«MEDICAL CARE IN THE WORKHOUSES IN BIRMINGHAM AND WOLVERHAMPTON, 1834-1914 by ALISTAIR EDWARD SUTHERLAND RITCH A thesis submitted to the University of ...»
rate is 25%, but many who recover are left with pock-marked facial scarring due to destruction of the sebaceous glands and a few with blindness. The disease confers life-long immunity.145 A new species of smallpox appeared in the late nineteenth century, producing a milder disease with a fatality rate of only 1%.146 Inoculation into the skin of pus or powdered scab to give immunity to the disease had been practised in England from the early eighteenth century, but had a 1% to 3% risk of death.147 Following the work of Edward Jenner toward the end of the century, vaccination using cowpox or vaccinia virus to produce a mild infection was a safer procedure, but as it did not provide life-long protection, re-vaccination after a few years was necessary. It was commonly performed by vaccinators in the 1860s using the arm-to-arm technique, taking lymph from pustules on a previously inoculated person.148 These developments in smallpox prevention have been well documented, but, according to Hardy, the nineteenth-century history of smallpox has been neglected by historians.149 In susceptible communities, smallpox causes large epidemics, but then declines in prevalence, although can remain endemic in cities.
Known as Variola minor.
Hopkins, pp.7, 47; P. Razell, The Conquest of Smallpox, Firle, Sussex, 1977, pp.20-21. However, it was less than 1% using the Suttonian method of superficial inoculation, Razzell, pp.22-23.
Worboys, pp. 117-18.
Hardy, p.110; for instance, Razell for eighteenth-century developments.
Creighton, pp.606, 614.
1838, but only 55 the following year.151 However, there is no mention in the poor law records for Birmingham or Wolverhampton of admissions to the workhouse at this time. The epidemic of 1837-40 brought about the first piece of legislation against smallpox in England, with the Vaccination Act of 1840, which provided free vaccination for children if their parents wished it. A further act, thirteen years later, made it compulsory in infants before they were four months old, financed by the poor law rates under the responsibility of the guardians. In the years following the epidemic, smallpox remained prevalent in the country and isolated cases occurred; for instance, a man with ‘virulent smallpox’ admitted to Wolverhampton workhouse in 1845 was promptly transferred to a room on his own, under care of a dedicated nurse.152 Between 1863 and 1865, the number of smallpox patients present in the workhouse at any one time ranged between none and nine, with a peak in May and June of 1864.153 In November 1863, the workhouse master transferred inmates from isolated cottages to enable them to be used for smallpox patients, as they were the only buildings away from the main hospital.154 The guardians considered extending facilities for paupers with infectious disease on the grounds that it was better to admit them than to treat them at home in order to increase their chances of recovery, thereby accepting a medical role for the poor law.155 In May 1864, Birmingham guardians arranged 15 patients on outdoor relief and 10 from the workhouse to be transferred to the General Hospital.156 However, later that year there were 41 cases of smallpox and Ibid., p.604.
WALS, MJ, PU/WOL/U/2, 7 June 1845.
WALS, WC, 30 September 1863 to 13 September 1865.
Ibid., 18 November 1863.
Ibid., 24 February 1864.
BCL, BBG, GP/B/2/1/31, 25 May 1864.
10 of fever in the institution, which was so crowded that inmates were moved between departments to accommodate the infectious patients.157 The next great epidemic took place in 1871-72, resulting in 42,084 deaths in England and Wales in those years and afflicting mostly youths and adults.158 The increased virulence of the virus resulted in a fatality rate that was much greater, at 66% in the first year and 77% in the second, and also it affected those who had already been vaccinated.159 According to Hardy, it was the worst of the century.160 On this occasion, both workhouses in Birmingham and Wolverhampton were deluged by admissions of smallpox sufferers (see Tables 3.2 and 3.3). The guardians in Birmingham found it necessary to appoint a temporary MO, Mr Edward Burton, to care for smallpox patients in the workhouse and prevented him from seeing private patients, unless they had smallpox. Eliza Matthews and Elizabeth Fellon were appointed as additional nurses for patients with smallpox.161 When the MO commenced duties on 19 December 1871, there were 21 patients in three wards, but, by 10 May the next year, this had increased to 75 patients in seven wards and the time spent treating them had increased from two and a half hours per day to between four and five hours.162 By the time his services were no longer required on 8 February 1873, he had treated 982 patients.163 William Sharp, master of Birmingham workhouse, provided the guardians with a detailed report on the epidemic. The first case to arrive on 11 March 1871 was a BCL, VGPC, GP/B/2/8/1/4, 2 December 1864.
BCL, BBG, GP/B/2/1/40, 27 December 1871, 10 January 1872.
BCL, VGPC, GP/B/2/8/1/6, 10 May 1872.
BCL, BBG, GP/B/2/1/41, 19 March 1873.
servant girl from Hockley, followed on 27 April by four children from London and later by four more. He considered that the disease had not displayed ‘much of an epidemic nature’ at that time, but the number of admissions increased rapidly after Christmas, for instance 109 admissions in January 1872 compared with 21 in the month before (Table 3.2).164 The greatest number of patients in the wards at any one Table 3.2: Number of Patients with Smallpox Admitted, Died and Discharged, Birmingham Workhouse, 1871-74
time was 94 on one day in April and two days in June. The Borough sanitary authorities were responsible for arranging 6% of admissions. The mortality rate of 15% was well below the average of 77% for the country as a whole. The patients had been nursed by an inmate under the supervision of the nurse in the female infirmary initially, until the two paid nurses were appointed. Visiting by relatives and friends was strictly prohibited, even when the patient was dying, to ensure complete isolation.
