«MEDICAL CARE IN THE WORKHOUSES IN BIRMINGHAM AND WOLVERHAMPTON, 1834-1914 by ALISTAIR EDWARD SUTHERLAND RITCH A thesis submitted to the University of ...»
had been prescribed alcohol, but it was also being given to inmates employed in disagreeable work, including those caring for epileptic patients. Without their help, eight extra nurses would have been required, costing an estimated £400 annually. The guardians were encouraged that the cost per inmate was lower than the average for urban unions and made no changes to existing arrangements.102 Birmingham guardians were also concerned in the early 1880s that medical extras had become excessive and sought advice from the LGB. Their inspector, Dr Mouat, re-iterated one of the principles of the poor law in treating the sick, namely ‘that they should be denied nothing that was essential to their health… but must not have luxuries or what they would not have in their own station in life’. He was, thus, applying the principle of less-eligibility to sick inmates, but, if alcohol was an essential treatment, those who were destitute would qualify for it whether at home or in the workhouse, and those who were poor could receive it in voluntary hospitals. It appears to have been used as a reason to limit consumption, as he went on to say that the effect of alcohol could be obtained by prescribed medicines, such as beef tea and Liebig’s Extract.
BCL, VGPC, GP/B/2/8/1/8, 23 June 1882.
BPP, 1895 (44), p.25; BCL, BBG, GP/B/2/1/6, 9 and 24 April 1849.
was strong in Birmingham.105 For example, Joseph Chamberlain introduced schemes for municipalising the drinks trade in the town in the second half of the nineteenth century.106 At the end of the century, the amount of beef, eggs, milk, tapioca, poultry, port wine and brandy had increased in the infirmary despite the same average number of patients, but the volume of whisky consumed had deceased.107 In the last decade of the century, Wolverhampton guardians considered the latest parliamentary return on the consumption of alcoholic liquors in workhouses.108 One guardian expressed the view that it was much greater in Wolverhampton than the majority of other workhouses and showed no sign of decreasing if the current MO remained in post. However, rather than calling for his resignation, the guardians decided to call the MO’s attention to the desirability of reducing it, as the amount prescribed to the sick was in excess of other workhouses. They also prohibited the issue of alcohol to inmates not requiring it for medical reasons.109 Table 5.2 suggests that Wolverhampton was above the national average for consumption per inmate, but that it had not changed from ten years before, whereas there had been a decline across the country. The following year, the auditor’s report alleged misconduct on the MO’s behalf in the prescription of ‘intoxicating liquors’ in the workhouse. Edward Watts denied the accuracy of the charges and gave an explanation of his practice of ordering stimulants in a written response, which the guardians accepted as a satisfactory answer.110 Early in the twentieth century, the expenditure on spirits for the infirmary in the new workhouse was again under scrutiny. The additional bed capacity may J. Nicholls, The Politics of Alcohol: A history of the drink question in England, Manchester, 2009, p.138.
BCL, Infirmary House Sub-committee (hereafter IHSC), BP/B/2/4/5/2, 9 May 1901.
The return in question was BPP, 1892 (292).
WALS, WBG, PU/WOL/A/24, 25 November, 9 December 1892.
Ibid., 17 March 1893.
have led to greater consumption, but, as Table 5.3 shows, the cost had increased before the move into the new institution in 1903, following which a greater range of spirits were provided.111
Although Wolverhampton guardians were concerned over expenditure on alcohol, they also expressed a desire to obtain a good quality product. In 1899, they expressed a wish to pay 25s per gallon for port wine, but on being told by the clerk that this was not economic, they reduced the amount to 15s.112 However, three years later, they raised this to 18s and decided that brandy should be three-star in quality.113 The alcoholic strength of sherry was confirmed to be satisfactory for its use in making white wine whey, administered to patients suffering from diarrhoea. The other ingredients of this concoction were milk and boiling water and it was also used in the treatment of fevers.114 Thus, there was conflict between the guardians’ continual attempts to control the cost of alcohol consumption, and their desire to ensure that what was available was of sufficient quality to be an effective remedy.
WALS, HC, PU/WOL/E/2, 27 March 1906.
WALS, WBG, PU/WOL/A/28, 29 September, 18 and 27 October 1899.
