«MEDICAL CARE IN THE WORKHOUSES IN BIRMINGHAM AND WOLVERHAMPTON, 1834-1914 by ALISTAIR EDWARD SUTHERLAND RITCH A thesis submitted to the University of ...»
spinster.21 Nurses appointed at the General Hospital in Birmingham at this time came from similar backgrounds, but this changed in the second half of the nineteenth century, with younger and more unmarried women being appointed, as occurred in other voluntary hospitals.22 By early the next century, the 11 of the applicants for posts as charge nurses at Wolverhampton workhouse were working as nurses and the other five were not in employment.23 This recruitment pattern relates to female nurses as nursing was a female dominated occupation and men were rarely employed in voluntary hospitals.24 Surprisingly, when 27-year-old Ellen Spencer was appointed as night nurse in Birmingham in 1877, she was described as a ‘trained nurse’, since training was still in its infancy at that time. Edward Harwood, aged 51 years, who was employed as male nurse the same year, had previously worked as a farmer before posts as porter and nurse in other workhouses.25 The occupational background of men before they took up nursing was different from women, although John Warder, who was appointed assistant keeper in the insane wards in 1846, had been a gentleman’s servant.
S. Wildman, ‘The development of nursing at the General Hospital, Birmingham, 1779-1919’, International History of Nursing Journal, 4 (1999), pp.21, 24; S. Hawkins, Nursing and Women’s Labour in the Nineteenth Century, Abingdon, Oxon, 2010, pp.67-68.
WALS, House Committee (hereafter HC), PU/WOL/E/1, 15 June and 5 October 1904.
R. G. S. Brown and R. W. H. Stones, The Male Nurse, London, 1973, p.15; C. Mackintosh, ‘A historical study of men in nursing’, Journal of Advanced Nursing, 26 (1997), p.232.
TNA, MH12/13326, 3 March, 13 April 1877.
TNA, MH12/13290, July 1846.
TNA, MH12/13298, 31 December 1851.
lunatic asylums.28 Between 1881 and 1914, the commonest previous occupations of probationers, who were all female, appointed at Portsmouth and Leeds workhouse infirmaries, other than nursing, were in domestic and personal services.29 At times, employees performing non-nursing duties in Birmingham workhouse were selected as nurses. For instance, Fanny Giles, who was appointed as nurse of the women’s infirmary ward in 1844, had been employed as cook for at least three years beforehand.30 Domestic tasks formed a major part of a nurse’s duties, which Brian Abel-Smith has described as a ‘specialised form of charring’.31 However, Anne Borsay contests this description on the grounds that non-child nursing was being recognised as an activity in its own right by the beginning of the nineteenth century.32 Nevertheless, responsibility for the good order of the wards and the cleaning not only of the wards, but also of all the rooms and passages of Westminster Hospital, London was included in the nursing regulations in 1835.33 Carol Helmstadter and Judith Godden have described hospital nurses in the early nineteenth century as ‘essentially cleaning women’.34 Nurses gave minimal personal attention, although they assisted those patients who were required to be in bed by day and those who were unable to wash themselves. In addition, they carried out such treatments as bleeding with leeches, blistering using poultices, which they would prepare themselves, and administering emetics and enemas, all of which required supervision and care of patients for a period following treatment.35 The PLCs issued a General Consolidated Order in 1847, defining the duties of the nurse as attending upon those in the sick L. D. Smith, ‘Behind Closed Doors; Lunatic Asylum Keepers, 1800-60’, Social History of Medicine, 1 (1988), p.307.
BCL, HC, GP/B/2/3/1/1, 28 May 1844; Census Enumerator’s Books (hereafter CEB), 1841.
Abel-Smith, p.4; Wildman, ‘Local nursing associations’, pp151-52.
A. Borsay, ‘Nursing, 1700-1830: Families, Communities, Institutions’, in A. Borsay and B. Hunter (eds), Nursing and Midwifery in Britain since 1700, Basingstoke, 2012, p.39.
Helmstadter and Godden, p.27.
White, pp.8, 24; Dingwall, Rafferty and Webster, pp.10-11, 55; Helmstadter and Godden, pp.35-37.
wards, administering all medicines and medical applications, as directed by the medical officer (hereafter MO), and ensuring a light was kept at night in the these wards. The only qualification required was the ability to read the directions for giving the medicines.36 As was the case with nursing in voluntary hospitals, a workhouse nurse’s working life was arduous, with long hours and a requirement to be available both day and night.
