«MEDICAL CARE IN THE WORKHOUSES IN BIRMINGHAM AND WOLVERHAMPTON, 1834-1914 by ALISTAIR EDWARD SUTHERLAND RITCH A thesis submitted to the University of ...»
BCL, BBG, GP/B/2/1/3-5.
Griffiths, pp.165, 233, 293.
BCL, BBG, GP/B/2/1/5, 8 March 1847; ‘loathsome’ disease or disorder was a term often applied to leg ulceration: I. S. L Loudon, ‘Leg ulcers in the eighteenth and early nineteenth centuries’, Journal of the Royal College of General Practitioners, 31 (1981), p.264.
BCL, BBG, GP/B/2/1/6, 2 January, 9 April 1849.
BCL, BBG, GP/B/2/1/15, 28 February 1855; Griffiths, pp.173, 233-34.
A few years after Wolverhampton workhouse opened in 1839, medical admissions began to increase significantly. In March 1842, 36-year-old Thomas Haney was admitted because of a bowel disorder and, one month later, William Watts, a miner aged 28, with fever. Watts required re-admission early the following year because of Table 2.2: Medical Relief in Birmingham Workhouse for Selected Weeks, 1851
The transfer of inmates to the new workhouse took place in March 1852.
Table 2.4: Inmates and Patients in Wolverhampton Workhouse, on Selected Days, 1842-45
debility, which rendered him unable to work. Samuel Highland had been incapacitated due to a fractured leg for three months before he entered the workhouse in October 1842.124 Subsequent admissions over the following 18 months included Mary Sutherland, aged 40; Anne Langford, aged 35; and Mary Blunt, aged 55, all for debility; John Wittle, a miner aged 41, for ‘disease of the head’ from fever; Elizabeth Davies, aged 33, with dropsy; another Elizabeth Davies, aged 45, after suffering lung disease for two months; and Ann Smallwood, aged 54, with a three-week history of asthma.125 At this time, there was on average 52 patients in the infirmary wards, although a gradual increase of 12% took place between 1842 and 1845 (Table 2.4).
As a proportion of all inmates, those who were sick increased by 4% over this period, with roughly an equal number of men and women. When patients in the infectious and insane wards are included, the proportion increased markedly between 1842 and
guardians were concerned about the rapidity of the increase in the number of sick paupers, but concluded that ‘Not a remedy or a comfort ought to be withheld; the sick and the infirm, the destitute infant and the helpless aged, are our charge’.127 The proportion of sick inmates remained around the one-third level throughout the next three decades, similar to that of Birmingham workhouse, with 588 sick out of a total of 1,781 inmates in 1863.128 Including those certified as insane in Wolverhampton in the early 1870s, this increased the share of all sick inmates to around half of the workhouse population.129 Sixty-five inmates died in the workhouse in 1840, giving a mortality rate of approximately 16%, based on the average number WALS, WBG, PU/WOL/A/3, 24 March, 1 April 1842; PU/WOL/A/4, 28 October 1842, 6 January 1843.
WALS, WBG, PU/WOL/A/4, 27 January, 17 February, 5 May, 16 June, 14 July, 29 September 1843, 29 March 1844.
WALS, WC, 2 December 1846.
Ibid; this quote appears in an abbreviated form in the heading of the chapter.
WALS, WC, 14 August 1867; BCL, BBG, GP/B/2/1/30, 11 November 1863.
Ibid., 20 November 1872.
of inmates in the year ending in March 1841 of 405. The majority of deaths took place in the age group 16 to 59 years (45%), with only 31% in those aged 60 years and above. For the 44 inmates for whom a cause of death was recorded, 13 were due to debility; five to tuberculosis; four adults to venereal disease, plus Maria Lee aged 5 Table 2.5: Sick and Total Number of Inmates in Wolverhampton Workhouse for the Years 1841-46, 1857-66, 1870-72, and Number of Deaths in Years 1857-66130
1857-58 570 194 34% 118 21% 1858-59 529 121 23% 128 24% 1859-60 511 185 36% 146 27% 1863-64 575 215 37% 162 28% 1864-65 603 211 35% 169 28% 1865-66 620 220 35% 137 22%
weeks who caught venereal disease from her mother; three to liver disease; and only Samuel Lester from fever.131 Wolverhampton’s death rate increased to between 21% and 28% of admissions in the late 1850s and early 1860s, and was similar to that in Birmingham workhouse in the first half of the 1850s, namely between 18% and 28% in the first four months of each year (Tables 2.4, 2.6). The major cause of death in Birmingham was chronic lung disease, such as asthma and consumption. Most of the The numbers for 1841-46 are the total admitted to the workhouse in each year, ending at Michaelmas; for 1857-66 and 1870-74, they are the average for the year.
