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«MEDICAL CARE IN THE WORKHOUSES IN BIRMINGHAM AND WOLVERHAMPTON, 1834-1914 by ALISTAIR EDWARD SUTHERLAND RITCH A thesis submitted to the University of ...»

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years would be given that designation as a diagnosis.153 The Report of the Royal Commission on the Aged Poor (1895) confirmed that the majority of older inmates in the late 1800s suffered chronic infirmity.154 As older people form the majority within the disabled population, Anne Borsay has maintained that old age is an easily measured parameter of disability.155 The proportion of older paupers among adult inmates in Birmingham workhouse steadily increased between 1841 and 1911, when it more than doubled, but with a more marked rise in 1871 (Tables 2.9 and 2.10).156 Apart from a decrease of 12% in 1851, the proportion in Wolverhampton workhouse remained at the same level from 1851 until 1891, when it had increased to a similar level as Birmingham. However, age alone cannot predict precisely how many inmates were disabled. For instance, on one day in September 1903, 81% of inmates aged 60 years and over in Wolverhampton workhouse were unable to ‘take care of themselves’ due to physical or mental illness, in the opinion of the medical officer, compared with 42% in Birmingham and the national average of 61%. The difference between the two workhouses was due to all inmates aged 75 years and over in Wolverhampton needing care. Only 51% in Birmingham were dependent, with onethird more women unable to care for themselves than men.157 Few workhouses had dedicated wards for more dependent inmates; only three in London did in 1866, but only Lambeth provided them for both men and women.

Smith was critical of the practice of ‘congregating the bedridden together’, as at Ibid., pp.2-3, 63.

BPP, 1895 [C.7684], p.xxxvi.

Borsay, Disability and Social Policy, p.8.

Further detail on older inmates in Birmingham workhouse can be found in A. E. S. Ritch, ‘“Sick, Aged and Infirm’’ Adults in the New Birmingham Workhouse, 1852–1912’ (unpublished MPhil dissertation, University of Birmingham, 2010), pp.60-83.

BPP, 1904 (113), pp.iii, iv, 127, 132.

Table 2.9: Birmingham Workhouse Population by Age Group, 1851-1911158

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1851 178 135 80 107 63 58 11 5 637 22% 42% 49% 21% 13% 17% 10% 9% 2% 1% 1861 244 225 262 357 260 134 7 4 1,493 27% 40% 16% 15% 18% 24% 17% 9% 0.5% 0.3% 1871 293 219 227 307 377 252 49 37 1,761 41% 57% 17% 12% 13% 17% 21% 16% 3% 2% 1881 180 126 457 506 635 330 68 39 2,341 46% 53% 8% 5% 20% 22% 27% 14% 3% 2% 1891 90 73 547 458 656 447 83 56 2,410 52% 55% 4% 3% 23% 19% 27% 19% 3% 2% 1901 87 119 585 440 747 545 76 104 2,703 54% 59% 3% 4% 22% 16% 28% 20% 3% 4% 1911 119 68 593 413 915 435 72 78 2,693 56% 60% 4% 3% 22% 15% 34% 16% 3% 3% Source: Census Enumerator’s Books, 1851-1911.

Lambeth, because of the detrimental effect on the sanitary arrangements.159 However, he did suggest that older inmates who were incontinent of urine should be placed in separate wards, classing them as ‘Offensive and Disagreeable’.160 In his report on 48 provincial workhouses, Smith indicated that Birmingham provided 159 beds in the bedridden wards, 31% of total beds. The only other union designating wards as ‘bedridden’ was Cheltenham, with 18 beds, or 23% of total capacity. Bath provided 114 beds (27%) for invalids and Manchester, Bridge Street Workhouse, 15 beds for ‘old helpless women’ and 91 for ‘helpless sick men’ (a total of 13%).

Numbers for 1851 include children in the Infant Poor Asylum, built to take children, as accommodation was not available in the old workhouse. They were transferred to the new workhouse in 1852.

BPP, 1866 (372), pp.37, 73, 106, 153.

BPP, 1867-68 (4), p.7.

Table 2.10: Wolverhampton Workhouse Population by Age Group, 1841-1911

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1851 66 58 100 95 62 32 10 5 428 25% 36% 20% 14% 23% 22% 14% 7% 2% 1% 1861 86 113 107 109 120 35 14 24 608 32% 47% 14% 19% 18% 18% 20% 6% 2% 4% 1871 119 86 114 150 167 56 15 9 716 35% 48% 17% 12% 16% 21% 23% 8% 2% 1% 1881 157 126 153 160 204 83 24 18 925 36% 51% 17% 14% 17% 17% 22% 9% 3% 2% 1891 17 15 197 179 273 113 17 12 823 50% 51% 2% 2% 24% 22% 33% 14% 2% 1% 1901 34 21 199 152 349 175 43 28 1,001 59% 63% 3% 2% 20% 15% 35% 17% 4% 3% 1911 51 37 221 180 312 107 34 19 961 49% 54% 5% 4% 23% 19% 32% 11% 4% 2% Source: Census Enumerator’s Books, 1851-1911.

