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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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of patients with infectious disease in the medical relief book were laid, with the implication of medical negligence.107 However, it is likely the guardians were looking for a way to terminate his contract, as he had not complied with their request for his resignation.

Conflict between the Guardians and the Medical Officers Disputes between MOs and guardians over conditions of employment and conditions within the workhouse were numerous, with guardians frequently ignoring their requests for treatment and improvement to workhouse conditions. A power struggle between MOs and guardians or other workhouse officials often resulted in charges of medical negligence. The medical ethos of striving to cure patients was at variance with the principle of less-eligibility, which prevailed in keeping the standard of medical welfare low. Price carried out an extensive study of the employment, disciplining and dismissing of WMOs of the NPL.108 He demonstrated that most charges for negligence arose out of the issues of attendance and record keeping.109 Extremely low salaries, the conflict between doctors’ private and public duties and their immense workload were instrumental in making it virtually impossible to attend to all ill inmates promptly. However, there have been few studies of this aspect of their work. Reforming MOs were at greater risk of being charged, but almost 40% of WALS, WBG, PU/WOL/A/8, 7 November, 21 November, 12 December 1851.

K. Price, ‘A regional, quantitative and qualitative study of the employment, disciplining and discharging of workhouse medical officers of the New Poor Law throughout nineteenth-century England and Wales’ (unpublished PhD thesis, Oxford Brookes University, 2008).

R. Klein has demonstrated that failure to visit was the second commonest cause of dissatisfaction with general practitioner services in the 1970s, with the manners of practitioners being the first;

Complaints against Doctors, London, 1973, pp.105, 116.

WMOs were disciplined throughout the nineteenth century.110 The tightening of the rules of employment in 1871 and the subsequent crusade against outdoor relief, which was extended to include medical relief, was a ‘barely concealed attempt to set PL MOs up as the nation’s “fall-guy”’.111 It made negligent practice a necessity and

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‘groundless charges’ to rid themselves of troublesome MOs and, as a result, doctors bore the brunt of failings in poor law medical practice.112 Before considering the events in Birmingham and Wolverhampton, it is necessary to have an understanding of the context in which they arose. In the nineteenth century, a doctor’s practice was judged on the basis of what ‘an ordinary man’ would consider reasonable, rather than by standards set by the medical profession.113 MOs were viewed as providing a service similar to any business, and failure to carry it out efficiently was regarded as negligence. This differs from the twentieth-century concept of negligence, which is failure to practise acceptable standards of clinical care.

The frequency of visits to the workhouse was a common cause of conflict between guardians and MOs in Wolverhampton. The report of the enquiry into the charges of negligence against Cooper, WMO, in December 1851, referred to earlier, was generally favourable to him, but he was severely reprimanded by the guardians. The seven charges mostly reflected his non-attendance and poor bookkeeping. First, he had neglected to see Ellen Dunnock, a sick child, who had died twelve hours after admission to the workhouse in the early evening. He had confined William Newell in Price, ‘Quantitative and qualitative study’, p.342.

Ibid., pp.141, 230.

K. Price, ‘‘‘The Shape of the Iceberg’’: Doctors and Neglect under the New Poor Law, c.1871, in J. Reinarz and R. Wynter (eds), Complaints, Controversies and Grievances in Medicine, London, 2014, p.138.

Ibid., p.136.

the lunatic wards for three days as punishment, but omitted his name from the list of patients in those wards. For 69 hours from one Saturday, he had been absent without leave and failed to provide a deputy, and in that time Thomas Franks, nine years old, was admitted badly burnt. Franks did not receive medical attention for 26 hours, only being seen one hour before he died. Cooper had not attended to Lydia Gidderidge during her 58-day stay in the workhouse and omitted her name from the medical relief book. He had failed to record many of the episodes of illness among the children.

