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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 alcohol, although they continually strove to restrict consumption, as they did with most other forms of expenditure. In this respect, they were no different to managers at voluntary hospitals, where restrictions on the medical use of alcohol were put in place. However, they do not appear to have had much success in Wolverhampton and Birmingham in curtailing its use. The evidence from these workhouses suggests that MOs continued to prescribe food, alcohol, drugs and other treatments despite pressure for restriction by guardians or outside agencies. Furthermore, the standard of care they provided was at times exemplary. The main factor limiting the treatment of patients was the capability of the nursing staff at administering the MOs’ orders and this aspect will be addressed in the next chapter.

–  –  –

During the nineteenth century nursing practice underwent major reform. At the time the New Poor Law (hereafter NPL) was enacted in 1834, the majority of nursing care in workhouses and workhouse infirmaries was carried out by inmates, who were predominantly older women. They were rewarded for their work with extra rations, which often included beer and gin, gaining them the reputation of working frequently in a state of intoxication. Pauper nurses were prone to be unreliable, incompetent, at times cruel, and liable to steal food and medication meant for patients.2 It was acceptable in the nineteenth century to imbibe alcohol while at work, though nurses in voluntary hospitals were also supplied with alcohol, often as part of their remuneration, and drunkenness among these nurses was therefore also not Wolverhampton Archives and Local Studies (hereafter WALS), Wolverhampton Chronicle (hereafter WC), 23 May 1860.

The majority of accounts of the poor law medical service make only brief mention of nursing care, possibly because it is the least well-documented part of the service within the archival records. The

only dedicated accounts are R. White, Social Change and the Development of the Nursing Profession:

A Study of the Poor Law Nursing Service, 1848-1948, London, 1978; M. Lorentzen, “‘Lower than a scullery maid’”, Nursing History, 3 (2003), pp.4-15. Sections on poor law nursing care appear in R.

Hodgkinson, The Origins of the National Health Service, London, 1967, pp.556-72; M. Higgs, Life in the Victorian and Edwardian Workhouse, Stroud, 2007, pp.127-36; B. Abel-Smith, A History of the Nursing Profession, London, 1960, pp.36-49; C. Maggs, ‘Nurse Recruitment to Four Provincial Hospitals 1881-1921’, in C. Davies (ed.), Rewriting Nursing History, London, 1980; A. Negrine, ‘Medicine and Poverty: A Study of the Poor Law Medical Services of the Leicester Union, 1867-1914’, (Unpublished PhD thesis, University of Leicester, 2008), pp.98-122; M. E Baly, Florence Nightingale and the Nursing Legacy, London, 1986, pp.20-40; R. Dingwall, A. M. Rafferty and C. Webster (eds), An Introduction to the Social History of Nursing, London, 1988, pp.66-76; S. Williams, ‘Caring for the sick poor: poor law nurses in Bedfordshire, c.1770-1834’, in P. Lane, N. Raven and K. D. M. Snell (eds), in Women, Work and Wages in England, 1600-1850, Woodbridge, 2004, pp.141-69. Comments on the standard of workhouse nurses are contained in T. Rogers (ed.), Joseph Rogers, MD.

Reminiscences of the Workhouse Medical Officer, London, 1889, pp.4-13, 246.

uncommon.3 It was unusual for non-pauper personnel to be paid to carry out nursing duties in workhouses prior to the NPL and for several decades afterwards, although paid nurses did become more common after the act. Nevertheless, most London workhouses still did not employ any paid nurses in the 1850s.4 This is not entirely surprising since the central authority never made it obligatory to employ nursing staff.