WALS, WBG, PU/WOL/A/29, 11 April 1902.
WALS, WBG, PU/WOL/A/32, 18 October 1907; Williams, p.551.
The use of alcohol by WMOs for its perceived therapeutic benefits varied considerably between workhouses throughout the country. For example, Edward Davies, WMO in Wrexham, abandoned the use of alcoholic drinks in the treatment of disease in 1873. Cases of erysipelas, typhoid fever and pneumonia were managed with ‘medicinal stimulants and nutritious diet’, such as milk, eggs and beef tea. The mortality rate in the workhouse fell from 41 for the three years before his prohibition to 36 for the same period afterwards.115 On the other hand, Alfred Sheen, MO to Cardiff workhouse and senior surgeon to Glamorgan and Monmouthshire Infirmary, cautioned against the liberal use of stimulants and advised that they should be ordered with the same care as was taken with the prescription of medicines. He applauded the reduction in their use and recommended the same approach as with patients in an ‘ordinary hospital’. He was of the opinion that ‘Cases of sickness occur where it would be a gross dereliction of professional duty, if not an act of culpable negligence, …to withhold stimulants’.116 The expenditure at Cardiff workhouse on alcohol was modest at 10s and 7d per patient in 1871 and at similar levels per inmate in 1881 and 1892 (9d and 8d) as Birmingham.117 This demonstrates that Sheen was moderate in his use of alcohol, while considering it essential for some patients. The medicinal use of alcohol remained a controversial topic among the medical profession throughout the nineteenth century.
BPP, 1876 (202), pp.3-4.
BPP, 1872 (391), pp.32-33; 1883 (108), p.19; 1895 (44), p.36.
Drug Therapy Treatment in the nineteenth century was essentially symptomatic and most drugs were herbal products or mineral preparations. The choice of treatment regimen did not depend on the diagnosis or nature of the illness, as there were only two specific therapies, quinine for intermittent fever and mercury for syphilis.118 The major component of the depletive regimen was cathartic drugs, which purged the patient, but were also thought to have a systemic stimulant effect. Although aloes, rhubarb and senna were used, the most popular purgative was calomel (mercurous chloride).119 However, it produced severe side effects, with excessive salivation, inflammation and bleeding of the gums, loosening of the teeth, profuse sweating and, in more severe poisoning, loss of teeth and necrosis of the mandible.120 Emetics, anodynes (analgesics), hypnotics and diaphoretics (drugs increasing perspiration) were included in the depletive regimen. Stimulant drugs consisted mainly of bitters and tonics to increase the general strength of the body and promote appetite and diuretics to promote the excretion of urine. The most popular was Peruvian bark containing quinine; but iron compounds were also used. Arsenicals, most commonly in the form of Fowler’s solution, were thought to be useful for numerous conditions and regarded as a ‘multi-potent drug’.121 Wolverhampton Board of Guardians became concerned in 1855 at the method employed in dispensing medicines in the workhouse. The nurse who was instructed by the MO to prepare pills of calomel passed the task onto one of the older female Warner, Therapeutic Perspective, pp.62-63.
Risse, pp.192, 198.
Ibid., pp.199-200; Warner, Therapeutic Perspective, p.141.
J. C. Whorton, The Arsenical Century, Oxford, 2010, p.236.
inmates. As a result, it was given to patients without the required amount of mercury being weighed. Calomel was used to treat fevers and, for cholera, was given as ‘blue pill with soap’.122 Richard Nugent, MO, described the treatments in general use in the workhouse. The ‘Universal Assafoetida Pill’ was given to old women and ‘asthmaticals’. It contained gum resin that was considered to be an antispasmodic and expectorant, useful for treating cough in older people. The other pills in general use were Pil Hydrarg, which contained only mercury dissolved in nitric acid, and Pil Saponis cum Opio, the soap considered to be beneficial for digestive disorders.
