«MEDICAL CARE IN THE WORKHOUSES IN BIRMINGHAM AND WOLVERHAMPTON, 1834-1914 by ALISTAIR EDWARD SUTHERLAND RITCH A thesis submitted to the University of ...»
proportion of total relief showed marked differences between the two towns, being much greater in Birmingham than Wolverhampton from 1881, possibly also due to the influence of the crusade. However, James Turner, chairman of Birmingham guardians in 1907, explained that the high institutionalisation rate was due to the entirely urban nature of the parish, with an almost exclusively working-class population. The policy of the board of guardians was to provide out-relief whenever a ‘respectable home’ was available.84 The degree of overcrowding, in terms of the number of persons per household, was more severe in Birmingham (30%) compared with Wolverhampton (19%).85 This is likely to have contributed to a higher incidence of infectious disease, including tuberculosis.
Physical Disability Institutionalisation was one of the responses to disabled people that took place throughout history. The trend toward greater institutionalisation in the nineteenth century had its basis in the medical model of disability, which regarded impairment as a personal tragedy and a sickness.86 As a result, disabled people were seen as invalids, incapable of social participation. Bill Hughes argues that the medical model of disability, with its emphasis on the disabled body, provoked not only pity but also BPP, 1909 [Cd. 4835], p.339.
Booth, pp.88, 92.
D. M. Turner, ‘Introduction’, in D. M. Turner and K. Stagg, (eds), Social Histories of Disability and Deformity, London, 2006, p.6; B. Hughes, ‘Disability and the Body’, in C. Barnes, M. Oliver and L.
Barton (eds), Disability Studies Today, Cambridge, 2002, pp.58-76.
fear in the non-disabled gaze, resulting in charitable paternalism on the one hand and segregation on the other.87 He considered both types of response arose from ‘the gaze that composes impairment as disorder’.88 The predominant Victorian response to an impaired body was social exclusion and institutionalisation, under the ambit of medical jurisprudence, but an emotional response also took place with the provision of charitable institutions.89 However, establishments for people with sensory impairments, such as blindness and deafness, and for children with physical ailments predominated, although they developed to a large extent only in the late Victorian period.90 Less institutional care was provided for those who developed disability later in life, as this was seen as inevitable and incurable or even as divine punishment for past misdemeanours.91 The concept of chronic illness, as a category of ill health, did not emerge until the twentieth century and its recognition as a social problem in the United Kingdom did not take place until after World War II.92 Furthermore, disability studies, as an academic discipline, did not become established until the 1980s.93 Prior to that time, historical assessment of disability had come from ‘outsiders’, such as doctors and policy makers, since historians had neglected this area of study, leaving it ‘unhistorical as a discourse’.94 However, major historical studies have not appeared until the twenty-first century. Anne Borsay’s Disability and Social Policy in Britain since 1750 explores the exclusion of disabled people from the full rights of citizenship Ibid.; B. Hughes, ‘The Constitution of Impairment: modernity and the aesthetic of oppression’, Disability Society, 14 (2002), pp.155-72.
Hughes, ‘Impairment’, p.157.
Hughes, ‘Disability’, pp.60-62.
A. Borsay, ‘History, Power and Identity’, in C. Barnes, M. Oliver and L. Barton (eds), Disability Studies Today, pp.104-6; Hughes, ‘Disability’, p.62; Hughes, ‘Impairment’, p.157.
Edwards, p.263; A. N. Bergen, ‘The Blind, the Deaf and the Halt’ (unpublished PhD thesis, University of Leeds, 2004), p. 371.
C. Timmerman, ‘Chronic Illness and Disease History’, in M. Jackson (ed.), Oxford Handbook of the History of Medicine, Oxford, 2011, p.394; G. Weisz, Chronic Disease in the Twentieth Century: A History, Baltimore, 2014, p.176.
Turner, ‘Introduction’, pp.2-3.
