«MEDICAL CARE IN THE WORKHOUSES IN BIRMINGHAM AND WOLVERHAMPTON, 1834-1914 by ALISTAIR EDWARD SUTHERLAND RITCH A thesis submitted to the University of ...»
London, following the Metropolitan Poor Act 1867 (hereafter MPA). The act set up the Metropolitan Asylum Board to manage isolation hospitals and lunatic asylums, rather than local boards of guardians, and provided centralised funding from the capital’s poor rates. This system of care for infectious diseases remained unique to London. Gwendoline Ayers’ major work is devoted to the general development of the board’s hospitals and asylums, but contains limited information on any one institution.28 Provincial English isolation hospitals have been neglected within historical accounts and the one substantial history concerns the institutions for fever patients in Edinburgh. However, in The Edinburgh City Hospital, James Gray puts the emphasis on the medical men who ran the institution.29 Workhouse histories contain only brief reference to isolation facilities. For instance, Margaret Railton and Marshall Barr devote only five pages to infectious diseases in their study of Battle workhouse and mention only occasional admissions, so that it is difficult to determine the workhouse’s impact on medical care.30 The history of tuberculosis has been the subject of a number of monographs, which testify to the role played by poor law infirmaries. However, they too are lacking in detail regarding the significance of the contribution by the infirmaries, both in terms of the extent of accommodation provided and the treatment regimes used.
Thirty years before the MPA, the MO of Wolverhampton Union workhouse called for a detached building to isolate inmates with infectious diseases, as he was apprehensive that typhus fever affecting a woman in the lying-in ward might rapidly G. M. Ayers, England’s First State Hospitals and the Metropolitan Asylums Board 1867-1930, London, 1971.
J. A. Gray, The Edinburgh City Hospital, East Linton, 1999.
Railton and Barr, pp. 96-98, 125-27.
spread throughout the workhouse.31 Although new fever wards were provided, they had become so overcrowded five years later, that beds had to be pushed together to allow three inmates to sleep in two beds. This followed a marked increase in the number of ‘fever patients’ admitted, for instance in the midsummer quarter in 1847, patients suffering from fever constituted 66% of the 593 patients admitted.32 A larger building accommodating between 40 and 50 patients with infectious disease was needed 20 years later.33 In 1847, the MOs in Birmingham workhouse were also calling for immediate separate provision for fever cases, because of overcrowding so that in some instances, two patients occupied the same bed. In the summer of that year, 130 patients were suffering from ‘contagious fever’ out of a total of 345, and the majority were Irish. The likely cause was typhus and one district surgeon, three nurses, seven pauper assistant nurses and the schoolmaster all died of the infection.34 As a result, the guardians purchased property adjacent to the workhouse to provide accommodation for 120 patients.35 In the early 1850s, patients diagnosed with ‘fever (mild)’ constituted from 10% and 30% of those admitted with infectious diseases.36 Detached buildings for the admission of patients with fever and infectious disease, separate from the main infirmary were included in the plans for the second Birmingham workhouse erected in 1852 (Appendix H).37 However, twelve years later, the workhouse medical officer (hereafter WMO) declared these wards inadequate ‘according to the advanced state of sanitary science’, as they were too Wolverhampton Archives and Local Studies (hereafter, WALS), Master’s Journal (hereafter MJ), PU/WOL/U2, 20 March 1842.
WALS, Wolverhampton Board of Guardians’ minutes (hereafter WBG), PU/WOL/A/6, 29 January 1847; Wolverhampton Chronicle (hereafter WC), 20 September 1847.
WALS, WBG, PU/WOL/A/12, 1 September 1864; DX/673/66.
BCL, BBG, GP/B/2/1/5, 8 March, 12 October, 28 October 1847.
BCL, BBG, GP/B/2/1/5, 20 April 1847.
The National Archives (hereafter TNA), MH12/13297-99, 13300.