However, the most frequently used medicine was ‘Salts and Magnesia’, which may have been a term used for Magnesii Sulphas, or magnesium sulphate, used as an antacid.123 Because of the disquiet regarding the system of dispensing, the MO was requested to change the practice, but the guardians deferred discussion on the issue of whether all medicines should be purchased by them.124 The MO was required to pay the cost of drugs he prescribed and he estimated this in 1866 as £50 per annum out of his salary of £130. He considered the guardians should have covered the cost of the castor oil and quinine required by patients.125 The guardians decided against paying for medicines until ten years later, at which time they also appointed Samuel Richards as workhouse dispenser.126 Eleven years later, they became concerned at the rising cost of the drugs bill and took steps to limit the amount of any drug dispensed to no more than that indicated on the prescription. They also requested the MOs to agree a common form of the main drugs used.127 TNA, MH12/11682, 23 January 1856.
Ibid.; T. J. Graham, Modern Domestic Medicine, London, 1848, pp.6, 56.
WALS, WC, 14 February 1855; WBG, PU/WOL/A/9, 9 March 1855.
WALS, WC, 3 October 1866.
WALS, WBG, PU/WOL/A/16, 20 and 27 November, 11 December 1874.
Ibid., PU/WOL/A/20, 5 June 1885.
Prior to the passing of the Poor Law Amendment Act (1834), Birmingham guardians employed two resident dispensing apothecaries in addition to the house surgeon.128 Because of the increasing influence of the PLB, the guardians relieved the dispensers of their duties in 1850, in spite of the number of sick inmates increasing from an average of 135 in 1834 to 233 in October 1847.129 The increased workload of the MO eight years later, with an average of 318 patients in the infirmary, made it necessary for the guardians to re-employ a non-resident dispenser.130 The guardians became concerned that the expenditure on drugs had increased by over £217 in the six months from September 1886 to March 1887 compared to the equivalent period the previous year. The dispenser reported that prescriptions had increased by 120 daily between the two periods and a greater variety of drugs were used instead of ‘stock’ items. The purchase of iodoform, which was expensive, had cost around £40 and the use of another expensive drug, iodide of potassium, had increased threefold. The Infirmary Committee considered the additional outlay was justified as the number of sick inmates discharged from the infirmary to the workhouse or their homes had increased from 1,856 in the earlier period to 1,947 in the later one and deaths in the infirmary had decreased from 630 to 557. The Committee concluded that ‘we can confidently assert that the Sick Inmates are made most comfortable, that their lives are prolonged, and that they are fully treated up to the scientific attainments of the present day’.131 When the infirmary moved to its new building in 1889, a temporary part-time dispenser was employed for the workhouse only, although the guardians considered BCL, BBG, GP/B/2/1/3, 16 November 1831.
Ibid., GP/B/2/1/6, 11 December 1849 ;GP/B/2/1/3, 8 July 1834, 4 January 1835; GP/B/2/1/5 12, October 1847.
Ibid., GP/B/2/1/15, 28 February 1855.
BCL, ISC, GP/B/2/4/1/4, 25 November 1887; an abbreviated version of this quotation appears at the beginning of this chapter.
doing without one. Ebenezer Teichelmann, WMO, estimated that the 30 prescriptions he wrote daily for the treatment of workhouse inmates would take two hours to dispense and recommended the dispenser be continued for three hours each day. The large number of prescriptions was necessary as the majority of the 98 patients in the convalescent and new chronic wards were on medication.132 In the new infirmary, it was decided to keep a stock of drugs in locked cupboards in the wards, but to have them sent to the dispensary for checking monthly (Appendix C).133 They consisted mainly of purgatives, laxatives, expectorants, astringents, analgesics, tonics and stimulants, as well as ointments for local application. The following year, the ward list also contained morphine, cocaine and ether. Senior nurses were now allowed to
understanding of how drugs were employed in the workhouse, it is necessary to consider how specific disease states were treated.
‘The Itch’ The itch was an ambiguous condition of the skin, which covered a variety of dermatological diseases. Despite its omnipresence in poor law institutions and its links to immorality and poverty, few historical studies have been undertaken since the first half of the twentieth century.135 Although the itch was associated with venereal disease and leprosy, a common, but not universal cause was scabies caused by the mite, Sarcoptes scabiei, which burrows into the epidermis, where the female lays her BCL, WMC, GP/B/2/3/2/1, 11 April 1890.
BCL, WIMC, GP/B/2/4/4/2, 15 May 1895.
Ibid., 15 May 1896.