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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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suffered chronic ailments, not requiring frequent examination. Throughout the previous six years, Suckling had paid a daily visit, usually lasting two hours, during which he examined ‘every fresh case’ on the medical side, commencing treatment, and any case in which the resident officers required help. He claimed that in his time at the workhouse, more clinical reports had been published in the medical journals and more cases shown at medical societies from the infirmary than any other in the country, proving that the ‘cases there are gone into properly’.71 His account was challenged by an anonymous WMO, who doubted that Suckling’s stated workload could be completed in two hours.72 Three years after the infirmary opened, improved arrangements for medical staffing were introduced, with the appointment of two additional visiting physicians (Table 4.2). Each of the physicians and the surgeon was allotted one of the resident MOs, who rotated every six months.73 The resident officers held office for short periods of time, sometimes being succeeded by one of the clinical clerks. In the early 1900s, the tenure of the posts was fixed at one year, but with renewal possible.74 The majority of the visiting physicians were of high professional standing in the town, with honorary posts at the voluntary hospitals. Otto Kauffman, for example, became Professor of Medicine at the University of Birmingham, after visiting posts at the infirmary were abolished in 1913.75 At this time, Frederick Ellis FRCS, MD was appointed Medical Superintendent at an annual salary of £750, to increase incrementally to £1,000.76 Ibid., p.1308.

Anonymous, ‘Birmingham Workhouse Infirmary’, The Lancet, i (1889), p.47.

BCL, Workhouse Infirmary Management Committee (hereafter WIMC), GP/B/2/4/4/2, 28 January 1893, 25 January 1894.

BCL, WIMC, GP/B/2/4/4/4, 8 May 1903.

Hearn, p.23.

BCL, Birmingham Union Board, GP/B/2/1/81, 19 March 1913.

Table 4.2: Visiting Surgeon and Physicians to Birmingham Infirmary, 1882

–  –  –

Source: BCL, BBG, GP/B/2/1/50-82, 1887-1913.

After the new infirmary opened in 1889, the WMO, Charles Mitchell, continued to have a heavy workload, as not all patients had been moved to the new institution.

Initially, he had the support of the visiting physician and surgeon, who had a minor portion of their duties allocated to the workhouse. The visiting physician’s input lapsed when Suckling resigned, but was restored two years later with the appointment of the senior physician at the infirmary, Alfred Carter, at an annual salary of £25.

However, when four years later, he had not completed the required reports for almost a year and did not have evidence to prove his attendance at the workhouse, he was asked to resign.77 No subsequent appointments appear to have been made. The WMO spent a considerable amount of his time seeing patients in the venereal and BCL, Workhouse Management Committee (hereafter WMC), GP/B/2/3/2/2, 27 April 1894, 11 March 1898.

bedridden wards. He spent two and a half hours each morning examining tramps and outpatients and visited the receiving wards five times each day between noon and

10.00pm. He admitted 30 to 40 inmates daily, with each one taking up to 15 minutes, so that he could be busy until 11.00pm.78 In addition, all potential admissions to the infirmary had to be seen at the workhouse by the WMO. In 1880, the board of guardians decided that it was not desirable for patients to be admitted directly to the infirmary and this policy had the LGB’s approval.79 This practice continued into the first decade of the twentieth century, although the majority of unions had accepted by then that the principle of deterrence no longer applied to sick paupers.

Having only one resident medical attendant in the workhouse returned the institution to the inadequate level of medical staffing of the 1870s. Difficulties in medical

–  –  –

resident infirmary medical officers (hereafter IMOs) were required to perform his duties at these times, but it was often difficult to obtain their assistance. Delays occurred because of the time they took to arrive at the workhouse, after being called to see new admissions or sick inmates in the wards. This often arose because they were busy with duties in the wards or accompanying the visiting physicians.80 Eventually, in 1903, the Infirmary House Sub-committee recommended that all cases sent to the workhouse by the DMOs, as well as ambulance cases, should be received directly at the new infirmary lodge, during these periods of leave.81 However, that did not solve the problem of attendance to sick patients arriving at the workhouse on their own initiative. On one occasion in January 1904, a man in pain arrived at the Ibid., GP/B/2/3/2/1, 11 April 1890.

BCL, HSC, GP/B/2/3/3/7, 22 June 1880.

BCL, Infirmary House Sub-committee (hereafter IHSC), GP/B/2/4/5/3, 21 December 1903.

