1 The New Poor Law and the Indoor Medical Service 1 2 From Acute Illness to Chroni

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Table 2.12: Number of ‘Casualty Cases’ Admitted to Birmingham Infirmary, 85 1904-1910 Table 3.

1: Prevalence of Communicable Diseases in Britain in Nineteenth 109 and Early Twentieth Centuries

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Table 3.5: Cause-specific Death Rates for Phthisis, Birmingham 133 Registration District, 1871-1910 Table 3.

6: Phthisis Patients in the ‘Phthisis Hospital’ in Birmingham 138 Workhouse on 16 September 1904

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Table 4.2: Visiting Surgeon and Physicians to Birmingham Infirmary, 165 1882-1913 Table 4.

3: Workhouse Medical Officers in Wolverhampton Workhouse, 171 1839-1914 Table 5.1: Inmates, Patients and Alcohol Consumption in Wolverhampton 213 Workhouse, 1842-46 Table 5.2: Quantity and Cost of Alcohol Consumption in Wolverhampton, 214 Birmingham and all English and Welsh Workhouses, 1871-1892 Table 5.3: Cost of Consumption of Wines and Spirits in Wolverhampton 217 Workhouse, for the Years ending Lady Day 1900-1906

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Table 5.5: Operations Performed in Birmingham Infirmary, 1859-1892 242 Table 6.

1: Applicants for the Post of Nurse in the Female Infirmary 256 Wards at Birmingham Workhouse, 1852 Table 6.2: Weekly Average Hours Worked by Sisters and Nurses in 1911 257 Table 6.3: Nurses Appointed to the Infirmary Wards in Wolverhampton 258 Workhouse, 1839-1890

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Table 6.5: Salary Schedule for Officers in Wolverhampton Workhouse, 266 Table 6.

6: Paid and Pauper Nurses in Birmingham Workhouse, 1842 271

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Appendix A Prevalence of Selected Infectious Diseases in Birmingham Workhouse on the Last Day of the First Week of Each Quarter for the Years 1877and 1894-1911 Appendix B Medical Relief in Birmingham Workhouse for Selected Weeks, 1851-56 Appendix C List of Drugs Kept in the Wards of Birmingham Infirmary in 1896 Appendix D Elizabeth Wood’s Clinical and Temperature Charts, Birmingham Infirmary, 1885 Appendix E Qualification and Certificates for Nurse Training in Workhouses Appendix F Situation of First Workhouse in Lichfield Street, Birmingham, 1810 Appendix G Situation of Second Birmingham Workhouse and Infirmary, 1888 Appendix H Ground Plan of Second Birmingham Workhouse, 1867 Appendix I Plan of First Wolverhampton Union Workhouse, date 1871 Appendix J Plan of Second Wolverhampton Union Workhouse, 1902 Appendix K Plan of Isolation Hospital in Second Wolverhampton Workhouse, 1900 Appendix L Pauperism Rates and Institutionalisation Rates for Birmingham Parish, Wolverhampton Union and England and Wales, 1840-1911

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I wish to express my gratitude to my supervisors Professor Jonathan Reinarz, Director, The History of Medicine Unit, and Dr Malcolm Dick, Director, Centre for West Midlands History, for their guidance and constructive criticism concerning the progress of the research and the preparation of the thesis. The research was undertaken mainly at the Archives and Heritage Service at Birmingham Central Library and Wolverhampton Archives and Local Studies. I am grateful to the staff at both centres for their assistance in identifying relevant documents and for the retrieval of the volumes from the archives. I am grateful to Dr Stuart Wildman for his comments and suggestions relating to the chapter on nursing and to Dr Leonard Smith for drawing my attention to a volume concerning ‘insane’ inmates in Birmingham workhouse and suggesting references on mental health. I would particularly like to thank my wife, Christina, for her support throughout the four years of study and for undertaking the typing of the manuscript.

Parts of the material have been presented at seminars on Medicine and the Workhouse on 31 October and 1 November 2008 in Birmingham and on Health, Illness and Equality in Birmingham in March 2011; at conferences on Disability and the Victorians in Leeds Trinity University in August 2012 and on Food in Hospitals in Brussels in April 2013. The discussion following presentation was useful in formulating ideas for the study.

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AMO Assistant Medical Officer BBG Birmingham Board of Guardians BCL Birmingham Central Library BPP British Parliamentary Papers BUB Birmingham Union Board CEB Census Enumerators’ Books CL Commissioner in Lunacy CMB Central Midwives Board CsL Commissioners in Lunacy

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DMO District Medical Officer FRCS Fellow of the Royal College of Surgeons GHAR General Hospital Annual Report GPC General Purposes Committee HC House Committee

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HSC House Sub Committee IHSC Infirmary House Sub Committee IMC Infirmary Management Committee IMO Infirmary Medical Officer ISC Infirmary Sub Committee LGB Local Government Board MD Doctor of Medicine MJ Master’s Journal

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TB Tuberculosis TNA The National Archives VGPC Visiting and General Purposes Committee WALS Wolverhampton Archives and Local Studies WBG Wolverhampton Board of Guardians WC Wolverhampton Chronicle WIMC Workhouse Infirmary Management Committee WISC Workhouse Inquiry Sub Committee WJ Wolverhampton Journal WMC Workhouse Management Committee WMO Workhouse Medical Officer WVC Wolverhampton Visiting Committee