TNA, MH12/11675, 2 June 1841; BPP, 1843 (144), p.9.
deaths occurred in old people, most likely because they were moving into the
Wolverhampton in 1891, where 65% of workhouse deaths involved those of 65 years and over, but only 26% of deaths in the Borough were in that age group.
Furthermore, the proportions of those dying between the ages of 25 and 59 years were similar (26% and 24% respectively).133 Table 2.6: Admissions of Sick Inmates and Deaths in Birmingham Workhouse for the Months of January to April Inclusive, 1850-54
The proportion of sick inmates increased to around 40% by the mid-1870s in both workhouses, with that in Wolverhampton declining by half in the 1890s (Table 2.7).
In Birmingham, those who were ill reached as high as 60% of all inmates between 1885 and 1890. The explanation for this provided by a LGB Inspector was a significant increase in sick poor in large towns and it prompted the guardians to approve plans for a new infirmary managed separately from the workhouse.134 The large share of sick inmates remained after the new infirmary opened in 1899, but the subsequent decrease six years later remains unexplained. One difficulty in making comparisons arises from the varying definitions used to determine sick inmates. The BCL, BBG, GP/B/2/1/12, 23 March 1853.
TNA, MH12/11711, Medical Officer of Health’s annual report for 1891.
BCL, VGPC, GP/B/2/8/1/9, 14 August 1885.
majority of the numbers in Table 2.7 are based on inmates on the medical officer’s (hereafter MO) relief books. However, in 1890 and 1896 for both workhouses and in 1885 for Birmingham, they relate to inmates in the ‘wards for the sick’.
Birmingham’s number of sick inmates in 1896 is calculated from all those in the infirmary plus those in the workhouse who were ‘temporarily disabled’.135 A return in December 1869 gives details of the diseases suffered by sick inmates in the workhouses of England and Wales, with one diagnosis per inmate. Acute medical illnesses accounted for 32% of patients in Wolverhampton, 21% in Birmingham and 17% nationally; acute surgical conditions were less common, with only 8%; 0.4% and 6% respectively. Acute infectious disease accounted for less than 10% in both towns and the country as a whole, while old age was given the most frequent ‘diagnosis’, in around one fifth of patients. The most frequent causes of illness in Birmingham were bronchitis and emphysema (8%), rheumatism (7%), and paralysis (7%), all of which matched the national proportions. This is surprising as the workers in the brass trade, the major industry in Birmingham, experienced high levels of respiratory distress.136 Epilepsy was also a common diagnosis (9%), but in Wolverhampton, it was recorded in 43% of patients. The very high number of epileptic patients (121) is at variance with other figures recorded in the guardians’ minutes, although there is no record for this same year. Nevertheless, it is obvious that the large number of epileptics in the parliamentary paper is either a clerical error or an incorrect diagnosis on the part of the medical officer, since the national figure for epilepsy is only 3%. Ulcers of legs, or other sites on the body, were also more frequent in Wolverhampton at 11%, compared with 55 in Birmingham and 6% nationally.137 Leg ulcers were also one of BCL, LGB Returns, GP/B/5/1/2, 6 June 1896.
See Chapter 1 for details of the industry and its associated diseases.
BPP, 1870 (468-I), pp.2-3, 18-21, 54-63, 83, 87, 112-13, 116-17, 146-47, 172-73, 176-77, 202-3, 206-7, 232-33, 236-37.
Table 2.7: Sick and Total Inmates in Birmingham, Wolverhampton and all England and Wales Workhouses, 1867-96138
Source: BPP, 1867-88 (445), pp.4, 58; 1870 (468I), pp.2-3, 19, 21; 1877 (260), pp.4, 10-11; 1890-91 (365), pp.1-18; 1892 (292), pp.4, 16; 1896 (371), pp.4, 26; 1896 (64B.I), pp.4, 30; BCL, HSC, GP/B/2/3/3/6, 22 January 1878; VGPC, GP/B/2/8/1/9, 14 August 1885; LGB Returns, GP/B/5/1/2, 6 June 1896; WALS, Wolverhampton Chronicle, 29 December 1875, 4 April 1888; WBG, PU/WOL/A/22, 6 April 1888;
the commonest afflictions affecting patients in voluntary hospitals in the eighteenth century, for example 22% of inpatients in Birmingham General Hospital in the 1780s and 1790s and between 40% and 50% of surgical admissions in several voluntary hospitals in the early years of the nineteenth century.139 Surprisingly, almost half of sufferers were under the age of 30 years.140 Leg ulcers were one of the main reasons for inmates spending more than five years in workhouses in July 1861, accounting for11% of those given a specific diagnosis for ‘Bodily Disease’, only 3% less than for rheumatism, although there were no such patients in either Wolverhampton or Birmingham at that time.141 However, in January 1861, Thomas Ferris applied to Birmingham guardians to have his leg amputated because of an ‘enormous’ leg ulcer, The data for England and Wales for 1867 excludes Metropolitan Unions, but they are included thereafter.