The 14th Annual Report of the Poor Law Commissioners (hereafter PLCs) in 1847 listed the nurse as one of the officers of workhouses, giving guardians the right to appoint remunerated nurses. Eighteen years later, the Poor Law Board (hereafter PLB) issued a circular to metropolitan guardians advising the employment of paid nurses to promote better nursing in workhouses and stressing they be adequately remunerated.5 In the same year, The Lancet set up an investigation into the state of workhouse infirmaries and subsequently campaigned for the employment of paid nurses to ensure ‘a thorough and genuine performance of [nursing] duties’.6 In 1892, Dr Downes, Medical Inspector for the Local Government Board (hereafter LGB) issued a letter stating that paupers were not suitable for employment on nursing duties and suggested a paid nurse to patient ratio between 1:15 and 1:10, but the LGB only advised guardians that they should feel satisfied that the number of nursing staff was adequate for the care of those inmates who were sick. Three years later, the board issued a circular letter stressing that a nurse was required to have experience in the treatment of the sick, was to be competent, and requesting guardians to discontinue the use of inmates as assistant nurses ‘as far as possible’.7 Finally, in 1897, the LGB issued an order banning inmates carrying out nursing duties, but continued to sanction Abel-Smith, p.9. Further discussion on the supply of alcohol to nurses can be found in chapter 5.

Ibid., p.10.

British Parliamentary Papers (hereafter BPP), 1866 (469), pp.1-2.





Anonymous, ‘The Lancet Sanitary Commission for investigating the State of the Infirmaries of Workhouses’, The Lancet, ii (1865), p.19.

White, pp.78-81.

their employment as attendants, working under the supervision of a paid nurse, who required only practical experience in nursing, and with the approval of the medical officer. After the NPL, guardians were slow to appoint paid nurses, so that by 1849 there were only 171 employed in England and Wales.8 As a result of the 1866 circular, there was a considerable expansion in their numbers in metropolitan workhouses, from 111 in that year to 748 in 1883-84, while, in the country as a whole, the 884 paid nurses employed in 1870 represented a large increase in their number five years previously.9 By 1896, their number had risen to 3,715 nationwide, with around 40% in London.10 In the 40 years from 1869, sick inmates had more than doubled to over 100,000.11 However in the 1890s, inmates were still being employed as paid attendants to supplement the non-pauper nursing staff. Patient to nurse ratios were higher in poor law infirmaries than in voluntary hospitals; for instance, in 1909, the number of beds per nurse in infirmaries ranged between 7.2 and 22.2, while in voluntary hospitals it was between 2.1 and 4.7, depending on how much surgery was carried out in an institution.12 The next development to influence the standard of nursing care in workhouse infirmaries was the introduction of trained nurses. Five years after the Nightingale School of Nursing opened at St Thomas’ Hospital, London in 1860, 12 nurses from the school were sent to Brownlow Hill infirmary in Liverpool on a trial basis.13 The scheme was regarded as successful in improving the nursing standards and trained nurses were gradually introduced throughout the country. A training school was set up BPP, 1849 (306), p.1.

Ibid., p.51; Hodgkinson, p.570.

BPP, 1896 (371), pp.4-5; Abel-Smith, p.51.

Abel-Smith, p.51.

BPP, 1909 [Cd. 4573], pp.48-49.

The development of the Nightingale school of nursing is described in Baly, Florence Nightingale and the Nursing Legacy.

at the infirmary and other workhouse infirmaries followed suit, particularly in London and the other large cities. However, the introduction of training was slower and more difficult in workhouses than voluntary hospitals because of the LGB’s stance that all staff must be accountable to the guardians.14 One result was a severe shortage of trained nurses to satisfy the requirements of the infirmaries. To ease the problem of nurse recruitment, the Association for Promoting Trained Nursing in Workhouse Infirmaries and Sick Asylums (also known as the Workhouse Training Association) was set up in 1879 and began financing nurses’ training, following which it ‘placed’ them in workhouses.15 The Departmental Committee on Nursing the Sick Poor in 1902 also addressed the shortfall of trained nurses and recommended that individual poor law training schools should be co-ordinated into a national scheme, with major and minor schools providing a three-year or one-year course respectively. The shortened length of training in the minor schools would provide more nurses more quickly with sufficient skills to be competent. One reason for the scarcity was that infirmaries could not attract nurses trained in voluntary hospitals as infirmary nurses were less well paid, worked longer hours and had poorer working conditions than hospital nurses, plus their patients were of a lower social class. All this left poor law nurses with a lower status within the nursing profession.

