«MEDICAL CARE IN THE WORKHOUSES IN BIRMINGHAM AND WOLVERHAMPTON, 1834-1914 by ALISTAIR EDWARD SUTHERLAND RITCH A thesis submitted to the University of ...»
This did not apply in Gibbon’s case and was unlikely to have applied in Watts’s case, as the majority of Wolverhampton’s MOs were appointed in their 20s. One exception was Thomas Galbraith, who was in his early 30s when he succeeded to Watts’s position as MO. He was still in office in 1914 and until that time, the only serious complaint against him arose once more because of illness. He needed reminding of the times he was required at the workhouse because of late and irregular attendance in his early years of appointment. It was also impressed upon him that his ‘first and principal duties’ were to the inmates of the workhouse.138 Two years later, he was again requested to be more punctual as his later arrival at the institution disrupted the serving of meals.139 Early in the twentieth century, a tramp, William Buck, complained that the MO had not seen him, although he had requested a visit on his arrival at the workhouse late one evening. Galbraith was unwell at this time and his deputy, Dr Carter, had left the workhouse before Buck arrived, but returned in the late evening to visit patients in the infirmary. He did not see Buck, as the nurse informed him that everyone in the tramp wards would be in bed and no one needed to be seen urgently. Carter did not visit the following day (Monday), as he assumed Galbraith would be fit for work and Buck left the workhouse early the following morning.
Ibid., 7 April 1898.
‘neglect in his duties’, but felt he had done his best in difficult circumstances.
Nevertheless, the board instructed Galbraith that, in future, he must ensure the master is made aware directly of the arrangements in place, if he is unable to attend.140 Over the period of this study, Reading Union workhouse employed three MOs on a part-time basis similar to Wolverhampton, but there are no recorded incidents of nonattendance or charges of neglect of duty.141 Similarly, no charges were brought against the WMOs for Nottingham union. They were employed on a whole-time basis and not allowed to practise privately, but also had district duties. Although they were designated as resident, they were required only to live as close to the workhouse as possible.142 Leicester Union WMOs had similar contracts to Wolverhampton and, while two remained in post for around ten years, one did so for 34 years. John Moore, appointed in 1857, suffered ill health toward the end of his ten-year appointment.
When he failed to reduce a fracture of an inmate’s leg, which developed gangrene and resulted in her death, he was asked to resign.143 The longest-serving MO, Clement Bryan, was a lax record-keeper, which resulted in him being questioned several times, but no charges against his conduct in other matters were ever brought, and no complaints by patients about their treatment were recorded.144 By requiring WMOs to be resident, it might be assumed that Birmingham guardians had insured that attendance at the workhouse would not be an issue. However, the officers were not required to be present at all times, although their movement in and WALS, WBG, PU/WOL/A/30, 30 January 1903; House Committee (hereafter HC), PU/WOL/E/1, 29 January, 26 February 1903.
Railton and Barr, Battle Workhouse.
Negrine, ‘Medicine and Poverty’, p.57.
Ibid., pp.60-63, 66.
out of the workhouse was recorded in the porter’s book. As a result, one surgeon, Redfern Davies (in post 1858-61) was required to resign because of insufficient time in the institution. He first came into conflict with the guardians over his attempts to carry out major operations in the workhouse, rather than transfer patients to the local voluntary hospitals, as preferred by the guardians. He defended his views vigorously at first, but eventually apologised and accepted he could only operate in the workhouse in cases of urgency and when the patient was unfit to be transferred.145 Davies was an enthusiastic and ambitious surgeon, who published reports of his practice in the medical press. The son of a local physician and Birmingham’s first coroner, Birt Davies, he had extensive local medical connections. After he had sustained an accident in December 1860, he thanked the guardians for allowing him leave to recover as he felt ‘I should have broken my heart’ if not permitted to return to work.146 Around this time, it came to light that Davies had been absent from the workhouse on numerous occasions, although he had been accustomed to do so prior to his accident. He had been leaving the workhouse daily, usually for about five or six hours for health reasons and intended to continue to do so.147 Although he initially declined to resign when requested by the guardians, he eventually agreed after they requested an enquiry by the LGB and he accepted that his absences were more numerous than he had thought, due to ‘want of memory’.148 It is possible that he did so to pursue medical interests elsewhere. The only other Birmingham MO to face charges of negligence was Adam Simpson, but before further discussion of his case, it is necessary to discuss puerperal fever, which was central to the cause of his dismissal.