Thomas Day, a lunatic, had been confined to bed by means of straps for several days, but he had not recorded it, nor reported it to the guardians, who had recently expressed their disapproval of such treatment. The way he treated individual inmates was the subject of only one charge, in which he was accused of acting ‘contrary to decency’. He had allowed between 20 and 30 boys and girls, of around ten years old, to be in a ‘state of nudity’ in one room together, while they were being treated for skin disease. Similarly, two adult males suffering from venereal disease were left naked in a ward with other inmates present.114 The PLB’s enquiry blamed these instances on the breakdown in the proper classification in the workhouse and so the treatment of the inmates was not directly attributable to Cooper. Nevertheless, the board censured him for not bringing the guardian’s attention to the lack of classification.115 In doing so, the PLB was giving higher priority to the administration of the workhouse than to the personal dignity of its inmates. The guardians had hoped that the warning from the PLB would secure for the inmates ‘that amount of professional attention’ that the guardians wished.116 However, within a few months, errors in bookkeeping and complaints by inmates regarding Cooper’s treatment continued. Following a further WALS, WBG, PU/WOL/A/8, 19 December 1851; WC, 11 February 1852; TNA, MH12/11680, 30 December 1851.





WALS, WC, 11 February 1852.

WALS, WBG, PU/WOL/A/8, 20 February 1852.

enquiry by Andrew Doyle, PLB Inspector, Cooper was requested to resign in the ‘interests of the Union’.117 Dr Mannix, one of the guardians, was of the opinion that Cooper had initially been ‘an active and efficient officer’, but had later ‘relaxed’ for reasons he could not fathom.118 One likely reason could have been a burgeoning private practice, since tension between public and private responsibilities often resulted in difficulty attending the workhouse.119 Cooper’s successor as WMO, Richard Nugent, was investigated for poor attendance at the workhouse within a few years of his appointment. He had recorded in the medical relief book in 1855 that he had visited every patient daily, whereas he was accused of failing to see Josiah Tomkinson, aged seven years, despite being requested to do so on two occasions. When he did see him, eight days before the boy died, he diagnosed skin disease, but entered ‘scrofula, rickets and spinal’ on the death certificate.120 Nugent was admonished by the guardians, who agreed to his request not to inform the PLB after he had given them an explanation of his conduct.121 One month later, he was reappointed as MO with 57% of the guardians’ votes in an election involving three other candidates.122 However, within a few weeks, inmate Benjamin Lane complained of not receiving treatment from Nugent, whose explanation on this occasion was judged unsatisfactory. The PLB were notified and subsequently issued Nugent with a censure, pointing out the importance of listening to the complaints of sick inmates with patience.123 Three months later, Nugent’s Ibid., 25 June, 16 July 1852; WC, 29 September 1852.

WALS, WC, 10 December 1851.

Price, ‘Quantitative and qualitative study’, p.231.

WALS, WBG, PU/WOL/A/9, 9 February 1855; WC, 14 February 1855.

WALS, WBG, PU/WOL/A/9, 16 February, 23 February 1855.

Ibid., 16 March 1855.

Ibid., 30 March, 13 April, 18 May 1855; WC, 23 May 1855; details of the treatment received by Lane can be found in Chapter 5.

conduct in the management of Mary Shaw was also called into question. She had developed severe abdominal pain, which worsened the same evening, so that she requested Nugent be called to see her. He attended between 8.00pm and 9.00pm, but threw off her bedclothes in what the nurse described was ‘an indecent manner’ and examined her very roughly. He was obviously in a ‘very bad temper’ and used threatening language when Mary complained of headache. Nugent admitted to the guardians that he was annoyed at being called out by the matron, as she had no authority to do so, and to ‘a simple case’ of abdominal pain. When requested to apologise for the language he had used, Nugent denied that he had been abusive, but was prepared to make an apology if the board were of the opinion that he said what the inmate and nurse had reported. The board stopped short of dismissing him, instead issuing a final warning.124 No further disagreements over Nugent’s attendances occurred for three years, but at that time the guardians had a return prepared detailing his conduct over two years. Nugent or his deputy had attended the workhouse for 539 days (74%) in the period, although the chairman of the guardians pointed out that they had often visited when there were no patients needing attention.