The main archival source for this chapter was the poor law minutes, which contain greater day-to-day information regarding nursing in Wolverhampton than Birmingham due to the smaller staffing level. In particular, once a trained matron controlled the management of nursing in Birmingham infirmary, much less detail appears in the minutes. This chapter will compare nursing practice at the workhouses Baly, p.100.

White, p.75.

in Wolverhampton and Birmingham between 1834 and 1914 and contrast the levels of nurse staffing for example to assess the degree to which the number of nurses were sufficient to meet the needs of the increasing number of patients. In the process, it will address the following questions. To what extent were pauper nurses utilised and paid nurses employed, especially in the early decades of the NPL? Was the turnover of nursing staff as high in these two workhouses as has been suggested by other studies and, if so, what were the reasons for their resignations or dismissals? How did the introduction of training influence the standard of nursing care, and what effect did the erection of an infirmary as a separate institution from the workhouse have on the training of probationer nurses? To what extent were men involved in nursing in the workhouse infirmaries and how were they affected by the nursing reforms? Was the reputation of nurses for maltreating their patients justified and to what extent did they exhibit a caring attitude towards their patients? In other words, was Anne Crowther justified in remarking that ‘the records of almost any union will produce a dreary tale of nursing inefficiency, neglect and cruelty’?16 In the process of answering such questions, this chapter will also attempt to draw out the experience of being a poor law nurse in the Victorian period.

Nursing Duties and Recruitment To understand the level of care a nurse would be able to perform, it is necessary to be acquainted with her previous occupational and social background. Hospital nurses in the early part of the nineteenth century were drawn mainly from domestic servants, M. A. Crowther, The Workhouse System 1834-1929, London, 1983, p.165.

–  –  –

voluntary hospitals, sisters, who supervised the nurses, often came from a higher social class, while the matron, topping the nursing hierarchy, originated from an even higher social standing, although was usually employed as a housekeeper rather than a nurse.18 Paid nurses in workhouses were equivalent to sisters in that they supervised the pauper nurses, but they did not share a common class background. Table 6.1 demonstrates the domestic service backgrounds of applicants for the post of nurse in the female infirmary wards in Birmingham in 1852, with those already employed as nurses the next most common. Surprisingly, one of the two candidates recommended to the board of guardians by the Visiting and General Purposes Committee was Sarah Davis, who had no obvious previous occupation, but they were impressed by her testimonial from a minister of religion.19 The other was Elizabeth Manton, who was already employed at the workhouse as night nurse and had a testimonial from Mr Humphrey, the workhouse medical officer (hereafter WMO). She had been dismissed from her post of nurse at the workhouse when the guardians reduced the nursing complement and had obtained a post as nurse at the Queen’s Hospital in Birmingham, but had subsequently applied successfully for the post of night nurse at the infirmary.

She was upgraded to infirmary nurse and Sarah Davis was given her previous post as night nurse, although the latter resigned for unknown reasons seven months later.20 The majority of candidates were middle-aged, widowed or separated from their husbands, similar to the 11 applicants a decade previously, where only one was a C. Helmstadter and J. Godden, Nursing before Nightingale, 1815-1899, Farnham, 2011, p.10; nurses appointed by nursing associations came from similar backgrounds: S. Wildman, ‘Local nursing associations in an age of nursing reform, 1860-1900’, (unpublished PhD thesis, University of Birmingham, 2012), pp.143-151.

Ibid., pp.8, 52.

Birmingham Central Library (hereafter BCL), Visiting and General Purposes Committee (hereafter VGPC), GP/B/2/8/1/1, 10 December 1852.

Ibid., 17 December 1852; Birmingham Board of Guardians’ minutes (hereafter BBG), GP/B/2/1/12, December 1852; The National Archives (hereafter TNA), MH12/13298, 11 February 1852;

MH12/13299, 7 July 1853.



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