J. Reinarz, Health Care in Birmingham, Woodbridge, 2009, p.18; Loudon, p.264.
BPP, 1861 (490), pp.ii, 168-69, 194-95.
which had been present for 25 years. The guardians deferred making a decision for one month, but the eventual outcome is not recorded.142 At the turn of the century in Wolverhampton workhouse, the proportion of those under the care of the MO, with the exclusion of ‘imbeciles and epileptics’, was only 23% (Table 2.8), although 3,257 patients had been attended in 1899.143 However, in August 1903, the month before the new workhouse opened, only nine men and eight women were both able-bodied and in health out of a total of 880 adult inmates. Of these, 230 were in the infirmary undergoing medical treatment, plus ‘40 were imbeciles’ and 50 epileptics.144 After the move to the new workhouse, the medical workload remained much as before, a similar number to the 2,496 patients admitted to Wolverhampton and Staffordshire General Hospital in the year 1902-3.145 In Birmingham, the proportion of those under medical care continued between 40% and 50% of inmates, although it was difficult to calculate precisely. Returns to the central authority were divided into those in the infirmary and those in the workhouse (Table 2.8). Infirmary inmates represent those with more acute illness, but those with chronic disease in the workhouse have been estimated from the ‘able-bodied temporarily disabled’ group. However, this would exclude non-able-bodied adults under the MO’s care and they will be now considered.
BCL, VGPC, GP/B/2/8/1/3, 11 January 1861.
WALS, WBG, PU/WOL/A/28, 2 February, 16 March 1900.
WALS, WJ, LS/LO7/79, p.lvi.
Ibid., p.80; WALS, WBG, PU/WOL/A/32, 9 February 1906.
Table 2.8: Sick and Healthy Inmates in Birmingham and Wolverhampton Workhouses on Selected Day, 1899-1900146
Source: BCL, LGB Returns, GP/B/5/1/4, 30 December 1899; WALS, WBG, PU/WOL/A/28, 9 February 1900.
Chronic Disability Inmates with more severe levels of disability formed a majority within the sick workhouse population and this section will concentrate on this important, but previously neglected, group. For instance, Edward Smith, MO to the PLB, noted that, among those in workhouse infirmaries classed as sick ‘in the hospital acceptation of Age breakdown is not available for children in Wolverhampton workhouse and those under the medical officer’s care exclude ‘imbeciles and epileptics’. The Birmingham returns do not differentiate between health and sickness for non-able-bodied inmates in the workhouse.
the term’, the majority suffered from diseases ‘of a chronic character, mainly chest complaints and debility’.147 One example was Manchester workhouse, which had become overcrowded in 1850 because of so many inmates with chronic disease that the guardians erected a new building to accommodate the able-bodied.148 A survey of workhouses in England and Wales in 1869 confirmed this pattern as 77% of inmates on the MOs’ books were assessed as having a chronic disorder.149 Birmingham and Wolverhampton were just below the national average (71% and 68% respectively), but, it could be much higher in some workhouses; for example, 96% in Bath Union Workhouse, where Smith reported the MO’s cases as ‘totally unlike those at a general hospital’.150 Among those diagnosed as having a surgical disease, chronic conditions were more common than acute illness, averaging 63% of all surgical cases in England and Wales and 50% in Birmingham.151 This situation persisted into the next two decades, as can be seen from the description of a female surgical ward in Birmingham
workhouse in 1885:
The female surgical ward is another big ward. Here 69 beds, closely arranged side by side, hold their suffering occupants, most of them old and decrepit. It is impossible to enter these long wards and see, amongst the old and infirm, younger women suffering from some affliction requiring medical and surgical treatment…without pitying their condition.152
Nationally, 43% of sick inmates in the survey were aged 60 years and over and 21%
of them had ‘old age’ recorded as the main disease, assuming that no-one under 60 BPP, 1867-68 (4), p.5.
BPP, 1870 (468-I), pp.2-3, 63.
Ibid., pp.2-3, 17, 21, 23; 1867-68 (4), p.35.
BPP, 1870 (468-I), pp.2-3, 21, 23; Wolverhampton workhouse contained only one surgical patient, diagnosed with an acute condition.
Birmingham Daily Mail, 5 August 1885.