S. Burch and I. Sutherland, ‘Who’s Not Yet Here? American Disability History’, Radical History Review, 94 (2006), p.128; J. Anderson and A. Carden-Coyne, ‘Enabling the Past: New Perspectives in the History of Disability’, European Review of History, 14 (2007), p.447.
since 1750, while in Chronic Disease in the Twentieth Century, George Weisz discusses how the concept of chronic disease has altered in meaning throughout history and yet remained an imprecise term, even in the twentieth century.95 The surveys of Birmingham’s chronic sick hospitals in mid-century were impeded by the lack of an exact definition of ‘chronic sick’. As a result, many older patients were labelled as chronic sick, although Michael Denham argues that negative attitudes to older people contributed.96 Consequently, within the disabled population, older disabled people have suffered relative neglect and Julie Anderson and Ana CardenCoyne assert that those who become more infirm in old age warrant ‘vigorous academic attention’.97 Although a sizeable proportion of workhouse inmates suffered from disability, their relative neglect within the historical discourse may have resulted also from the difficulty in identifying them within poor law institutions, a task made more difficult because those with identical disabilities could be allocated to different categories within the workhouse classification system.98 Workhouse Classification The classifying and separating of different categories of inmates was one of the main elements of psychological deterrence and depersonalisation within the workhouse system.99 This applied only to those who did not suffer from physical or mental illness for whom the guardians were allowed to provide whatever facilities they A. Borsay, Disability and Social Policy in Britain since 1750: A History of Exclusion, Basingstoke, 2005; G. Weisz, Chronic Disease in the Twentieth Century: A History, Baltimore, 2014.
M. Denham, ‘The Surveys of the Birmingham Chronic Sick Hospitals, 1948-1960s’, Social History Medicine, 19 (2006), p.280.
Anderson and Carden-Coyne, p.455.
Bergen, pp.22, 115.
Digby, ‘Poor Law’, p.17.
considered necessary and those who were suffering from acute medical conditions would usually be admitted to the general sick wards, while those with less-acute illnesses and age-related diseases would be allocated a variety of other departments.
Following the report of the Royal Commission on the Poor Laws in 1834, the PLCs considered that a minimum of four ‘classes’ were essential for ‘well-regulated’ workhouse administration, namely ‘the aged and really impotent’; able-bodied males;
able-bodied females; and children.100 However, their first annual report classified indoor paupers into seven groups, which included separating the ‘aged or infirm’ class into men and women, as it was considered that separation of the sexes of all classes was essential to good workhouse management.101 The Commissioners issued general workhouse rules in 1842, altering the categories relating to older men and women to those ‘infirm through age or any other cause’.102 This later classification differed from the earlier one in excluding those older inmates who were regarded as healthy, who from that time could only be placed with the able-bodied groups, but allowed younger disabled inmates to be housed with non-able-bodied paupers. Anne Digby draws attention to the fact that the term ‘able-bodied’ was never clearly defined and suggests it included all those over 15 years of age and who could support themselves through employment.103 Mary MacKinnon regards it as ‘virtually meaningless’, as it could include younger people who were incapacitated by short- or medium-term illnesses or accidents.104 The non-able-bodied class consisted mostly of older and permanently disabled inmates.105 Furthermore, guardians were permitted to subdivide classes in any way they saw fit, for instance by moral behaviour. Both central BPP, 1834 (44), p.172.
BPP, 1835 (500), p.60.
BPP, 1844 (45), p.2.
Digby, Pauper Palaces, p.144.
M. MacKinnon, ‘The Use and Misuse of Poor Law Statistics 1857 to 1912’, Historical Methods, 21 (1988), p.6.
guidance and local workhouse officials were divided in their views over whether sick older inmates should be treated in the infirmary or placed in the ordinary wards of the workhouse.106 In 1891, the able-bodied group were divided into those who were healthy and those who were temporarily disabled, resulting in an increase in the proportion of sick inmates. MacKinnon estimates that almost half of workhouse inmates were ill in the mid-nineteenth century.107 As a result, inmates who would have been regarded as sick or disabled cannot be easily identified as distinct groups within the workhouse population and are to be found within various sections of the workhouse community.
Non-able-bodied adults admitted to Birmingham workhouse in the 1840s could be found in wards for aged and infirm men and women, in the insane, venereal, itch, lying-in or bedridden wards. They would also have been present in the various infirmary wards.108 However, there is also one mention of a ward for partially disabled men, suggesting there may have been subdivision of categories of inmates in smaller wards within the broader classifications.109 The insane wards were renamed epileptic wards after the new workhouse was built and there were dedicated wards for men with leg ulcers and ‘consumptive cases’.110 There was less choice in the placement of inmates initially in Wolverhampton union workhouse with wards for able-bodied men and women, old men, old women, boys, girls and the infirmary.111 However, 25 years later, dedicated provision had been made for inmates suffering BPP, 1866 (372), p.1; 1867-68 (4), p.21.