The average length of visits was 62 minutes, but could be as short as five to 20 minutes, even when there were 200 sick inmates in the workhouse. Discussion of the report was postponed, but there is no record that it subsequently took place before

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comparison, the MO for Nottingham workhouse spent on average two hours and a half on his daily visits in 1866, with an average 300 patients under his care.126 WALS, WBG, PU/WOL/A/9, 27 July 1855; WC, 1 August 1855.

WALS, WBG, PU/WOL/A/10, 23 February 1858; WC, 11 August 1858; 28 September 1859.

BPP, 1867-68 (4), p.125; Bosworth, pp.236-37.

His successor, Henry Gibbons, was in post for over 22 years, and the only complaint regarding his conduct took place two years after his first leave of absence due to ill health in 1870. However, he had previously been reported by the LGB to the guardians for failing to enter the dates of an order for medical extras in the medical relief book.127 In April 1877, Patrick Reddington, an inmate of the workhouse, complained to the LGB about his treatment on admission, but the guardians found ‘no cause for complaint’ against Gibbons.128 Two years later, he was again off work, but this time for around six months, prompting the guardians to consider whether to grant continuing leave. However, one of them commented that sick inmates were ‘perfectly satisfied’ with the attention Gibbons gave them and he was able to resume his duties shortly thereafter.129 When he died suddenly in April 1882, approximately 50 years of age, the guardians’ response suggested admiration.130 Edward Watts was exonerated by the guardians after a complaint from Mrs Blower regarding her treatment in the workhouse, while he was deputising for Gibbons in August 1881.131 After Gibbon’s death, he was elected as MO on the casting vote of the chairman of the board, defeating four other candidates.132 A further complaint, in 1890, of neglecting William Thomas, a patient in the infirmary, also found Watts was not to blame.133 However, after sustaining an accident a few months later, lapses in his performance started to arise. In May the following year, the board’s auditor reported errors of omission and accuracy in the medical relief book, all of which were accepted by Watts and he was cautioned to be more careful in his record keeping.134 The WALS, WBG, PU/WOL/A/14, 2 December 1870.

Ibid., PU/WOL/A/17, 27 April 1877.

Ibid., 5 September 1879; WC, 13 August 1879.

WALS, WBG, PU/WOL/A/19, 14 April 1882.

Ibid., PU/WOL/A/18, 12 August 1881.

Ibid., PU/WOL/A/19, 28 April 1882.

Ibid., PU/WOL/A/23, 16 May 1890.

Ibid., 15 May 1891.

following month, Watts failed to visit the workhouse for three days, following which

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attendance was that he had been taken ill with influenza, but it is obvious he had failed to inform his deputy. Although the guardians were dissatisfied with his attendances over the previous three months, no action was taken against Watts after an exchange of letters between the guardians, Watts and the LGB.135 A more serious charge of neglect of duty on the part of Watts related to the treatment of Joseph Freeman, an inmate who died on 8 June 1894, and the guardians requested an enquiry by the LGB. When Watts saw Freeman on admission, two days before his death, he was complaining of abdominal pain. Although Watts allocated him to the ‘old men’s’ ward, the nurse later had Freeman transferred to the infirmary as his condition had deteriorated. Watts visited the workhouse the next day, but did not see Freeman, although he discussed his condition with the nurse. At the request of one of the guardians, who was medically qualified, he went to see Freeman and instigated treatment. Watts was also questioned as to why he had not attended a case of ‘Acute Scorbutis’ in the same ward when attending Freeman. His reply was that he did not think it necessary. The master reported that Watts was often in ‘a muddled state’ when visiting the workhouse.136 Watts died before the LGB enquiry into his conduct

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performance of their duties deteriorated when they suffered ill health, but strove to continue at work. Price found that almost one quarter of poor law MOs died in office due to many carrying on into old age, when they were more likely to make mistakes.137 Ibid., 17 July, 21 August, 4 December 1891.

WALS, WVC, PU/WOL/H/1, 15 June 1894.

Price, ‘Quantitative and qualitative study’, pp.209-11.



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