«MEDICAL CARE IN THE WORKHOUSES IN BIRMINGHAM AND WOLVERHAMPTON, 1834-1914 by ALISTAIR EDWARD SUTHERLAND RITCH A thesis submitted to the University of ...»
The main form of local treatment was the instillation of antiseptic solutions of silver salts into the male urethra and the vagina in women, but oral therapy with copaiba was thought useful in men.171 The majority of workhouses had dedicated ‘venereal’ or ‘lock’ wards. In the mids, Birmingham workhouse provided one ward of ten beds for men and three wards with a total of 31 beds for women (Appendix H), while Wolverhampton had one ward of five beds for men and three wards, each with five beds, for women.172 During the first week in January 1876, there were 55 patients with venereal disease in the Birmingham wards, constituting 6% of all sick patients, and eight (5%) in Wolverhampton, compared with an average of 2% in English workhouses.173 However, Wolverhampton guardians accepted that there would be ‘those who have BPP, 1913 [Cd. 7029], pp.16-18.
Parker, paragraphs 100-1; copaiba was an oil-resin obtained by incising the trunks of several species of Copaifera.
BPP, 1867-68 (4), pp.46, 153.
BPP, 1877 (260), pp.10-11, 17.
come to be cured of venereal disease’.174 At times, there were no venereal patients in Wolverhampton and only 26 beds were allocated for ‘syphilitic and skin’ patients in the infirmary in the new workhouse in 1903.175 As a result, Wolverhampton’s records contain few details regarding venereal patients and the treatment prescribed is not available from the minutes in either town. Nevertheless, in 1857, John Wilmshurst, WMO in Birmingham, claimed to provide superior treatment compared to that in other workhouses, where they were neglected by being ‘dosed with salt and senna and discharged cured’.176 Although he provided ‘specific medical treatment’, it is not clear whether he was using mercury, which had been in regular use in workhouses to treat venereal disease in the eighteenth century or perhaps the more recently introduced potassium iodide.177 He attributed his treatment to attracting an increased number of venereal patients to the workhouse and his view was given some support by a statement from workhouse inmate Emma Rose, aged 23 years. Rose was a resident at Kidderminster, where she had been in the workhouse for three months.
She claimed to have been confined to bed for that time, denied treatment and
recommendation of a fellow venereal patient at Kidderminster, she had travelled to Birmingham with the express purpose of being admitted to the workhouse. The MO at Kidderminster workhouse supplied details of the treatment she had received when she was there. He believed she did not require ‘internal remedies’, but silver nitrate WALS, WBG, PU/WOL/A/13, 15 November 1867.
WALS, WBG, PU/WOL/A/5, 23 August 1844; Wolverhampton Journal Illustrated Vol. II, LS/LO7/79, p.liv.
BCL, VGPC, GP/B/2/8/1/2, 7 August 1857.
Siena, Venereal Disease, pp.172-73.
had been applied daily for the removal of condylomata, as she had refused the quicker remedy of nitric acid.178 Toward the end of the century, the number of venereal patients in the workhouse in Birmingham diminished, totalling three males and seven females in September 1892.
As a result, the guardians hoped to transfer them to the Lock Hospital on a payment per patient basis. However, this did not prove possible due to the pressure of work at
arranged that venereal patients could be transferred temporarily to the ‘Skin and Lock Hospital’ for treatment with salvarsan for a course of therapy of up to ten days duration. They agreed a fee of 21s for one week or part of one week plus the cost of the drugs. In the following three months, Mary Whitehouse, Margaret Timmins, George Thomas and John Whitcombe all received salvarsan injections. Timmins returned to the workhouse much improved, but returned to the Lock Hospital for a second course of treatment, as did George Thomas.180 It is of interest to note that the guardians preferred to refer these workhouse inmates to the specialist hospital for treatment, rather than arrange it at their own infirmary, which at that time was developing into a general hospital.
BCL, BBG, GP/B/2/1/20, 18 November, 2 December 1857; condylomata are wart-like excrescences near the anus or vulva, which occur in the secondary stage of syphilis. Rose’s statement is available in full in A. E. S. Ritch, ‘“Sick, Aged and Infirm’’ Adults in the New Birmingham Workhouse, 1852– 1912’, (unpublished MPhil dissertation, University of Birmingham, 2010), pp.57-58.
BCL, HSC, GP/B/2/3/3/14, 21 June, 11 October 1892; Anonymous, ‘Weeding the Workhouse’, The Lancet, ii (1892), p.638; Reinarz, Health Care, p.110.