Ibid.

workhouse at 3.40pm, 40 minutes after the WMO had left, and the IMO had not turned up to see him by 6.00pm, when a further telephone message was sent. After several more telephone calls, Dr Cooper eventually arrived at 7.40pm, but the patient had not waited, returning the next day to be admitted to the infirmary.82 A further incident occurred three years later, also involving Dr Cooper. Night nurse Crocker had telephoned him at 9.00pm to see Thomas Jeffrey with a ‘very bad ulcerated leg’ in the probationary ward. He arrived an hour later, was annoyed at being called, made a cursory examination of the wound and ordered the patient to the tramp ward without prescribing a dressing.83 These were not the only problems resulting from the WMO being sole resident in the workhouse, available both day and night. For instance, on one occasion in 1901, William Sturrock apologised for the four-hour delay in attending a patient, Edward Porter. Sturrock had been called out of bed three times during the night then taken a ‘sedative draught to obtain sleep’. After Nurse Brisbane called him at 6.30am to see Porter, he had gone off to sleep again and the nurse did not call a second time.84 At that time, the 959 non-able-bodied and 575 able-bodied, but temporarily disabled, inmates present in the workhouse were likely to impose a heavy workload on the WMO.85 Difficulties in providing adequate medical care due to large numbers of patients also occurred in Wolverhampton workhouse.





BCL, HSC, GP/B/2/3/3/21, 26 January 1904.

BCL, HSC, GP/B/2/3/3/19, 11 April, 11 July 1899; GP/B/2/3/3/22, 8 January 1907.

BCL, HSC, GP/B/2/3/3/20, 10 September 1901.

BCL, LGB Returns, GP/B/5/1/3, 2 October 1901.

Part-time Medical Attendance in Wolverhampton Workhouse The advantage of appointing WMOs on a non-resident, part-time basis and allowing them to practice privately in addition was that they were more likely to stay in post for many years, providing greater continuity of medical care. This was the arrangement in the first Wolverhampton workhouse, providing a contrast to that in Birmingham, but was more in keeping with most moderately sized workhouses in England. The first two WMOs also acted as district officers, but after 1852, district work was separated from that in the workhouse (Table 4.3). All MO posts were advertised for tender in 1839, and Charles Hodgkin was appointed to the workhouse at £25 per annum.86 Following re-advertisement two years later, George Cooper took over the workhouse and Charles Hodgkin one of the districts.87 Thereafter, the WMOs remained in post for many years (just over 13 years on average), usually until they died or were asked to resign by the guardians. Only Richard Nugent resigned voluntarily, presumably to take up another appointment, as he had requested a testimonial three weeks before his resignation.88 Wolverhampton MOs rarely requested assistance when their workload increased, preferring to ask for an increase in salary. George Cooper requested a bonus, because of the influx of patients suffering from fever, but was rejected, even though the guardians accepted his duties had been onerous during the crisis, which had broken out in some lodging houses.

Their reason was that it was a contingency to which all contracts were liable. Mr Perks, one of the guardians, was particularly unsympathetic, stating that ‘when the medical officer took his situation, he took it as a man took his wife, for better or Wolverhampton Archives and Local Studies (hereafter WALS), Wolverhampton Board of Guardians minutes (hereafter WBG), PU/WOL/A/2, 19 March 1839.

Ibid., PU/WOL/A/3, 19 March 1841.

Ibid., PU/WOL/A/10, 28 October, 18 November 1859.

worse’.89 When Nugent’s salary was increased within a year of his appointment, it was on condition that he attended every case of midwifery to which he was summoned promptly, and the nurse was directed to call him as soon as any difficulty was suspected.90 Henry Gibbons’ salary was increased in 1866, to enable him to take on an assistant to carry out the dispensing.91 He supported his case by pointing out that the workhouse infirmary had 300 beds and the annual number of cases was 1,706.

Whereas, at the local voluntary hospital, there were only 100 beds, with 750 cases in the year, and the patients were cared for by eight ‘medical men’ and two pupils.92 Eight years later, the guardians agreed to pay the salary of a dispenser (£20 per annum) without altering Gibbons’ salary.93 At the beginning of the twentieth century, a LGB inspector questioned whether the MO’s two hours in the workhouse daily were sufficient to provide satisfactory care and suggested a resident officer should be appointed. A motion to the board of guardians to do so was defeated, but it was agreed to appoint a dispenser at a salary of £130 per annum.94 Agreement to appoint a resident MO was reached prior to the opening of the new workhouse in 1903.95 Surprisingly, considering the proposed increase in infirmary accommodation from 230 to 360 beds, Thomas Galbraith requested the decision be rescinded and the current arrangement remain in place, with himself as sole MO.96 The guardians decided to proceed with the appointment and George Anderson commenced in January 1904 with an annual salary of £130. His duties included examining all tramps daily, dispensing on Sundays and at other times in the absence of the Ibid., PU/WOL/A/6, 9 July 1847; Wolverhampton Chronicle (hereafter WC), 7 July 1847.

