«MEDICAL CARE IN THE WORKHOUSES IN BIRMINGHAM AND WOLVERHAMPTON, 1834-1914 by ALISTAIR EDWARD SUTHERLAND RITCH A thesis submitted to the University of ...»
periods varying from one month to sixteen years with an average just over four and a half years (Table 4.1). With only four MOs spending more than five years in office, there was little continuity of medical care, which varied according to the practices of individual officers.38 This is similar to the situation at the town’s General Hospital where the resident MOs between 1857 and 1875 had an average length of service of approximately three years. However, continuity was provided by eight honorary physicians and surgeons, whose periods in office ranged from eight to 37 years.39 A similar situation was not initiated at the workhouse until 1882, when a visiting
stimulus for these appointments was a visit, at the request of the guardians, by two Local Government Board (hereafter LGB) inspectors, one of which was Dr Frederic Mouat M.D. They suggested that two non-resident MOs should be appointed to provide adequate medical cover.40 The guardians’ reaction was to send a deputation to assess the medical administration of the workhouse at Liverpool, which housed around 3,000 inmates, compared with about 2,500 in Birmingham. Both the medical and surgical officers in Liverpool were non-resident, visited the workhouse daily and supervised the three assistants. The Liverpool guardians allowed the non-resident officers to have private practices in order to attract high quality candidates.41 Birmingham guardians decided to appoint only one visiting physician, Dr Cornelius Suckling, who already held an appointment as honorary physician to the Queen’s Hospital and became Professor of Medicine at Mason’s College, the precursor to the University of Birmingham.42 Five years later, Dr George Jordan Lloyd was appointed BCL, BBG, GP/B/2/1/6-68, January 1850 to December 1899.
BCL, General Hospital, Birmingham, Annual Reports, 1857-75.
BCL, Visiting and General Purposes Committee (hereafter VGPC), GP/B/2/8/1/8, 21 March 1882.
BCL, HSC, GP/B/2/3/3/8, 4 July 1882.
G. Hearn, Dudley Road Hospital, 1887-1987, Birmingham, 1987, p.23.
visiting surgeon at the workhouse at the same annual salary of £150.43 At the time of his appointment to the workhouse, Lloyd was Honorary Surgeon to the Queen’s Hospital and later became Professor of Surgery in the University of Birmingham. In making these appointments, the guardians were emulating the staffing arrangements at the voluntary hospitals. The WMOs continued to be appointed to full-time duties, were required to be resident and were not permitted to practice privately. Starting salaries rose from £150 per annum plus board, lodgings and a personal servant, to £200 per annum in 1861, but returned to the previous level in 1890 after the new infirmary opened (see Table 4.1).44 WMOs during these decades resigned for a variety of reasons. For example, in 1855, John Humphrey took up an appointment at a new civil hospital near Constantinople.45 Barber left because of ill health, and Fernie resigned due to the heavy workload.46 A few were appointed to public posts locally, for instance as Public Vaccinator in 1869 and two as district MOs in the 1890s. Edmund Whitcombe received his medical education at Sydenham College in Birmingham and was appointed WMO the year after becoming MRCS.47 He resigned 18 months later to take up the post of Assistant Medical Superintendent at the Borough Lunatic Asylum and was appointed to a chair of mental diseases at the University of Birmingham in the late 1880s (Table 4.1).48 Charles Mitchell left to set himself up in private practice and Ebeneezer Teichelmann to return to his native Australia. William Sturrock was called up for active service in BCL, BBG, GP/B/2/1/55, 5 January 1887.
In the 1860s, the starting salary of the medical officer at the Battle Workhouse was £120; see Railton and Barr, Battle Workhouse and Hospital, 1867-2005, Reading, 2005, p.16.
BCL, BBG, GP/B/2/1/15, 4 April 1855.
He used the words ‘unremitting duties’ in his resignation letter; see quote as part of heading.
Sydenham College was a rival medical school to Queen’s College in Birmingham.
BCL, BBG, GP/B/2/1/39, 10 August 1870; Anonymous, ‘Obituary. Edmund Bancks Whitcombe’, British Medical Journal, i (1911), p.1353.