BCL, Western Road House Sub-committee, GP/B/2/3/15/1, 19 July, 20 September, 8 and 22 November, 6 December 1912.
Epilepsy The Hippocratic Corpus included a treatise on the ‘The Sacred Disease’, as epilepsy was known as in the ancient world. However, it was not until the later part of the nineteenth century that the nature of the epileptic process was elucidated by Hughlings Jackson, a London neurologist who is regarded as ‘the father of modern epileptology’.181 His definition of the epileptic seizure, as a manifestation of a paroxysmal disturbance of brain function, remains the one in current use.182 The most striking form of seizure is the grand mal fit, with sudden loss of consciousness, muscle spasm followed quickly by muscular jerking. Numerous therapies were employed, including antiphlogistic regimens, the most popular in the early nineteenth century being mistletoe, silver nitrate and zinc oxide.183 However, none proved to be able to prevent fits or reduce their frequency. The first drug to achieve this effect was potassium bromide, first reported in 1857 to have been tried as a result of a chance association. Subsequent reports over the next three decades confirmed that it had virtually superseded all other drugs in the treatment of epilepsy, though it did have the side effects of physical weakness, mental dullness and skin rashes, known as bromism.184 The next development in drug therapy, the introduction of phenobarbitone, did not take place until 1912.
W. J. Friedlander, The History of Modern Epilepsy: The Beginning, 1865-1914, London, 2001, p.2.
M. J. Eadie and P. F. Bladin, A Disease Once Sacred: A History of the Medical Understanding of Epilepsy, Eastleigh, 2001, pp.4, 147.
D. F. Scott, The History of Epileptic Therapy, Carnforth, Lancs, 1993, pp.37-38.
Ibid., pp.49-50; Friedlander, p.277.
From the beginning of the nineteenth century, epileptics were confined with the insane in asylums and workhouses.185 In the latter, they were usually accommodated in what were called the ‘lunatic’ or ‘insane wards’, although in Birmingham the name was altered in the second workhouse in 1852 to ‘epileptic wards’. Any inmate with any type of fit would be classed as epileptic and many of the children with fits would also suffer from mental disability. In the mid-1860s, there were 30 epileptic patients in Wolverhampton workhouse, constituting 4% of total inmates and 13% of those designated as sick; for Birmingham, the equivalent figures were 133 patients, 7% of inmates and 20% of the sick.186 Nationally, 4% of patients in workhouses suffered epileptic seizures in 1870.187 The number of epileptic patients increased over the next twenty years to 57 (6% of all inmates) in Wolverhampton and to 323 (145 of inmates) in Birmingham.188 It is surprising that, as they were a significant proportion of sick inmates, so little information about them has been recorded in the guardians’ minutes, but epileptics were usually included in the reports of the Commissioners in Lunacy (hereafter CsL). Birmingham’s WMO in 1882 was of the opinion that many inmates were classified as imbeciles, who were epileptic but had no mental disorder.189 At the end of the century, there were 12 sane epileptic patients admitted to a workhouse from Wolverhampton County Borough and 118 from Birmingham County Borough. In Wolverhampton at that time, 13% of patients in the insane wards were sane epileptics.190 O. Temkin, The Falling Sickness: a history of epilepsy from the Greeks to the beginnings of modern neurology, Baltimore, 1971, pp.255-56.
WALS, WC, 11 and 25 December 1867; BPP, 1867-68 (4), p.153; BCL, VGPC, GP/B/2/8/1/4, 22 May 1865.
BPP, 1870 (468-I), pp.24-25, 54.
WALS, WC, 28 June 1882, 14 March 1883; BCL, VGPC, GP/B/2/8/1/9, 14 August 1885.
BCL, VGPC, GP/B/2/8/1/8, 27 October 1882.
BPP, 1900 (362), pp.2-3; WALS, WBG, PU/WOL/A/28, 2 February, 8 June 1900.
