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Of this latter group, 80 (29%) were in the infirm wards or in the infirmary; of the 450 inmates aged between 65 and 70 years, 130 (29%) were also in these wards. There was a greater preponderance of men, namely 57% of those aged above 60 years and 64% of over 70-year-olds.226 In the new workhouse in 1903, wards for partially ablebodied and older adults could accommodate 440 inmates (66% of the accommodation for non-sick inmates). The infirmary had 280 beds for surgical, medical and chronic cases out of a total of 502.227 However, the ‘mental and epileptic wards’ contained sick and bedridden patients, who were to receive similar diets the equivalent to patients in the infirmary.228 In 1912, Mr L. W. Riley successfully applied for the admission of his ‘paralysed wife’ to the infirmary, contributing 10s and 6d to her keep.229 The guardians obviously considered her admission appropriate, at a time when such patients were thought inappropriate in Birmingham infirmary. There is no further information on patients with chronic disease in the new workhouse and Wolverhampton workhouse appears typical of most poor law institutions, by not facilitating identification of this particular group of inmates. With no separation between infirmary and workhouse, the institution developed into a single general hospital.

WALS, WBG, PU/WOL/A/25, 25 January 1895.

TNA, MH12/11715, 8 July 1898; the most likely diagnosis in this case was tuberculosis.

Ibid., WALS, WBG, PU/WOL/A/28, 9 February 1900.

WALS, WJ, LS/L07/79, p.liv.

WALS, Special Committees, PU/WOL/P/1, 2 April 1906.

WALS, HC, PU/WOL/E/4, 25 April 1912.

Acute Medical Care Where a geographically separate infirmary was established, two distinct institutions evolved in the early twentieth century. Brian Abel-Smith has made the point that in urban areas, patients were divided into those with acute illness, who went to the infirmary, and the chronic sick, who went to the workhouse.230 By the early twentieth century, Birmingham infirmary had adopted the role of a general hospital, becoming the institution for acute medical care. It began accepting patients involved in accidents and this work increased during the first decade of the twentieth century (Table 2.12).231 Of the 480 cases admitted in 1910, 295 were discharged on the same day and 184 detained as inpatients. The accidents had occurred at home, at work or in the street in 359 cases, while the police had brought in the remaining patients.232 In 1907, Henry Manton, a Birmingham guardian, described it as a ‘casualty hospital’, as it could not refuse to admit those who had suffered accidents, given its position in the centre of the city and surrounded by factories.233 Three quarters of admissions were admitted directly to the infirmary, rather than via the workhouse, and many were not paupers. Manton cited the example of a lady who sustained an accident while riding

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financial contribution for her care.234 Although many patients were admitted with acute conditions, such as pneumonia, typhoid and rheumatic heart disease, Otto Kauffman, visiting physician, admitted that the majority of patients had chronic Abel-Smith, p.209.

BCL, Infirmary Management Committee (hereafter IMC), GP/B/2/4/4/5, 8 April 1907; Hearn, p.24.

BCL, IMC, GP/B/2/4/4/6, 9 January 1911.

BPP, 1909 [Cd. 4835], p.342.


conditions, particularly tuberculosis.235 The medical superintendent’s scheme to transfer patients with long-term conditions to the workhouse after an initial stay in the infirmary was designed to emphasise the infirmary’s role as an acute-care facility.236 By giving preference to acute illness and excluding older and disabled patients, he attempted to emulate the policies of the voluntary hospitals.

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

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Source: BCL, Infirmary Management Committee, GP/B/2/4/4/5, 24 January1910;

GP/B/2/4/4/6, 9 January 1911.

However, those involved in accidents had been brought directly to the workhouse before the early twentieth century. For instance, among inmates involved in accidents admitted to Leicester workhouse in 1873 were one with a fracture of the thigh, one with fractured ribs, four with fractures of the arm.237 In the 1840s, Thomas Wilshaw was brought to Wolverhampton workhouse having fallen from the shafts of a van that had then passed over his body. Although the MO was in immediate attendance, he died in less than an hour after arrival.238 A week later, another man was brought after being run over by a vehicle and received attention from the MO.239 A few years

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Roberts was admitted in 1855 after having cut his throat, which was sutured and Ibid., p.773; see chapter 3 for further discussion of tuberculosis, which was a common condition in workhouse infirmaries.