Living conditions were extremely harsh and many nurses ate and slept in the wards with the patients.37 However, protests against the poor quality of living accommodation and food were infrequent, but occurred in both voluntary hospitals and workhouse infirmaries.38 Evidence for the exact tasks they undertook is sparse.
In the early nineteenth century, Birmingham guardians’ main requirement was that they kept the wards in ‘that state of cleanliness which is essential to the welfare of the sick’.39 In Wolverhampton in 1890, nursing duties still included housekeeping tasks, such as keeping the porter’s book in his absence and assisting the matron ‘in the stores’. They were also responsible for personally supervising the bathing of all female children prior to examination by the MO.40 Bathing patients was the activity that took up most of the nurses’ time in Birmingham workhouse in 1907.41 One of their main tasks in the General Hospital in Birmingham was cleaning the wards, although they assisted those patients who needed personal care. By 1878, they were Ibid., pp.25-26.
Higgs, p.129; Helmstadter and Godden, p.59.
S. Wildman, ‘‘‘Docile Bodies’’ or ‘‘impudent’’ women: conflicts between nurses and their employers, in England, 1880-1914’, in R. Jutte (ed.), Medizin, Gesellschaft und Geschichte, Stuttgart, 2014, pp.13-17.
BCL, BBG, GP/B/2/1/2, 2 June 1818.
WALS, Resolutions passed by the Guardians as to the Duties of Officers, PU/WOL/L, 27 October 1890.
BCL, HSC, GP/B/2/3/3/22, 9 April 1907.
allowed to take patients’ temperatures but it was not until the early twentieth century that they had the responsibility for measuring patients’ pulse and respiratory rates.42 Table 6.1: Applicants for the Post of Nurse in the Female Infirmary Wards at Birmingham Workhouse, 1852
Source: BCL, VGPC, GP/B/2/8/1/1, 17 December 1852.
No information is available on the hours of work in Birmingham or Wolverhampton workhouses in the nineteenth century, but in the latter, nurses were granted leave on one Sunday per month in 1870.44 Early in the twentieth century, nurses were on duty from 7am until 8pm daily except Sunday, when they had leave for half a day once in a month. However, they were only on ‘active duty’ for two-thirds of this time and for Wildman, ‘Nursing at the General Hospital’, p.21.
All addresses were in Birmingham.
WALS, Wolverhampton Board of Guardians minutes (hereafter WBG), PU/WOL/A/14, 18 March 1870.
the remainder, needed only to be on-call on the premises. As a result, their time on active work did not exceed eight hours daily.45 In the early 1910s, Birmingham guardians admitted that nurses’ hours were long, but compared favourably with other infirmaries and the local voluntary hospitals (Table 6.2). Sisters worked from 8am until 1pm, 1.30pm until 4.15pm and 7.15pm until 9.15pm, and had a whole day of leave each month. Nurses worked from 7am until 8.30am, 9.15am until 1.30pm and
4.15pm until 9pm.46 However, by the following year, sisters’ hours had been reduced from 61 and a half to 54 and a half per month.47 Table 6.2: Weekly Average Hours Worked by Sisters and Nurses in 1911
Nursing Turnover in Wolverhampton, 1839-1890 The high turnover of paid nurses in workhouses, while generally accepted as being the norm, has not received detailed attention in the literature to date and there are no
Leicester workhouse, Angela Negrine cites only one example of a brief length of tenure, when five nurses appointed in 1886 all resigned at the same time in the Ibid., PU/WOL/A/30, 10 October 1902.
BCL, Infirmary Management Committee (hereafter IMC), GP/B/2/4/4/6, 27 February 1911.
BCL, Infirmaries Committee (Hospitals), GP/B/2/4/8/1, 10 September 1913.
following year.48 The nurse appointed by the Reading Union workhouse in 1870 resigned within days and her replacement was asked to leave within six months, because of inefficiency including giving patients the wrong medication.49 Furthermore, few accounts of poor law nursing include the early decades of the NPL or attempt to analyse why turnover was so high. It may have been the result of the long hours of work, the heavy workload or the fact that the nurses often ate and slept in the wards with their patients. An additional factor may have been the loss of women to marriage, a feature of women’s employment at the time, although the extent of this factor is debatable50.
