«MEDICAL CARE IN THE WORKHOUSES IN BIRMINGHAM AND WOLVERHAMPTON, 1834-1914 by ALISTAIR EDWARD SUTHERLAND RITCH A thesis submitted to the University of ...»
Poor law nurses in Bedfordshire c. 1770-1834’ in P. Lane, N. Raven and K. D. M. Snell (eds), Women, Work and Wages in England, 1600-1850, Woodbridge, 2004; S. King, ‘Regional Patterns in the Treatment of the Sick Poor, 1800-40’ Family and Community History, 10 (2007), pp.61-75; Negrine, ‘Medicine and Poverty: A Study of the Poor Law Medical Services of the Leicester Union 1876-1914’, (unpublished PhD thesis, University of Leicester, 2008); A. Tomkins, ‘The Excellent Example of the Working Class: Medical Welfare, Contributory Funding and the North Staffordshire Infirmary from 1815’, Social History of Medicine, 21 (2008), pp.13-30; D.
Green, ‘Icons of the New System:
Workhouse Construction and Relief Practices in London under the Old and New Poor Law’ The London Journal, 34 (2009), pp.264-84.
B. Reay, Microhistories: demography, society, and culture in rural England, 1800-1930, Cambridge, 1996, p.xxii.
M. Worboys, ‘Practice and the Science of Medicine in the Nineteenth Century’, Isis, 102 (2011), pp.110-12.
J. H. Warner, ‘The History of Science and the Science of Medicine’, Osiris, 10 (1995), pp.189-90.
throughout the nineteenth century.31 Birmingham parish workhouse was established in the early eighteenth century and provided a medical service to the town for almost 50 years prior to the erection of a voluntary hospital. It developed into one of the largest poor law institutions in England and toward the end of the nineteenth century its infirmary was separated geographically and administratively from the workhouse.
In these respects, it was more in keeping with poor law institutions in London than average-sized provincial workhouses. It also resembled metropolitan workhouses in terms of its high institutionalisation rate with regard to paupers in general and older paupers in particular.32 As a result, the practice of poor law medicine in Birmingham could be held to be atypical of provincial towns. The choice of Wolverhampton workhouse corrects this possible anomaly. Wolverhampton Union was established after the NPL, by the amalgamation of four parishes, and the union workhouse was a medium-sized institution in which the infirmary remained integral. In these ways, it was more typical of NPL urban workhouses and yet the community in which it was located was similar to Birmingham’s.
The emphasis in the study is on adult physical medicine. Poor law records relating to the health of children are sparse as they dwell mainly on their educational requirements.33 Furthermore children in Birmingham were moved to cottage homes, with medical facilities, in 1880 and those in Wolverhampton were transferred ten years later. Those with mental illness or disability as the sole diagnosis are not J. Vernon estimates that the populations of Birmingham and Wolverhampton increased tenfold between 1801 and 1931, in Distant Strangers: How Britain Became Modern, Berkeley, 2014, p.24.
A. Ritch, ‘English Poor Law Institutional Care for Older People: Identifying the “Aged and Infirm” and the “Sick” in Birmingham Workhouse, 1852-1912’, Social History of Medicine, 27 (2014), pp.76see Appendix L.
The one study that has addressed the care of children in the workhouse is F. Crompton, Workhouse
Children, although others which contain separate chapters or substantial sections on children include:
Negrine, ‘ Medicine and Poverty’; N. Longmate, The Workhouse, London, 1974; Higgs, Life in the Victorian and Edwardian Workhouse.