J. A. Langford, Modern Birmingham and its Institutions, Birmingham 1871, pp.381-82.
workhouse in Wolverhampton opened in 1903, it also had two wards for 20 patients of each sex with infectious disease within the infirmary buildings, which were designed on the pavilion style (Appendix J). There was an additional ‘Isolation Hospital’ with two two-bedded wards, two nurses’ rooms and three single bedrooms (Appendix K).39 However, little information is available on the arrangements for infectious patients in the separate infirmary built on the site of Birmingham workhouse in 1889, although the ‘infectious wards’ were allocated a larger area per patient than the general wards.40 Childhood Infections Susceptibility to infectious diseases was accepted as an inevitable part of childhood in Victorian Britain and institutional care would rarely have been considered necessary for the management of the disease process. The infections that were responsible for most of childhood morbidity and death in nineteenth-century Britain were measles, whooping cough, scarlet fever and diphtheria. They were highly transmittable diseases, by personal contact with infected individuals or by airborne droplets, had high fatality rates and were common in crowded conditions, such as schools and workhouses. The most contagious was measles, a viral infection, which almost BCL, Visiting and General Purposes Committee (hereafter VGPC), GP/B/2/8/1/4, 17 June 1864;
GP/B/2/8/1/5, 22 May 1865; BPP, 1867-68 (4), facing p.46.
WALS, Wolverhampton Journal Illustrated, vol. II, LS/LO7/79, p.liv; New Wolverhampton Workhouse, DX/120/10/4; DX/120/10/8; DX/120/10/9.
BCL, B. Col. 41.11, Miscellaneous Documents, vol. 4, ‘Report in reference to the New Workhouse Infirmary’, p.18.
always produced clinical disease in those infected.41 Secondary bacterial infection was responsible for 80% of deaths and could result in long-term disability in those who survived.42 The mortality rate was highest in the first two years of life and remained unchanged throughout the century.43 Little action was taken to reduce the death rate until the 1880s, but even then, it was unaffected by preventive services. It was also highest in large towns, as the disease required a certain density of population
community also may have related to the degree of overcrowding and the level of malnutrition.45 Birmingham guardians were concerned that Bridget Hunt’s children, who had been admitted to the workhouse with their mother in 1856, were suffering from measles, despite being detected by the WMO prior to admission. They urged that ‘infectious cases’ should be managed on outdoor relief, no doubt fearful of rapid spread of the infection within the institution.46 However, an outbreak of measles occurred in the workhouse twenty years later, with 65 admissions within nine months. The Children’s Hospital also admitted 48 sufferers, as the Borough isolation hospital could not accept admissions.47 Thereafter, a small number of cases were usually present up to 1911, even though the majority of children had resided in Marston Green Cottage Homes from 1880 (Appendix A). However, the year before they were transferred, there were 40 cases of measles on one day in March, representing 6% of children in the The infecting organism is a paramyxovirus, causing respiratory infection, with fever and a rash;
secondary bacterial complications affected the lungs and ears.
Ibid., pp. 9, 29.
Ibid., p.29; Dobson, p.140.
BCL, BBG, GP/B/2/1/19, 17 December 1856.
BCL, VGPC, GP/B/2/8/1/6, 6 October 1876; TNA, MH12/13326, MOH’s report for 1876.
workhouse.48 The largest numbers admitted between 1880 and 1911 occurred in the Lady Day and Midsummer quarters, reflecting the peak incidence of the disease in the spring. In four months in early 1886, 30 cases were admitted and in the first half of 1907, there were on average six cases in the infirmary.49 For the year ending on 31 May 1910, 19 cases of measles were admitted to the infirmary out of a total of 3,338 patients.50 In contrast, the presence of measles in Wolverhampton workhouse was only noted when three inmates suffered from the disease in February 1864 and a similar number in March 1891.51 Yet, the disease was prevalent in the Borough of Wolverhampton. For example, between 1884 and 1889 reported cases varied between 300 and 1,100, with a median mortality rate of 6%, slightly higher than the national rate of around 4.5%.52 Similarly, only two cases were recorded in any of the workhouses in the county of Worcestershire between 1834 and 1871 and both occurred in Droitwich, one in 1859 and the other ten years later.53 The reason why sufferers from measles were not often found in workhouses may have been because poor parents rarely sought medical attention for their affected children.54 The other highly contagious infection that was regarded as an almost universal experience in childhood and was not subject to substantial preventive action throughout the nineteenth century was whooping cough, now known as pertussis.55 It was the next most frequent cause of infant mortality after measles. The infection began with a catarrhal period, during which airborne transmission made it highly BCL, LGB Returns, GP/B/8/5/1/1, 29 March 1879.