Recruitment was not the main problem for the guardians, but retention of the paid nurses they had appointed. Nursing staff turnover was high over the next 50 years, with the guardians needing to employ 18 female nurses (Table 6.3). Excluding Nurse Elizabeth Careless, who remained in post for 26 years, the average length of stay was less than two years. The 19 male nurses and superintendents of the male insane employed over that time had similar lengths of stay of one year and six months and one year and 11 months respectively, but 10 of the nurses were in post for less than a year. The exceptions were the seven superintendents for the female insane who served three years on average (Table 6.4). This contrasts with the tenure of the MOs, which ranged between seven and 22 years after tendering had been abolished in
1841.51 However, continuity of nursing staff was better than it appears from these Negrine, pp.106, 111.
M. Railton and M. Barr, Battle Workhouse and Hospital 1867-2005, Reading, 2005, pp.37-38.
See Hawkins, pp.141-148 for a discussion of this issue.
See chapter 4, Table 4.3 for further details.
Table 6.3: Nurses Appointed to the Infirmary Wards in Wolverhampton Workhouse, 1839-1890
figures, as many of the nurses appointed were chosen from the superintendents of the insane and their assistants.
Two months after the union workhouse opened in 1839, the guardians advertised for a nurse for the sick, the only requirement being ‘persons willing to undertake the situation’. Sarah Keeling was subsequently appointed as ‘Head Nurse’ at the workhouse at a salary of £12 per annum.52 Within a month they were again Table 6.4: Appointments as Superintendents of the Insane in Wolverhampton Workhouse, 1861-1890
Source: WALS, WBG, PU/WOL/A/11-18, 1860-1881.
WALS, WBG, PU/WOL/A/2, 3 December and 27 December 1839.
advertising for a nurse and appointed Elizabeth Davies on a trial basis for one month, on an annual salary of £15, prior to a permanent arrangement if found suitable, suggesting Sarah Keeling had not been so.53 However, by November that year, Davies had been replaced by 35-year-old Maria Carphew.54 Over the next two years, she was reprimanded over her conduct, on the first occasion for failing to bath a child, as instructed by the WMO, and on the second for being described by him as ‘disorderly and riotous in the lying-in ward’.55 With only one paid nurse in the workhouse, pauper nurses were responsible for delivering babies in the lying-in ward.
When Sarah Porter’s illegitimate baby died shortly after such a delivery, the subsequent coroner’s verdict was that the lying-in ward was ‘perversely misconducted’.56 The pauper nurses in question were deemed no longer fit to carry out such duties, as they had not informed the MO in the Porter case. Despite the master and matron expressing their disquiet at pauper nurses acting as midwives, the guardians took no action.57 Two years later, the master again reported nurse Carphew for behaving with ‘gross indecency’ in the lying-in ward and she must have been dismissed or resigned as the records show four applicants for the post.58 Reasons for nurses leaving or resigning their posts were not recorded for the majority of nurses.
However, Edward Shubotham, who resigned in 1865, was on a list of nurses at Birmingham workhouse one year later.59 A married man in his mid-30s, he had been appointed in May 1860 when the WMO requested the appointment of a male nurse as he would have better control of the male patients, as well as being ‘better for the sake Ibid., 21 February and 15 May 1840.
Ibid., 1 January 1841; CEB, 1841.
WALS, WBG, PU/WOL/A/3, 24 June 1842, 26 May 1843; Master’s Journal (hereafter MJ), PU/WOL/U/2, 27 May 1843.
WALS, WBG, PU/WOL/A/4, 7 and 14 July 1843.
WALS, WBG, PU/WOL/A/4, 7 and 14 July 1843; MJ, PU/WOL/U/2, 8 July 1843.
WALS, MJ, PU/WOL/U/2, 3 May 1845.
WALS, PU/ WOL/A/12, 31 March 1865; BCL, VGPC, GP/B/2/8/1/5, 23 March 1866.
of morality’.60 The guardians questioned whether he would be as sympathetic as a female nurse, to which the MO responded that he had ‘never observed sympathy between nurses and patients in public institutions’.61 Subsequently, men were employed as nurses in the male ward for the next 30 years (Table 6.3).