Hearn, p.35.

A. Negrine, ‘Practitioners and Paupers’, in J. Reinarz and L. Schwarz (eds), Medicine and the Workhouse, Rochester, 2013, pp.202-3.

WALS, MJ, PU/WOL/U/2, 16 August 1845.


WALS, WBG, PU/WOL/A/4, 14 October 1842.

bandaged by the MO.241 Paupers also suffered injuries, both accidental and deliberate, while resident in the workhouse. In Wolverhampton workhouse, Thomas James Lovatt was scalded while taking a bath and died two days later from ‘shock’, while Martha Forrester, aged 84 years, fell on the old women’s ward, fracturing her thigh.242 A similar occurrence happened in Birmingham workhouse to an old man, Edward Heap, who was pushed over and dislocated his hip, while 84-year-old, James Potter, was injured by a tile falling from the roof of the aged men’s ward.243 In 1886, 68-year old William Peters managed to obtain a knife, with which he deliberately cut his abdomen.244 This is one example of patients admitted with mental illness being prone to attempted suicide and self harm.

There is scant information on the impact of medical treatment in workhouses on the lives of nineteenth-century paupers.245 In 1895, Wolverhampton guardians received a letter from a resident at Blakenhall expressing his ‘sincere thanks’ for their kindness in supporting him and his family, presumably with intermittent outdoor relief, during the five years in which he had been unable to work. He had kept at work as much as he could, but had recently been admitted to the infirmary so ill that he ‘thought to die’. However, he was discharged ‘completely cured’ after a few weeks and has been able to resume work to support his family.246 Eighteen years later, the guardians received letters of appreciation for the kindness shown by staff to two patients, one of whom had died.247 An expression of his appreciation was received by Birmingham guardians in 1884 from F. Broderson for the ‘extreme kindness’ with which he was TNA, MH12/11682, 2 February 1855.

WALS, WBG, PU/WOL/A/25, 13 March 1896; HC, PU/WOL/E/1, 13 December 1902.

BCL, WMC, GP/B/2/3/2/1, 15 June 1884; GP/B/2/3/2/5, 17 September 1908.

BCL, Incident Book, GP/B (ACC2009/109), box 15, 4 February 1886.

King, pp.234-35.

WALS, WC, 22 May 1895.

WALS, WBG, PU/WOL/A/36, 21 November, 5 December 1913.

treated, especially by the lady supervising the epileptic ward, where he had been a patient.248 Early in the twentieth century, Henry Yarwood also expressed his gratitude to the infirmary staff in Birmingham, who had ‘pulled me through my long and dangerous illness’. He had spent 16 weeks in Birmingham infirmary in 1902 receiving treatment for Bright’s disease, in what would have been an acute episode of a long-term renal disease. However, he had recovered sufficiently to return to playing his ‘organette’ and offered to do so without charge in the workhouse on Christmas day.249 Summary Sick paupers were not identified as a distinct group within the poor law system before 1910 and not separated out in official statistics until 1913. Before that time, those who were temporarily disabled were counted within the able-bodied class, while the chronic sick were included among non-able-bodied paupers.250 Thus, information regarding acutely ill inmates can only be gleaned from local studies, such as the present one. Significant medical activity took place in Birmingham workhouse’s Town Infirmary prior to the NPL and in the years immediately following it. The surgeons had the right to admit patients without seeking the guardians’ permission and were able to discharge almost half of those admitted, despite the guardians’

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discharge would only be possible if the patient could be maintained at home through BCL, VGPC, GP/B/2/8/1/9, 26 September 1884.

BCL, WIMC, GP/B/2/4/4/4, 15 December 1902; Bright’s disease is a group of diseases characterised by inflammation of the kidneys and oedema of the lower body.