BCL, BBG, GP/B/2/1/5, 14 August 1845; GP/B/2/1/6, 24 April 1849.
BCL, House Committee (hereafter HC), GP/B/2/3/1/1, 9 August 1842.
BPP, 1867-68 (4), pp.45-46.
WALS, MJ, WOL/PU/U/2, 16 April 1842.
‘bad legs’, ‘paralysis’, itch and venereal disease.112 Nevertheless, inmates with illness or disability could still be classified as able-bodied. This happened to a 35-year-old man in Birmingham workhouse who was suffering with difficulty in breathing and who subsequently died from cardiac failure.113 In Wolverhampton, only a few of the able-bodied men were considered fit to do a ‘fair day’s work’ in the mid-1860s and the situation was no different in the early years of the twentieth century.114 Medical Activity in Birmingham and Wolverhampton The medical function of the workhouse remains undefined and how the medical space within it was used is lacking in evidence.115 Birmingham guardians in 1818 gave the six visiting surgeons to the workhouse infirmary the authority to admit patients in emergency situations without an order from the guardians or relieving officers.
Furthermore, patients could only be discharged with the permission of the surgeons.
These powers continued after the NPL, until new regulations came into force in
1845.116 From 1818, the guardians required the surgeons to provide a quarterly report of activity in the infirmary. Table 2.1 gives details for the years between 1834 and the time of the new regulations. Admissions varied markedly throughout the period with a small increase towards the end, but the number of patients remaining in the infirmary rose steadily. Discharges of patients ‘relieved’ or cured varied between BPP, 1867-68 (4), p.153.
BCL, Workhouse Management Committee (hereafter WMC), GP/B/2/3/2/2, 28 February 1896.
Anonymous, ‘The Lancet Sanitary Commission for Investigating the State of the Infirmaries of Workhouses. Country Workhouse Infirmaries. No. IV. Wolverhampton Workhouse, Staffordshire’, The Lancet, ii (1867), p.555; WALS, WJ, LS/LO7/79, p.lvi.
S. King, ‘Poverty, Medicine and the Workhouse in the Eighteenth and Nineteenth Centuries’, in J.
Reinarz and L. Schwarz (eds), Medicine and the Workhouse, Rochester, 2013, p.232.
BCL, BBG, GP/B/2/1/2, 2 June 1818; TNA, MH12/13287, 28 December 1842.
41% and 48%, although it was usually just over 50% in the mid-1840s, while deaths remained between 10% and 14%. After 1840, between half and three-quarters of patients discharged were described as cured, rather than relieved. On average, there Table 2.1: Admissions, Discharges and Deaths in Birmingham Workhouse Infirmary for Selected Periods, 1835-47117
were around 18 admissions per week and about 125 patients in the infirmary each day in the late 1830s and 160 in the early 1840s. They were under the care of a house The percentages in the discharges and deaths columns are proportions discharged or died of the total of patients in the infirmary at the beginning of the quarter and the number of admissions. The majority of transfers were to an asylum.
surgeon and six visiting surgeons, who also attended sick paupers in the dispensary and at home. Sick inmates represented between 26% and 50% of all those in the workhouse, averaging around a third of the workhouse population.118 In the 1840s, the infirmary provided a similar number of medical beds as the General Hospital, although it admitted a third fewer patients, and had more beds than the Queen’s Hospital.119 As a result, the wards in the infirmary were extremely overcrowded and described as ‘offensive and disagreeable’, with the floors covered with extra beds.
For instance, the ward for ‘women with loathsome disease’ contained 17 patients, but only 14 beds.120 When plans for the new workhouse and infirmary were being made in March 1849, there were 160 patients with physical illness, plus 95 who were insane, in the old workhouse infirmary.121 Although the number of patients treated in the infirmary in Table 2.1 suggests a steady increase, there was a decline in the early 1850s, before numbers rose again in the middle of the decade (Table 2.2). In the new infirmary in 1855, the daily average number of patients had increased to 318, compared with the weekly average of 122 for the Queen’s Hospital in 1857-58 and a daily average of 204 for the General Hospital in 1860-61.122 However, the greater patient turnover in the voluntary hospitals ensured that they treated a greater number
contribution was significant in facilitating the hospitals’ level of activity by accepting patients from them who required a longer in-patient stay.