Dependent patients might not always be placed with sick inmates. In York Street workhouse in Nottingham in 1841, three men suffering from paraplegia or spinal and hip disease were in the sick wards, while three with paralysis and one with spinal disease, plus four women with paralysis, were in wards in the workhouse.161 In Battle workhouse in 1873, half of the 189 inmates classed as ‘infirm or disabled’ were in the infirmary and the others in the main workhouse building.162 E. C. Bosworth, ‘Public Healthcare in Nottingham 1750-1911’ (unpublished PhD thesis, University of Nottingham, 1998), pp.215-16.

M. Railton and M. Barr, Battle Workhouse and Hospital, 1867-2005, Reading, 2005, p.49.

‘Bedridden Wards in Birmingham Workhouse’ As Birmingham had specific wards for those with disability, designated ‘bedridden wards’, identification of the more disabled section of ‘non-able-bodied’ adults is possible. However, detailed recording of the medical condition of these inmates did not take place, but their proportion and the levels and nature of their disabilities can be determined. The first reference to these wards was in a list of appointments in April 1842, when Mary Ann Raven was appointed as nurse in No. 9 ward, the women’s bedridden ward, at an annual salary of £8.163 The following year, she was transferred to the kitchen in an exchange with Fanny Giles.164 Dependent patients were also present in the women’s infirm ward, where many were in a ‘helpless and weak state’ and required as much attention during the night as in the daytime.165 The men’s bedridden ward did not have a designated nurse until 1848, with the appointment of Ann Brittain at a salary of £10 per annum. Two years’ later, Ann Edwards, who was then nurse on the women’s ward, was delegated to take charge of the men’s ward as well, since the nurse for that ward had left. The guardians recognised the need for the care of the bedridden, whom they considered ‘very helpless creatures’ requiring ‘a responsible person’ to assist them.166 Thereafter, one nurse was appointed for each ward. At that time, neither the guardians nor the MOs regarded those in the bedridden wards as sick. In their recommendation in 1849 as to the maximum number of inmates the workhouse could accommodate, they included bedridden inmates among those ‘in health’. They allocated 73 beds in the bedridden wards, making up 11% of total accommodation and 17% for those designated as BCL, HC, GP/B/2/3/1/1, 5 April 1842.





Ibid., 16 May 1843.

Ibid., 7 June 1842.

BCL, BBG, GP/B/2/1/7, 2 April 1850.

healthy paupers; in addition, there were 160 beds for ‘sick’ inmates and 95 for ‘lunatics’.167 Accommodation in the bedridden wards in Birmingham was insufficient in 1860, within eight years of the opening of the new workhouse, resulting in unoccupied children’s dormitories being used to accommodate these patients throughout the year.168 Overcrowding in the wards had more impact on male patients, with 36 in a ward meant to accommodate only 30.169 The situation had deteriorated to such an extent that, in May 1865, all 83 bedridden men were scattered throughout the workhouse with none of them in the appropriate ward. By contrast, all 63 bedridden women were in their designated ward, with seven beds vacant. Together, they constituted 31% of those classified as older inmates (Table 2.11).170 The following year, 141 (29%) of the 481 patients in the infirmary were described as bedridden.171 The 77 men were nursed by Edward Shubotham, who also had responsibility for the male convalescent ward and the ‘bad-leg and venereal ward’, resulting in an additional 58 patients under his care. He was assisted by 13 paupers. Jane Smith had charge of the female bedridden department, which incorporated the ‘bad-leg ward’ and was assisted by four inmates.172 The MO was satisfied with the quality of the nursing care, pointing out that only one woman in the bedridden wards was suffering from ‘bed-sores’ and these had been present on admission. The patient suffered from paralysis and had been provided with ‘water-cushions’.173 By the early 1870s, accommodation had been increased to 212 beds (98 for men and 114 for women), BCL, BBG, GP/B/2/1/6, 9 April 1849.

BCL, VGPC, GP/B/2/8/1/3, 27 January, 2 November 1860.

BCL, VGPC, GP/B/2/8/1/3, 14 June 1861.

BCL, VGPC, GP/B/2/8/1/4, 22 May 1865.

Ibid., GP/B/2/8/1/5, 23 March 1866; BPP, 1867-68 (4), pp.45-46.

BCL, VGPC, 2/8/1/5, 23 March 1866; BPP, 1867-68 (4), pp.46, 50.