1914, having joined the Territorial Army six years before. 49 In general, there were few WMOs in Birmingham who left public service and were appointed to positions at local voluntary hospitals, one exception being Redfern Davies, who was honorary surgeon to Birmingham Children’s Hospital three years after resigning from the workhouse. As those acting as resident MOs in workhouses were at an early stage in their careers, poor law records rarely contain detailed information about their practices after resignation. However, part-time workhouse MOs could hold honorary appointments at voluntary hospitals in addition to their poor law duties, for instance, Dr L. M. Guilding at Battle workhouse was also assistant surgeon at the Royal Berkshire Hospital.50 Humphrey’s workload increased when around 250 children were transferred from the Infant Poor Asylum to the new workhouse a few months after it opened in 1852 and his salary was increased by £25.51 He complained that he had attended over 1,048 patients in that year, with 706 coming under his care within the previous six months, and he felt the strain of being the only MO on site.52 He requested help in the form of an articled pupil, as was allowed to the district MOs. The guardians agreed but the PLB refused, because it would have permitted someone to be resident in the workhouse and not be directly responsible to the guardians through the master.53 Two years later, he repeated his request for assistance, as attending the large number of patients in the infirmary and the sick wards of the workhouse (721 in total) reputedly left him completely exhausted at times. It also meant that he was not able to give BCL, BBG, GP/B/2/1/39, 10 August 1870; Advisory Sub Committee, GP/B/2/8/2/1, 23 September 1914.
Railton and Barr, p.90.
BCL, BBG, GP/B/2/1/11, 6 October 1852. The Asylum for the Infant Poor had been in use since 1797 for pauper children; see chapter 1 for details.
BCL, VGPC, GP/2/8/1/1, 31 December 1852.
BCL, BBG, GP/B/2/1/12, 5 January to 5 February 1853.
patients all the attention they deserved.54 At his suggestion, a non-resident dispenser was appointed at an annual salary of £75.
Humphrey’s successor in 1855 was William Fernie. However, Fernie resigned within two years because the pressure of his ‘unremitting duties’ left no opportunity for relaxation.55 In his testimonial, the guardians accepted that his duties were ‘onerous’ because of the ‘crowded state’ of the workhouse, but took no action to rectify matters and merely advertised for a replacement.56 One of the two candidates selected for interview for the vacant post was assistant surgeon at St Pancras Workhouse, but he withdrew his candidacy when he discovered the extent of the duties at Birmingham.57 The successful candidate was John Wilmshurst, who was resident MO at Birmingham Lying-in Hospital, but when his request in the first year of his tenure for additional help was turned down, he resigned three months later. The reason the guardians gave for their refusal was that other large workhouses in England, such as City of London, Clifton, Greenwich and Lambeth, had only one MO, although Manchester, St Marylebone and Nottingham had two.58 In 1864, Edmund Robinson, after two years in post, reported that his workload had significantly increased, so that he was occupied all of the day and part of the night with his workhouse duties.59 His request for an increase in salary, rather than for assistance, was granted, raising his remuneration from £200 to £250 per annum. In BCL, BBG, GP/B/2/1/15, 28 February 1855. His exact phrase is quoted in the heading of the chapter and his detailed quote is available in A. E. S. Ritch, ‘“Sick, Aged and Infirm’’ Adults in the New Birmingham Workhouse, 1852–1912’ (unpublished MPhil dissertation, University of Birmingham, 2010), p.51.
BCL, BBG, GP/B/2/1/19, 8 April 1857; the words were underlined in his letter to the guardians in the Board minutes Ibid., 15 April 1857.
Ibid., 6 May 1857.
BCL, LGB Returns, GP/B/18/2/1, 15 October 1856.
Edward Smith’s report on provincial workhouse infirmaries in 1866, Robinson is recorded as being satisfied with his workload and did not need assistance, in spite of having to care for between 600 and 700 sick inmates. Interestingly, his salary had by then been increased to £350 annually and this level would not have been possible with additional medical personnel.60 Commenting on Smith’s report, The Lancet praised Birmingham workhouse as one of the best managed in the provinces, but found it hard to believe ‘that the whole of these 600 sick are properly attended to, even granting the chronic nature of a large number of the cases’.61 The employment of only one MO was also severely criticised in 1865 by a local doctor who found it unbelievable that ‘a rich and progressive town like Birmingham’ would permit ‘an infirmary containing 599 beds to be officered by one medical man’.62 In early 1874, The Lancet once again criticised Birmingham guardians for employing only one resident MO, suggesting that ‘the medical supervision of the infirmary, with its 958 patients, must be merely nominal’.63 A few months later, following a LGB inspector’s criticism of the adequacy of the staffing of the medical department, the guardians eventually agreed to the appointment of an assistant medical officer (hereafter AMO), at an annual salary of £100.64 However, Cuthbert Fitzsimmon was not appointed until June 1876, but both he and his successor, Aird Jolly, remained in post for less than a year. Charles Mitchell followed them in 1877 and eleven years later he was promoted to WMO.65 Ibid.; British Parliamentary Papers (hereafter BPP), 1867-68 (4), p.43.