BCL, Incident Book, GP/B/(Acc 2009/109), Box 15, 12 May 1886; LGB Returns, GP/B/5/1/7, 5 January to 30 March, 1907.
BCL, Infirmary Management Committee (hereafter IMC), GP/B/2/4/4/5, 11 July 1910.
WALS, WC, 10 February 1864; 18 March 1891.
TNA, MH12/11721, H. Malet, ‘Annual Report of Health of Wolverhampton for 1898’; Smith, p.143.
F. Crompton, Workhouse Children, Stroud, 1997, p. 90.
Smith, p.146; Hardy, p.28.
contagious. Thereafter, paroxysms of coughing developed, ending with a stridulous inspiratory ‘whoop’.56 When John Edwards, his wife and six children applied to enter Wolverhampton workhouse in 1843, the MO confined them to the receiving ward so that they could be considered for out relief. The children had been diagnosed as having whooping cough and he wished to prevent it spreading throughout the institution.57 Despite no further mention in the workhouse records, whooping cough was a significant cause of death among infants in Wolverhampton in the 1890s, most frequently accounting for around 1% of deaths in children less than six years of age in the first quarter of each year. In some years, mortality was much greater; for instance, 8% in 1892, 9% in 1890 and 18% in 1892.58 This mortality rate was greater than the 0.3% for England and Wales in the 1890s.59 However, the Wolverhampton rate is for the quarter of the year with the highest incidence, rather than for the whole year. The disease also gets no mention in the Birmingham guardians’ records, despite being the most common childhood infection in the infirmary and being prevalent for the whole of the period covered in Appendix A. The only recorded cases in Worcestershire workhouses were in 12 children affected in an outbreak in Droitwich in 1868.60 As with measles, parents did not feel the need to seek medical attention for the condition and the preventive authorities did not promote isolation in institutions. Nevertheless, unlike measles, sufferers were admitted to Birmingham workhouse.
The causative organism is a small rod-shaped bacterium, Bordetella pertussis. The paroxysmal coughing is mediated via the production of toxin and can result in apnoeic attacks in infants.
WALS, MJ, PU/WOL/U2, 18 November 1843.
TNA, MH12/11721, H. Malet, ‘Annual Report of Health of Wolverhampton for 1898’.
One of the other great killers of very young children was scarlatina, or scarlet fever.61 It was one of the most difficult diseases to diagnose clinically in its early stages and there was no diagnostic test.62 Different strains of the bacteria have varying degrees of virulence and a more virulent strain became prevalent after 1830, leading to eight epidemics in the subsequent five decades.63 The severe local epidemics, which occurred frequently, were usually associated with infected milk.64 A milder strain reappeared toward the end of the century, but epidemics continued into the next, occurring in 1901, 1907 and 1914. Nevertheless, the fatality rate fell by almost 50%, from 49% in the ten years after 1895, to 26% in the next decade. 65 In the epidemics in the 1860s and 1870s, the greatest number of deaths occurred in London, northern industrial cities and the Black Country.66 In Wolverhampton, in the first quarter of each year in the 1890s, the mortality rate among children less than six years old was usually between 1% and 3%, although, in 1895, it was almost 8% (17 deaths).67 The fatality rate for all ages in that decade was between 3% and 6%, whereas, in the mids, it was considerably higher at between 9% and 19%.68 The mortality rate in England and Wales fell dramatically in the 1860s and had reduced by 81% by 1891.69 The reduction was due to a combination of reduced virulence of the organism and measures to control the spread of infection. The disease was one of the first to have an active preventive policy applied to it, in the form of institutional isolation, It is caused by a haemolytic streptococcal bacterium, Streptococcus pyogenes, which can also produce tonsillitis and erysipelas. Scarlet fever is the response to the toxin produced by the organism and results in widespread erythema of the skin.
C. Creighton, A History of Epidemics, Vol. 2, London, 1965, pp.727-28.
TNA, MH12/11721, H. Malet, ‘Annual Report of Health of Wolverhampton for 1898’, p.17.