BPP, 1867-68 (4), p.48.

which were only 87% occupied, so that the bedridden patients made up 17% of all those in the infirmary and 31% of older inmates.174 The number of women (109) in the bedridden wards in 1873 showed an increase of 70% over that in 1866. An even greater increase of 100% of ‘chronic, permanent and bedridden female cases’ took place in Leicester workhouse between 1866 and 1872.175 However, severely disabled Table 2.11: Number of Patients in the Bedridden Wards in Birmingham Workhouse, 1865-1911

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Sources: BCL, VGPC, GP/B/2/8/1/4, 22 May 1865; GP/B/2/8/1/5, 23 March 1866;

HSC, GP/B/2/3/3/3, 3 June 1873; VGPC, GP/B/2/8/1/9, 14 August 1885; HSC, GP/B/2/3/3/13, 8 December 1891; WMC, BP/B/2/3/6, 16 June 1911.

patients were to be found in other departments and not included in the bedridden numbers; for instance, the Commissioner in Lunacy had noted that 13 men in the wards for epileptics and lunatics were bedfast and, on another visit, 20 inmates in the same department were confined to bed.176 BCL, House Sub-committee (hereafter HSC), GP/B/2/3/3/3, 3 June 1873.

A. Negrine, ‘Medicine and Poverty: A Study of the Poor Law Medical Services of the Leicester Union 1876-1914’, (unpublished PhD thesis, University of Leicester, 2008), p.127.

Ibid., GP/B/2/3/3/2, 25 October 1870; LGB Letters, GP/B/1/2/1/1, 18 February 1871.

In 1885, the guardians gave consideration to the number of beds that would be required in the proposed new infirmary and to those sick inmates who would need to be transferred there from the workhouse. They suggested that the 288 patients in the bedridden wards should remain in the house, as they required mainly nursing care and were not ‘classed under the head[ing] of sick’.177 The MO disagreed, assessing half the patients as requiring acute care and 144 beds were allocated for them in the infirmary. The guardians later decided that those patients who never or only occasionally required medication should be retained within the wards in the workhouse.178 The 288 bedridden patients constituted 21% of the 1,353 inmates in the sick wards, but after the acute cases had been transferred to the infirmary, their number within the workhouse decreased to 126 in 1891.179 They remained at this level into the twentieth century, but with a preponderance of female patients; for instance in 1911, there were 103 women but only 30 men.180 Until this time, there had been generally similar numbers of bedridden patients of each sex, in contrast to the much greater number of men in the ‘aged’ inmates’ wards. The female bedridden department was divided into four wards, each with one nurse in charge, although the wards varied in size between 10 and 38 beds.181 Three years later, similar proportions (35 men and 112 women) continued to occupy the bedridden wards, the majority of whom were older adults. However, there were also 84 men in the male chronic ward in the workhouse, plus 61 patients of unrecorded gender in the convalescent ward.

Most of the patients in these two wards were ‘crippled’ or suffering from cardiac or respiratory disease.182 BCL, VGPC, GP/B/2/8/1/9, 14 August 1885.

BCL, BBG, GP/B/2/1/57, 19 June 1888.

BCL, VGPC, GP/B/2/8/1/9, 14 August 1885; HSC, GP/B/2/3/3/13, 8 December 1891.

BCL, WMC, GP/B/2/3/2/6, 16 June 1911.

Ibid.

BCL, Birmingham Union Board Minutes (hereafter BUB), GP/B/2/1/83, 23 September 1914.

Disabled patients were usually included in those described as infirm, making it difficult to identify the extent of their disability.183 Although designated as ‘bedridden wards’, these wards were occupied by patients exhibiting varying degrees of dependence. In 1866, one third were reported as able to ‘leave their beds and their rooms’.184 No further information is available until the 1890s, when it was recorded that some of the 126 bedridden patients (60 men and 66 women) were able to do light work in the workhouse and four did knitting and sewing and one inmate in the male department was occupied in carving frames. The reasons for the 127 inmates who were too disabled to do the ‘work of the house’, were age in 65 men and 22 women, blindness in 16 men and 4 women, and infirmity in 6 men and 14 women.185 The census of April that year recorded 11 men and five women as blind among the 1,184 inmates in the workhouse. Three of the men were aged in their forties or fifties and another three men and two women were over 70 years of age.186 Blindness was a common cause of admission to the workhouse. For instance, in a study of residents of Herefordshire suffering from disability in 1851, Christine Jones found that the majority of those who were blind were receiving either indoor or outdoor relief. Ten years later, only 32% of blind adults were in work.187 In 1873, there were nine women in the ‘Blind Womens Room’ in Birmingham, although only eight beds were provided.188 In 1907, Miss Stannier was in charge of 36 patients in one of the bedridden wards with 36 patients under her care and Miss Rigby in another with 48 patients. The Negrine, p.134.

BPP, 1867-68 (4), p.45.

BCL, HSC, GP/B/2/3/3/13, 8 December 1891.

Census Enumerator’s Books (hereafter CEB), 1891.

C. Jones, ‘Disability in Herefordshire, 1851-1911’, Local Population Studies, 87 (2011), pp.34, 39.

BCL, HSC, GP/B/2/3/3/4, 25 November 1873.



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