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Introduction Although the literature on poor law history is extensive, sick paupers have largely been neglected within this body of knowledge, despite the inextricable link between illness, disability and poverty.1 One possible reason for the paucity of research is the scarcity of sources relating to poor law medical relief and the fleeting references to medical care within poor law archives.2 More important has been the lack of definition of ill health as a cause for poor law relief, lending some historians to suggest that distinguishing medical relief from other forms of help is not important The classic text on the history of the poor law arguably remains that written by the Webbs, English Poor Law History, published in London in 1927, although many studies since have taken a more critical, if less integrated, approach by investigating particular aspects of poor law administration.

Major studies of the national system include: D. Fraser (ed.), The New Poor Law in the Nineteenth Century, London, 1976; K. Williams, From Pauperism to Poverty, London, 1981; M. E. Rose (ed.), The poor and the city: the English poor law in its urban context, 1834-1914, Leicester, 1985; A. Digby, British Welfare Policy: Workhouse to Workfare; D. Englander, Poverty and Poor Law Reform in Nineteenth Century Britain, London, 1998; L. H. Lees, The Solidarity of Strangers, Cambridge, 1998;

A. Kidd, State, Society and the Poor in Nineteenth-Century England, Basingstoke, 1999. A regional or local analysis is contained in: M. Fissell, Patients, Power and the Poor in Eighteenth-Century Bristol, Cambridge, 1991; Brundage, The English Poor Laws 1700-1930; S. King, Poverty and welfare in England 1700-1850, Manchester, 2000. Those devoted primarily to the workhouse include: A. Digby, Pauper Palaces, London, 1978; M. A. Crowther, The Workhouse System 1834-1929, London, 1981; F.

Driver, Power and Pauperism, Cambridge, 1993; M. Higgs, Life in the Victorian and Edwardian Workhouse, Stroud, 1997; S. Fowler, Workhouse: The People, The Places, The Life Behind Doors, Richmond, 2007.

The main published studies covering the medical field are: R. G. Hodgkinson, The Origins of the National Health Service: the Medical Services of the New Poor Law 1834-71, London, 1987; M. Flinn, ‘Medical Services under the New Poor Law’ in D. Fraser (ed.) The New Poor Law in the Nineteenth Century, London 1976; J. V. Pickstone, Medicine and Industrial Society, Manchester, 1985; H.

Marland, Medicine and Society in Wakefield and Huddersfield 1780-1870, Manchester, 1987; J.

Reinarz and L. Schwarz (eds), Medicine and the Workhouse, Rochester, 2013; A. Gestrich, E. Hurren and S. King (eds), Poverty and Sickness in Modern Europe, London, 2012.

and that the sick poor are not worthy of study as a specific subgroup.3 Mary Fissell found, in her study of the poor in eighteenth-century Bristol, that medical care for many paupers was such an integral part of their welfare support that it was not possible to make a clear distinction between health care and poor relief. The support provided to families often defied separation into medical and welfare components.

However, she did accept that illness could be a clearly defined point of entry to relief for some paupers.4 Indeed, even when sickness or physical disability was not a key reason for an application for relief, it was often a necessary accompaniment for success. Furthermore, relief granted on the basis of unemployment often unmasked underlying sickness.5 Alannah Tomkins’ view is that there is much to be learned from trying to distinguish ‘the sick from the total pool of “the poor”’ and from examining the provision of identifiable medical relief.6 As a result of the limited dedicated research on sick paupers, there remain gaps in the knowledge of the nature and role of poor law medical care and an inadequate understanding of its importance in the life cycle of illness among paupers.7 Additionally, the poor law institutional medical service has been less intensively researched by historians than outdoor medical relief. This is difficult to comprehend since sickness was very often the major reason for admission to a workhouse and an increasing proportion of sick paupers were admitted as the nineteenth century S. King, ‘Poverty, Medicine and the Workhouse in the Eighteenth and Nineteenth Centuries’, in Reinarz and Schwarz (eds), Medicine and the Workhouse, p.245; A. Tomkins, ‘“Labouring on a bed of sickness”: The material and rhetorical deployment of ill-health in male pauper letters’, in Gestrich, Hurren and King (eds), Poverty and Sickness in Modern Europe, pp.51-52.

Fissell, pp.99-100

A. Gestrich, E. Hurren and S. King, ‘Narratives of poverty and sickness in Europe 1780-1938:

Sources, methods and experiences’, in Gestrich, Hurren and King (eds), Poverty and Sickness in Modern Europe, p.21.

Tomkins, ‘“Labouring on a bed of sickness’”, p.52.

King, ‘Poverty, Medicine’, pp.229, 245; Gestrich, Hurren and King, ‘Narratives of poverty and sickness in Europe’, p.21; A. Negrine, ‘Practitioners and Paupers’, in Reinarz and Schwarz (eds), Medicine and the Workhouse, p.193.

progressed under the influence of the New Poor Law (hereafter NPL) enacted in 1834.

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