Williams, p.203.

resumed employment or a measure of outdoor relief. Although the proportion of sick inmates in Wolverhampton workhouse was half that in Birmingham in the early years after the NPL, patients with a range of acute conditions were treated and the

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workhouse experienced a much higher proportion of sick inmates than the national average for the whole of the period studied, reaching over half by the mid-1880s and before the new infirmary was opened. By comparison, Wolverhampton workhouse’s proportion was more often similar to the country as a whole. One explanation could be the greater density of population in Birmingham as the towns were similar in respect of general health and cleanliness. Alternatively, it may have resulted from Birmingham’s longer tradition of providing institutional poor law medical services and a more active medical profession in the town.251 The workhouse also provided care for those suffering from chronic illness and disability. The relative neglect of those in the bedridden wards in the guardians’ records needs to be seen in the context of the medical model of disability prevalent in the nineteenth century. Furthermore, the special health needs of older and disabled patients remained unrecognised until the early twentieth century and chronic diseases did not arouse the interest of the medical profession, nor did it improve the profile of the infirmary to the same degree as acute illness.252 Deborah Stone has suggested that interesting insights into the measurement of disability can be gained from study of English welfare policy and that disability as an administrative category arose from the classification system of the NPL. She asserted that the ‘sick, aged and infirm’ classes Chapters 1 and 4 provide further evidence of medical activity in Birmingham.

Edwards, pp.230, 238; A. Levene, ‘Between Less Eligibility and the NHS: The Changing Place of Poor Law Hospitals in England and Wales, 1929-39’, Twentieth Century British History, 20 (2009), pp.


are part of today’s concept of disability.253 WMOs were responsible for the assessment and allocation within the classification system and for determining inmates’ ability to work. Poor law medical practice explains how the concept of disability became associated with clinical medicine and medical practitioners became ‘gatekeepers for disability verification’ in the twentieth century.254 Although the number of patients categorised as suitable for the bedridden wards in Birmingham increased considerably and extra accommodation was needed, their increase was in proportion to that of all types of inmate admitted to the workhouse.

Their misplacement into other wards of the house was primarily driven by their number outstripping the available accommodation and there was no evidence that they were given lower priority in this respect than other groups of inmates. They were subject to a range of disability levels and suffered from the same chronic conditions as older patients in long-term institutional care today. What the records do not reveal is the nature of the medical care they received. They did make considerable demands on the MOs’ time, but the level of nursing staff and pauper assistants allocated to the bedridden wards was of the same proportion as the other wards in the infirmary.255 Less information is available relating to disabled inmates in Wolverhampton workhouse, but examination of the local records revealed that a substantial proportion of sick inmates were dependent. Surprisingly, many within the able-bodied class were considered unfit for work. However, using age as a surrogate for disability, the increasing number of dependent inmates reflected the rise in the admission of all D. Stone, The Disabled State, Philadelphia, 1984, pp.29-30, 51.

S. Sneyder and D. Mitchell, ‘Afterword - regulated bodies: disabled studies and the controlling profession’, in Turner and Stagg (eds), Social Histories of Disability and Deformity, p.182; Turner, ‘Introduction’, p.8; Stone, p.28.

BCL, Workhouse Inquiry Sub-committee, GP/B/2/3/11/1, 22 March 1878; VGPC, GP/B/2/8/1/5, 23 March 1866.

classes of pauper. David Thomson argued that the workhouse did not play an important role in the care of older people in the mid-nineteenth century because ‘the aged formed a minor portion of any workhouse population’ and played only a minor part in the actual day-to-day provision for an older population.256 Nigel Goose has challenged this assertion as ‘simply not acceptable’ because of the findings in his study of workhouse populations in Hertfordshire.257 The proportion of older inmates in Wolverhampton workhouse in mid-century (usually around a third) would also contradict Thomson’s opinion.258 This chapter has filled a gap in the narrative by considering the period at which state-organised and publicly funded institutional care for sick older paupers with chronic illness and disability commenced and explains why its status in the eyes of the providers remained low.

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