Anonymous, ‘Dr. Edward Smith’s Reports on the Treatment of the Sick in Selected Provincial Workhouses’, The Lancet, i (1868), p.166.
T. P. Heslop, ‘The Medical Aspects of Birmingham’ in S. Timmins (ed.), Birmingham and the Midland Hardware District, London, 1866, pp.701-2.
Anonymous, ‘Birmingham’, The Lancet, i (1874), p.109.
BCL, VGPC, GP/B/2/8/1/6, 13 March 1874, 2 July and 29 November 1875.
Further detail of the AMOs can be found in Ritch, ‘“Sick, Aged and Infirm”’, pp.47, 49.
A subcommittee was set up in October 1877, at the instigation of the LGB, to consider medical and nursing arrangements in the workhouse. The WMO, Adam Simpson, considered that he had had no particular difficulty in performing his duties before an assistant was appointed, but admitted there was more work with the patients than he could perform, although he had given them satisfactory attention. He had needed to work hard, but had ‘broke down’ on occasions, so that it was not the patients who had suffered, ‘rather it was himself’.66 Simpson estimated that three MOs were needed to provide sufficient care for the number of patients, which he put at 900 to 1,000. The two assistants would share the work between them and visit their patients daily; he would provide supervision and be available for consultation over difficult cases.67 Charles Mitchell, AMO agreed that patients did not suffer, but they were liable to be overlooked and with more time, could be more carefully examined.
Mitchell spent from 9.00am to 12 noon daily going round the wards and seeing people in the body of the house and saw admissions in the afternoon. He was called up at night about twice per week.68 The subcommittee recommended the appointment of a third MO to improve the medical care of patients. When Suckling was appointed visiting physician in 1882, he took charge of the medical wards, leaving Simpson to cover the surgical wards. The assistants were divided between the medical and surgical departments and when Jordan Lloyd took up office as visiting surgeon five years later, he became responsible for the surgical wards of the infirmary. The central authority had finally recognised the need for adequate medical staffing in workhouses.
The guardians on the subcommittee in 1877 were impressed by the large number of acutely ill patients, which had turned the workhouse into ‘a large Hospital containing BCL, Workhouse Inquiry Sub Committee (hereafter WISC), GP/B/2/3/11/1, 24 January 1878.
Ibid., 22 March 1878.
cases of so many various kinds of disease’.69 In doing so, they were recognising in their own institution the national trend toward the increasing involvement of workhouses in medical care and this development will be explored in the next section.
Developing the Infirmary into a General Hospital After the new Birmingham infirmary opened in 1889 on a separate site adjacent to the workhouse, the medical staffing began to be aligned with that of the voluntary hospitals. The two AMOs in the workhouse were transferred as resident surgeons and Charles Mitchell, who had been acting as WMO, was appointed to the post on a substantive basis. The visiting physician and surgeon had their duties apportioned between the two institutions, with the majority of their time spent at the new infirmary. An editorial in The Lancet was once again extremely concerned that the
medical staffing was inadequate, stating:
The 1,700 beds will... be occupied by sick persons requiring active medical supervision and treatment. For this number of persons there is to be a medical staff consisting of a visiting physician and a visiting surgeon, and two resident assistant medical officers… there is to be no medical superintendent. We have no hesitation in saying that it is impossible the sick can be properly cared for under these circumstances. The varying wants of sick people needing personal attention requires a detailed supervision, of which there can be none in the Birmingham Infirmary.70 In a letter of reply the following week, Cornelius Suckling, visiting physician, defended the staffing arrangement by pointing out there would also be two qualified resident clinical clerks, so giving a complement of six MOs and that many patients BCL, VGPC, GP/B/2/8/1/7, 3 May 1878.
Anonymous, The Lancet, ii (1888), pp.1244-45.