covered, since ‘lunatics, imbeciles and idiots’ have been the subjects of more studies than other classes of pauper and because a lack of space within the word limit of the thesis would not allow full justice to be given to this group.34 Because of rapid population expansion throughout the nineteenth century, the workhouses in both towns experienced continual overcrowding, which necessitated the erection of additional wards and buildings. Nevertheless, there were important differences in their approaches to the provision of poor law medical services. While Birmingham always provided separate facilities for sick inmates and employed nurses and a resident medical officer (hereafter MO), discrete sick wards and paid nurses were a later development in Wolverhampton, where MOs were employed on a part-time basis. Both institutions developed into large general hospitals in the early twentieth century, a role they continue to play today. The study starts in 1834 at the time of the Poor Law (Amendment) Act, although Wolverhampton Union was not formed until two years later. Birmingham continued as a Local Act Parish until it combined with two local unions in 1912 to form the large Birmingham Union and the use of the poor law buildings within the combined union was revised in a plan put forward by the medical superintendent the following year. However, war broke out before the reorganisation could take place and 1914 has thus been chosen as the end date for the period of study. This has the added advantage of not encroaching on the 100-year rule, which makes accessing archives more difficult. The main primary sources were the minutes of the board of guardians and its various committees. The minutes reflect L. Smith, ‘The Pauper Lunatic Problem in the West Midlands, 1818-1850’, Midlands History, 21 (1996), pp.106-13; A. Scull, Museums of Madness: The Social Organisation of Insanity in NineteenthCentury England, London, 1979; A. Scull, The Most Solitary of Afflictions: Madness and Society in Britain, 1700-1900, New Haven, 1993; J. Melling and B. Forsythe, The Politics of Madness: The State, Insanity and Society in England, 1845-1914, London, 2006; L. Smith, Cure, Comfort and Safe Custody: Public Lunatic Asylums in Early Nineteenth-Century England, Leicester, 1999; P. Bartlett, The Poor Law of Lunacy: The Administration of Pauper Lunatics in Mid-Nineteenth–Century England, London, 1999.
the guardians’ primary concern with the management of poor law relief and entries could be limited to brief reports of issues discussed or merely a record of the outcome of debate. Birmingham usually recorded in detail letters and reports, whereas Wolverhampton only noted their receipt. However, Wolverhampton’s meetings were reported in greater detail each week in the Wolverhampton Chronicle. Masters’ journals elaborated on day-to-day events, but only one was available in each location and each covered only a few years. Matters concerning the sick were recorded sporadically, usually only at times when difficulties or complaints were experienced.
Minutes of committees and sub-committees concerned with infirmary management were more helpful in this respect, but were only available from the late nineteenth century. The poor law minutes were supplemented by reports of the central authorities on poor relief and of parliamentary enquiries, by census reports, local newspapers and correspondence between the central authority and the boards of guardians, accessed at The National Archives.
Poor Law Historiography The poor law administration gave rise to a massive archive of paperwork, but it contains little of the views and experiences of paupers themselves and even less in the case of pauper patients.35 Felix Driver has pointed out that they survive only in ‘fragmentary form, inevitably marked by the bureaucratic rituals of the system’.36 Despite this lack of direct source material, Roy Porter considered that a variety of Crowther, Workhouse System, p.193; Driver, p.3; N. Goose, ‘Workhouse Populations in the MidNineteenth Century’, Local Population Studies, 62 (1999), p.52. Despite a detailed study of the poor law medical service in Leicester, Negrine concluded that ‘the views of the majority of patients on their medical treatment and care are mainly unknown’, A. Negrine, ‘Medicine and Poverty’, p.126.
materials could yield information about patients’ experiences, while Digby asserts that the use of the available records can strip paupers of their anonymity and bring out the significance of the poor law in human lives.37 Recent studies have focussed on the experiences of the poor as found in pauper narratives.38 They were written frequently to obtain medical relief and so offer new insights into the relationship between poverty and sickness. The contributors to a volume dedicated to pauper narratives, Poverty and Sickness in Modern Europe, have described the experiences of the dependent poor in a number of countries, but research to date has ‘barely scratched the surface of the narrative material available’.39 In addition, few letters were sent to institutions and none written by paupers resident in the workhouse have become available.40 Further research may unearth letters from inmates, as this methodology is still in its early stages.41 Risse and Warner contend that clinical records are a valuable source of ‘medical experiences and perceptions of the past’ and can help define the changing nature of clinical behaviour and practice.42 As no routine recording of medical details was required within workhouse infirmaries, surviving poor law records are not a rich source of clinical information. Therefore, this study is less a ‘history from below’, than a social history, drawing out medical details and the experiences of inmates and patients where possible.
R. Porter, ‘The Patient’s View: Doing Medical History from Below’, Theory and Society, 14 (1985), p.183; Digby, Pauper Palaces, p.231.
Gestrich, Hurren and King (eds), Poverty and Sickness in Modern Europe; Tomkins, ‘Workhouse Medical Care’, pp.86-102; King, ‘Regional Patterns in the Experiences’, pp.61-75.
Gestrich, Hurren and King, ‘Introduction’, p.13.