BCL, BBG, GP/B/2/1/23, 22 February, 8 and 22 June 1859.
BCL, BBG, GP/B/2/1/26, 21 August 1861.
BCL, VGPC, GP/B/2/8/1/3, 16 August 1861.
BCL, BBG, GP/B/2/1/26, 25 September, 9 October 1861.
Puerperal fever was the major single cause of maternal death after childbirth, with a fatality rate of between 35% and 80%; the earlier the onset of the condition, the higher the mortality.149 The disease reached epidemic proportions in lying-in institutions in the nineteenth century, although sporadic cases also occurred.150 The commonest causative organism was Streptococcus pyogenes, discovered by Pasteur in 1879. The bacterium gained entry via the traumatised birth canal, resulting in local infection, including peritonitis, which could spread into the blood stream, causing septicaemia.
Symptoms usually began a few days after delivery, with shivering, headache, vomiting, abdominal pain and high fever.151 One of the earliest physicians to publish evidence of the contagious nature of the disease and of its transmission by midwives and doctors was Alexander Gordon in 1795, following an outbreak near Aberdeen.
According to Loudon, Gordon’s ‘brilliant treatise’ was neglected and forgotten because it could not be linked to generally accepted knowledge at that time.152 Further evidence in support of the contagious theory was provided by Oliver Wendell Holmes in America in 1843 and Ignaz Semmelweiss in Vienna in 1847, the latter significantly reducing maternal mortality in hospital by instituting hand washing using a solution of chloride of lime.153 However, both met with formidable opposition from the medical establishment, most likely due to the inference that doctors spread the disease. However, Loudon suggests that, by the 1850s, it was difficult for doctors to plead total ignorance of the part played by contagion.154 For 20 years from the mids, the contagious versus miasmic nature of puerperal fever attracted considerable I. Loudon, The Tragedy of Childbed Fever, Oxford, 2000, p.6; this is the major text devoted to the history of puerperal fever.
M. Dobson, Disease, the Extraordinary Stories Behind History’s Deadliest Killers, London, 2007, p.72; Loudon, Childbed Fever, p.6.
W. F. Bynum, Science and Practice of Medicine in the Nineteenth Century, Cambridge, 1994, p.205; Loudon, Childbed Fever, p.5.
Loudon, Childbed Fever, pp.13, 32.
attention by the medical press and, by the end of this time, most British lying-in hospitals had adopted Joseph Lister’s methods of antisepsis, with a subsequent decline in maternal mortality.
Adam Simpson, LRCS, Ed., was born in county Tyrone in Ireland in 1836 or 1837.
He remained single and after he left the service of Birmingham workhouse, he lived in nearby Gillott Road with his unmarried sister.155 He was appointed WMO in August 1870, but the records for that period of the Visiting and General Purposes Committee, which recommended his appointment to the board, are missing from the archives. He suffered at least four episodes of ill health in his first five years in office, one of which was described by the master as a ‘serious illness’.156 When he unsuccessfully applied for the post of surgeon to West Riding Prison in 1875, the guardians’ testimonial stated he had given them ‘utmost satisfaction’ in the performance of his duties.157 Medical assistance in the workhouse increased in 1876 with the appointment of an AMO and again two years later, when a further assistant was appointed. With the appointment of a visiting physician in 1882, Simpson’s duties were limited to the surgical side of the infirmary.
The first LBG enquiry into his conduct took place 16 months after the first AMO had been in post and it centred on whether the deaths of Henry Binks and a man named
In his will, he left a bequest to the National University of Ireland in Dublin on condition that Irish would be a compulsory subject in the university’s matriculation examination. It became available to the university in 1923 and was used to fund a journal of Irish studies, Eigse, until 1999 and afterwards a post-doctoral fellowship; BCL, Register of Wills, 1913, pp.l469-72; http://www.nui.ie/eigse/journal history, accessed 26 June 2009; http://www.nue.ie/awards/research.asp, accessed 8 December 2009.