In July 1845, Thomas Green, one of the visiting surgeons to Birmingham infirmary, took on the responsibility for the ‘lunatic department’. His detailed case notes are available for the 824 patients admitted over the next five years, until he resigned to take up the post of medical superintendent at the newly opened Borough Lunatic Asylum (Table 5.4).191 Of the 42 admissions in the first year, 9 required some form of restraint. George Proctor, aged 17 years, was prone to violent fits, which he had had from childhood, and wore a pair of boots at night, which were secured to the bedstead. William Roper, aged 20, was one of six patients who were secured at night with a strap, which went over the top of the bedclothes and was fastened to the sides of the bed. He and Frederick Wade, aged 25, also wore boots at times as well as the strap. In the case of Fanny Docker, aged 17, the strap was used to prevent her falling out of bed. It was tied to one side of the bed only when used for Emma Oxford, who had been having continual episodes of fitting for one week with seizures that were always ‘very violent’. However, Hannah Hoskins, whose fits occurred at intervals of one to two weeks, only required ‘slight restraint’ after some attacks. Venesection was used to good effect initially on 42-year-old James Benham, who had been epileptic for 25 years. When his fits returned after two months with greater violence, a further 16 ounces of blood was taken from his arm, but the result is not recorded. Frederick Wade’s fits had become less violent than at the time of admission in 1843. However, in April 1846, he became more violent again after fitting. He was noted to be deaf, have increasing enlargement of the ‘glands of the neck’, and was treated with one milligram of iodine, presumably as the swelling was thought to be a goitre.192 The clinical picture would be in keeping with a diagnosis of hypothyroidism.
BCL, BBG, GP/B/2/1/5, 22 July 1845; GP/B/2/1/6, 30 October 1849; Register of Insane (hereafter RI), MH/344/12/1, 1845.
BCL, RI, MH/344/12/1, 1845-50.
Although the CsL forbade the use of mechanical restraint, workhouse staff found it difficult to manage epileptics and lunatics without it.193 They were commonly used in asylums in the first half of the nineteenth century, especially confining patients to their bedsteads by means of straps. When, in 1852, the CsL recommended to Wolverhampton guardians that straps and ‘all other means of coercion’ should be removed for use by the attendants and kept locked up, the guardians complied.195 However, when they criticised the use of restraint in Birmingham a few years later, the workhouse master defended the practice as it was being used to prevent the women concerned from falling out of bed.196 In Wolverhampton in the mid-1870s, the danger of a fall from bed was minimised by allowing all the 18 epileptic women and 25 men to sleep in low bedsteads with padded headboards and sides.197 However, these beds were not in use in Birmingham infirmary 15 years later, although an attendant was present throughout the night to provide surveillance.198 At the end of the century, a restraint jacket was still available on the wards in Wolverhampton, although it was only used occasionally during the transfer of inmates to the asylum.199 There is no evidence to determine whether bromides were used in either workhouse, but potassium bromide solution is listed in the pharmacopeia of Cardiff workhouse in
1890.200 Nevertheless, frequent accounts of numerous fits taking place on the wards continue after the introduction of this remedy. During a visit by a Commissioner in Lunacy (hereafter CL) to Wolverhampton workhouse in the late 1860, several of the G. M. Ayers, England’s First State Hospitals and the Metropolitan Asylums Board 1867-1930, London, 1971, p.40.
L. D. Smith, ‘Behind Closed Doors; Lunatic Asylum Keepers, 1800-60’, Social History of Medicine, 1 (1988), pp.320-21.
WALS, WBG, PU/WOL/A/8, 7 May 1852; WC, 12 May 1852.
BCL, VGPC, GP/B/2/8/1/2, 9 November 1855.
WALS, WC, 3 January 1877.
TNA, MH12/13365, 26 February 1892.
WALS, Workhouse Visiting Committee (hereafter WVC), PU/WOL/A/2, 1 February 1900.
30 epileptic patients were lying on the floor fitting. The previous year, Edmund Howell sustained a severe injury to his nose when he fell at the onset of a seizure and, fifteen years later, one epileptic patient fractured his ankle as a result of banging his leg on the bathroom floor during a fit.201 In Birmingham workhouse in the early 1870s, Eli Ensor, aged 28 years, had a seizure around every seven days, Downes Ireland, 32 years, once per month and Elizabeth McGuire, 32 years, every seven to ten days.202 Dr Cornelius Suckling, Visiting Physician to Birmingham workhouse, provided details of the number of fits occurring per week among the 33 to 39 men in the epileptic wards over nine weeks in 1889. They ranged between 89 and 168, with a mean value of 138 and a median of 149. In addition, one man suffered 150 fits in one week.203 A few years before, the guardians received a letter of thanks from the ViceConsul of Sweden and Norway on behalf of one of his countrymen, F. Broderson, who had been a patient in the epileptic ward, where he was surprised when he saw Table 5.4: Epileptic and Insane Patients in Birmingham Workhouse, by Gender, 1845-50
23% 19% 5% 12% 16% 11% 11% 6% 1847-50 29 33 32 17 223 212
what could be done for the patients.204 However, it is not clear if he was epileptic or suffering from mental illness.