Ibid., pp.12, 24; Tomkins, ‘Workhouse Medical Care’, p.99.
Gestrich, Hurren and King, ‘Introduction’, p.13.
Risse and Warner, pp.183, 202.
Historian Ludmilla Jordanova has suggested that local studies are more likely to access such sources.43 King has made the point that ‘detailed local studies of poverty and the operation of the poor laws have been notable for their absence’ and that the systematic local study is uncommon.44 Nigel Goose is in agreement when he draws attention to the lack of studies which are ‘firmly rooted within the local or regional economic and social context’ and the ‘specific circumstances of local communities’.45 Intensive local studies can contribute to the general understanding of the character of the poor laws, as considerable local control over poor law administration led to wide variability in implementation throughout England. Also, they can reveal hidden complexities, which can supersede a broader picture.46 Digby’s regional study of workhouses in Norfolk was one of the first to demonstrate how local perspectives have been valuable in creating a more balanced national picture and she maintains that more such studies could supply ‘valuable additional information on poor law topography’.47 Local studies of poor law medical services have been carried out by Angela Negrine in Leicester and Ennis Bosworth in Nottingham.48 Both conclude that a genuine effort was made to provide good standards of medical care for most of the time and that considerate treatment was often provided. However, they consider that it is difficult to evaluate the quality of care when the attitude and views of patients are missing from the records.49 More recently, Graham Butler has carried out an analysis of the institutional and medical responses to sickness and disease in L. Jordanova, ‘Has the Social History of Medicine Come of Age?’ Historical Journal, 36 (1993), p.441.
Tomkins, Experience of Urban Poverty, p.235.
Digby, Pauper Palaces, p.232. This view is supported by Negrine, p.322; King, Poverty and Welfare, p.4; Jordanova, p.441; Rose, p.4; Driver, pp.73-74; Kidd, p.46.
Negrine, ‘Medicine and Poverty: A Study of the Poor Law Medical Services of the Leicester Union 1876-1914’ ; Bosworth, ‘Public Healthcare in Nottingham 1750-1911’ (unpublished PhD thesis, University of Nottingham, 1998).
Negrine, p.236; Bosworth, p.269.
Newcastle-upon-Tyne between 1750 and 1850.50 He found that workhouse medicine was an important element within the medical response to sickness in this industrial city and was more complex than has been described in other provincial workhouses.51 However, microstudies relating to the sick poor remain relatively uncommon across Europe and few have investigated the attitude of paupers to their illnesses or to medical officials.52 The recent trend in poor law historiography has been to stress diversity and regionalism. King has questioned whether England had a single welfare system under the NPL, rather than a number of ‘coalescing’ systems, whereas Alan Kidd is more dogmatic that there never was a ‘national poor law’.53 However, he has cautioned against the temptation to make generalisations suggesting a uniform welfare system from a few local or regional studies.54 Within local or regional historiography, the workhouses of the large provincial cities have been neglected, particularly those with rapidly expanding populations in the early nineteenth century as a result of industrialisation.55 London’s poor law institutions have received extensive scrutiny, but its medical welfare system has been described as so dissimilar to other major English cities as to be ‘something of an oddity’.56 David Green’s study of the poor laws in the capital has confirmed its heavy reliance on indoor relief and high rates of pauperism.57 Michael Rose’s contention that the recent historiography of the nineteen-century poor law has a rural bias would account for the paucity of studies of G. A. Butler, ‘Disease, Medicine and the Urban Poor in Newcastle-upon-Tyne, c. 1750-1850’ (unpublished PhD thesis, Newcastle University, 2012).
Gestrich, Hurren and King, ‘Introduction’, p.23.
King, Poverty and Welfare, p.10; Kidd, p.46.
Kidd, pp.18, 30.
There have been studies carried out of smaller industrial cities and towns, for example, Negrine in
Leicester; Marland in Wakefield and Huddersfield; P. Wood, ‘Finance and the urban poor law:
Sunderland Union 1836-1914’, in M. E. Rose (ed.), The poor and the city: the English poor law in its urban context, 1834-1914, Leicester, 1985, in Sunderland; Driver in Huddersfield; Fissell in Bristol.
King, Poverty and Welfare, p.13.
D. Green, Pauper Capital, Farnham, 2010, pp.38, 153, 191-92.