BCL, BBG, GP/B/2/1/40, 27 December 1871; VGPC, GP/B/2/8/16, 30 August 1872, 2 January 1874, 16 April 1875.
BCL, BBG, GP/B/2/1/44, 10 November 1875.
infirmary in the mid-afternoon after diagnosing bronchitis, but did not consider his condition needed urgent further attention. In the ward Binks was given milk, beef tea and a dose of the cough mixture kept on the ward when he became breathless. When seen again by Simpson at 8pm, he had deteriorated and was prescribed brandy and a linseed poultice for his chest. The cause of death was accepted as bronchitis by the coroner, but the jury at the inquest were of the opinion that Binks should have received earlier attendance. Simpson disagreed that this would have affected the outcome.158 After the LGB requested the guardians to obtain his resignation, Simpson placed the matter before the board, remarking on the kindness and courtesy he had ‘invariably received at [their] hands’ over the previous seven years. The board considered he had not given ‘all attention’ required to Binks, but there was no direct evidence to ‘inculpate’ him in the Washbrook case. They concluded that censure was sufficient and gained the LGB’s consent to retain him in office.159 In deciding Simpson’s future, the guardians, undoubtedly, took into consideration the remarks by the LBG that he had under his care more patients than he could properly attend to, even in the most cursory manner. They were also of the opinion that he was uniformly kind to his patients.160 This incident led to the setting up of an enquiry by the guardians into the deficiency in medical and nursing staff in the infirmary and to the subsequent appointment of the second AMO. Four years later, Simpson was charged with using medical treatment as a punishment for patients by confining Ellen Peters, of reputed sound mind, in the padded room. There were also allegations by the Nurse Burns that blisters and shower baths were being used to punish Peters and Mary Jane Skett. Peters was a patient in the venereal ward and her conduct had been TNA, MH12/13326, 26 March 1877.
BCL, HSC, GP/B/2/3/3/6, 1 May 1877; VGPC, GP/B/2/8/1/7, 21 September 1877; BBG, GP/B/2/1/45, 26 September, 24 October 1877.
BCL, VGPC, GP/B/2/8/1/7, 21 September 1877.
strange, plus breaking windows, trying to cut her throat and ‘exposing her person’.
Skett had been in the imbecile wards for three years. Both claimed they had been subjected to shower baths and blisters as punishment and had been told as much by the two AMOs. At least one of the guardians found it difficult to believe that blisters were ‘proper treatment’. At a local enquiry, Simpson did not directly deny the use as punishment, nor state they were used as treatment.161 Price considers that the case was built on a contemporary grey area between methods of workhouse punishment and medical ideas on treatment of pauper lunatics.162 Wolverhampton guardians made this distinction in 1902, when the MO sent William Lewis to the ‘syphilitic ward’ after he had been causing annoyance to other patients. Lewis was not suffering from venereal disease, but only one inmate on that ward was, because of no available space in the infirmary. After Lewis complained he had been transferred as a punishment, the guardians accepted that the MO had the authority to send patients to any ward he deemed best for medical treatment, but informed the MO it was improper to do so as punishment.163 Baths and showers were used both as treatment and punishment in the early nineteenth century, and Leonard Smith has pointed out that the distinction between the two inevitably became intermingled.164 Thus, Simpson’s actions were in current use as medicinal treatments and he assessed the inmate involved as suffering from mental illness. The guardians referred the matter to the LGB as Simpson no longer retained their confidence, but the central authority merely censured him.165 This incident led to the appointment of the visiting physician the TNA, MH12/13338, 17 December 1881.
Price, ‘Quantitative and qualitative study’, p.315.
WALS, HC, WOL/PU/E/1, 31 December 1902.
L. D. Smith, ‘Behind Closed Doors; Lunatic Asylum Keepers, 1800-60’, Social History of Medicine, 1 (1988), pp.321-22.
BCL, VGPC, GP/B/2/8/1/8, 9 December 1881; BBG, GP/B/2/1/49, 14 December 1881; BPP, 1886 (19-Sess. 2), pp.11, 22; Anonymous, ‘Charge Against the Medical Staff of the Birmingham Workhouse’, British Medical Journal, ii (1881), p.993.