The workhouse master praised the conduct of officers and inmates who Table 3.3: Number of Smallpox cases in Wolverhampton Workhouse and Union District, 1871-72
were required to attend the patients, as well as that of the patients themselves for ‘submitting so readily to the regulations’. Only one man had absconded and another patient had misbehaved. Finally, the concern that the health of the inmates already present in the workhouse would be endangered proved unfounded as only 12 contracted the disease.165 Although the number of patients declined after the epidemic, admissions with smallpox continued (Table 3.2). By June 1873, there were only 15 patients in the 103 beds available in the smallpox wards, which were reduced within five months to 30 beds, occupied by 21 patients.166 However, the reduction in admissions in early 1873 was only a brief respite before a further increase occurred in the early months the following year (Table 3.2).
Smallpox patients were noted to be present in Wolverhampton workhouse at the time the first patients arrived in Birmingham in March 1871, although Henry Gibbons, MO, had declared it free from smallpox one month later.167 The guardians directed Mr Gibbons to re-vaccinate all inmates who had not been vaccinated within the previous five years.168 July that year saw five cases occur among inmates in the workhouse, with one death.169 By October, an increasing number of cases of smallpox was being reported by the district MOs, with a subsequent increase in admissions to the workhouse (Table 3.3). The number of infected paupers peaked around December and January the next year, a few months earlier than in Birmingham. Mary Ann Salt was engaged in November as an additional nurse to care
Humphreys, the nurse for the male wards of the infirmary, contracted the infection, but recovered within a few weeks.171 BCL, HSC, GP/B/2/3/3/3, 28 January 1873.
BCL, HSC, GP/B/2/3/3, 3 June 1873; GP/B/2/3/4, 25 November 1873.
WALS, WBG, PU/WOL/1/14, 10 March, 14 April 1871.
Ibid., 6 April 1871.
WALS, WC, 5 July 1871.
Ibid., 3 November 1871.
WALS, WBG, PU/WOL/1/15, 29 December 1871, 5 January 1872.
The next epidemic in 1884-85 was less severe, resulting in only 5,043 deaths in
guardians in Wolverhampton Union’s district in the autumn of 1882, when they appointed a temporary attendant for the smallpox wards and stopped workhouse visiting. However, only four patients with smallpox were in the workhouse at that time.173 When Willenhall Board of Health enquired if they could admit infected patients to the workhouse, they were informed that admission was restricted to paupers.174 In April the following year, the guardians went further, by forbidding the admission of sufferers of smallpox or ‘other infectious epidemic disease’ after 8 June.
This was successful as the infectious wards were free of smallpox cases by 27 July and the temporary nurse was given notice to leave.175 Birmingham also experienced an outbreak of smallpox in the workhouse prior to the epidemic in 1884 and all visiting and leave was stopped.176 Neither institution appears to have admitted smallpox sufferers during the epidemic. By that time, alternative arrangements were in place, in association with the local health boards, for admission for isolation, which was one of the main preventive measures against the disease, along with disinfecting rooms, clothes and bedding.177 The vaccination programme in England became less effective after this epidemic as the number of cases decreased, the virulence of the virus declined and the antivaccination lobby gained prominence.178 The fear of catching the disease from vaccination or being infected with syphilis and the risk of scarring in young children Creighton, p.614.
WALS, WBG, PU/WOL/A/19, 15 September, 3 November, 17 November 1882.
Ibid., 22 September 1882.
Ibid., 27 April, 4 May, 27 July 1883.
BCL, BBG, GP/B/2/1/47, 7 April 1880.
Hardy, p.124; the arrangements in co-operation with health boards is discussed later in the chapter.
created reluctance to agree to vaccination among the general public.179 The disease was recognised as highly contagious throughout the nineteenth century, but in the 1870s, opinion became polarised between the anti-contagionists, who believed it resulted from miasma, and the proponents of the new germ theory, who believed a specific infectious agent was the cause.180 The anti-vaccinationists gained the upper hand and Vaccination Acts of 1898 and 1907 allowed parents to decline protection for their children by stating ‘conscientious objection’.181 Consequently, 33% of unvaccinated children died in the 1893-94 epidemic in Birmingham, compared with only 0.5% of vaccinated children.182 However, partly due to a decline in virulence of the virus, later epidemics in 1892-93 and 1901-2 were mild.183 Isolated incidents occurred in Wolverhampton workhouse in the 1890s and 1900s, unrelated to the times of the epidemics. A man from Willenhall was admitted in February 1893 because of the need for urgent isolation. He had contracted the disease while working in Derby and once back home was sleeping in the same bed as his wife and newborn child. As Willenhall did not have an isolation hospital, the only relevant facilities were in the workhouse.184 The guardians had contracts with the sanitary authorities in Wolverhampton and Bilston, but not in other districts of the Union.
They had been paying Wolverhampton 15s per week for the maintenance of paupers with infectious diseases. However, two years previously, the sanitary authority offered to admit paupers without charge as part of its duty to contain the spread of Worboys, p. 118; G. Mooney, ‘“A Tissue of the most Flagrant Anomalies”: Smallpox Vaccination and the Centralization of Sanitary Administration in Nineteenth-Century London’, Medical History, 41 (1991), pp. 261-90, includes detailed discussion of the importance of the objections to vaccination.
Hopkins, p.92 and a discussion of the theories of the cause of smallpox can be found on pp.10-12;
Hardy, p.113; Pickstone, p.158.
A. Hill, ‘The Epidemic of Small-pox in Birmingham’, Public Health, 8 (1895-96), p.6.
Hardy, p.137; Hopkins, p.96.
WALS, WBG, PU/WOL/A/24, 3 February 1893; WC, 8 and 15 February 1893.