WALS, WBG, PU/WOL/A/8, 24 June 1853.

Ibid., PU/WOL/A/13, 5 October 1866.

Ibid.; WC, 30 October 1866.

WALS, WBG, PU/WOL/A/16, 11 December 1874.

WALS, General Purposes Committee (hereafter GPC), PU/WOL/D/1, 28 February 1901.

WALS, WBG, PU/WOL/A/29, 10 May 1901; PU/WOL/A/30, 28 August 1903.

Ibid., 10 August 1903.

dispenser, administering anaesthetics, lecturing to and instructing probationer nurses.97 Among the eleven applications for the post, two were female, but they were summarily rejected.98 Anderson remained in post for eight years and was replaced by William Coghill, who obtained a post in Coventry three years later.

Some poor law historians have been critical of part-time poor law MOs for their lack of attendance on sick paupers and for leaving this task to their unqualified assistants.99 However, both Brand and Ruth Hodgkinson point out that it is not possible to assess their efficiency with any degree of accuracy as the complaints of the sick poor were rarely recorded.100 The Wolverhampton guardians, in a special meeting in 1890, included in the regulations for the MO that he must attend at least once daily. Four years later, they required that he should arrive no later than 10.30am every morning.101 However, when the occasion demanded it, officers could spend long periods in the workhouse. George Cooper was in attendance from 5.00am one morning in June 1845 to attend a woman with a difficult and protracted labour and he stayed till she had given birth at noon.102 On an earlier occasion, the labour of ‘E. D.’ was also protracted and the master reported that the safety of the mother and child was due to Cooper’s skill and the ‘great attention’ he gave to the delivery.103 Despite this dedication, the infrequency of his attendance at the workhouse became a source WALS, WBG, PU/WOL/A/30, 18 December 1903.

Ibid., 2 December 1903.

Crowther, Workhouse System, p.163; S. Fowler, Workhouse: The People, The Places, The Life Behind Doors, Richmond, 2007, p.156; J. Lane, A Social History of Medicine; Health, Healing and Disease in England, 1750-1950; Loudon, Medical Care, pp.50, 63; A. Digby, Pauper Palaces, London, 1978, p.171.

Brand, ‘Parish Doctor’, p.122; Hodgkinson, ‘Poor Law Medical Officers’, p.311.

WALS, Resolutions re. Duties of Officers, PU/WOL/L, 27 October 1890; Workhouse Visiting Committee (hereafter WVC), PU/WOL/H/1, 16 March 1894.

WALS, Master’s Journal (hereafter MJ), PU/WOL/U/2, 7 June 1845.

Ibid., 4 November 1843; for further information on midwifery in Wolverhampton workhouse, see F.

J. Badger, ‘Delivering maternity care: midwives and midwifery in Birmingham and its environs, 1794 (unpublished PhD thesis, University of Birmingham, 2014), pp.232-35.

–  –  –

discrepancies between the entries in the medical report book and porter’s book relating to his times of attendance, he was reprimanded after being found guilty of ‘gross carelessness in bookkeeping’ and inflating the amount of time he spent in the institution. However, the board did so reluctantly because of his previous good service.104 Around this time, the PLB had informed the guardians that Cooper was entitled to hold his appointment on a permanent basis.105 However, the guardians wished him to forgo the permanency by resigning in the following March and recorded his verbal agreement in the board minutes. Cooper maintained that he was opposed to resigning as he approved of the PLB’s ruling on the permanency of MO appointments and he had merely agreed to respond in writing to the guardians’ formal request for his resignation.106 Subsequently, further charges of failing to enter details Table 4.3: Workhouse Medical Officers in Wolverhampton Workhouse, 1839-1914

–  –  –

Source: WALS, WBG, PU/WOL/A/2–25, 1839-1914.

WALS, WBG, PU/WOL/A/8, 17 October 1851.

WALS, WC, 24 September 1851.

TNA, MH12/11650, 30 December 1851.



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