«MEDICAL CARE IN THE WORKHOUSES IN BIRMINGHAM AND WOLVERHAMPTON, 1834-1914 by ALISTAIR EDWARD SUTHERLAND RITCH A thesis submitted to the University of ...»
Three years later, the guardians appointed midwives for the districts and one, Mrs Edge, was also required to attend midwifery cases in the workhouse on the payment of 4s per case.104 Elizabeth Vincent, a widow aged 37 and nurse in the women’s infirmary ward in August 1842, resigned in July the following year, was re-appointed to the same post in the following April, but resigned a month later to become Matron Ibid., 5 April 1842.
Ibid., 5 April, 7 June 1842.
Ibid., 14 June, 5 July, 19 July 1842.
BCL, BBG, GP/B/2/1/5, 8 July 1845; for a discussion of midwifery in Birmingham workhouse at this time, see F. J. Badger, ‘Delivering maternity care: midwives and midwifery in Birmingham and its environs, 1794-1881’, (unpublished PhD thesis, University of Birmingham, 2014), pp.232-35.
of the Lying-in Hospital at Islington in London.105 The clinical activity, for which the seven paid nurses and 14 paupers acting in a caring role were responsible, involved 264 admissions to the Town Infirmary in the relevant quarter of 1842, with 158 inpatients on average.106 In July of the same year, the PLCs advised the guardians that paying gratuities to inmates for employment appeared to be an illegal charge on the poor rates and recommended the practice cease forthwith.107 The guardians reviewed a list of 15 ‘servants employed’ in nursing duties, which included those classed as both paupers and non-paupers (Table 6.6). They had been receiving salaries ranging from £8 to £20 yearly. The guardians resolved that inmates who were employed in tasks in the workhouse should receive extra rations of meat at dinner and a daily beer allowance, presumably instead of monetary remuneration.108 However, four years later, the allowances for pauper assistant nurses were reduced to the ordinary diet of the workhouse, plus one pint of tea with bread and butter twice daily.109 This decision may have been the consequence of new and replacement appointments increasing the nursing establishment to 19, of which only seven had remained in post from 1842.
They included a few who had been pauper nurses in that year, but as they were continuing to receive an annual salary, would now be designated as officers.110 At this time, the daily number of inmates varied between 470 and 500, with around onethird needing medical attention.111 Taking into consideration only those nurses directly involved with sick inmates and lunatics reveals that there was one nurse for BCL, HC, GP/B/2/3/1/1, 11 July 1843, 16 April, 28 May 1844.
BCL, BBG, GP/B/2/1/4, 11 October 1842.
Ibid., 31 July 1845.
Ibid., 14 August 1845.
Ibid., 26 June 1849.
Ibid., GP/B/2/1/6, 24 April 1849.
Ibid., 9 April to 24 December 1849.
every 11 patients. This was similar to the situation at the General Hospital in 1851, with 220 beds and 17 nurses, giving a ratio of 1 nurse to 13 beds.112 Despite the greater number of nurses to care for patients in Birmingham workhouse, staff turnover appears almost as high as in Wolverhampton, although fewer were dismissed for misconduct. The misbehaviour of the two nurses in the fever wards has already been Table 6.6: Paid and Pauper Nurses in Birmingham Workhouse, 1842
Wildman, ‘Nursing at the General Hospital’, p.24.
mentioned and, two years later, Mary Williams and William Fitzer, both nurses in the
dismissals, George Bates had used violent language when intoxicated; the nurse in the women’s sick ward was declared inefficient by the WMO; Charlotte Greasley had acted ‘most improperly’ to her patients on the female venereal ward; and two nurses were dismissed in 1849 without reasons being recorded.114 Ann Rose, the nurse in the old women’s ward, was reprimanded for selling the tea, sugar and butter provided for the inmates, but resigned of her own accord.115 However, these incidences involved a
resignations and the release of three nurses, the nursing complement was reduced to seven nurses, including one night nurse, plus one ‘Insane Keeper’ in early 1851. Only four nurses in employment two years before had been retained, indicating a high turnover of staff in a short period of time.116 Maintaining Nursing Care in the Second Birmingham Workhouse The smaller number of nurses was unlikely to be able to cope with the increasing incidence of sickness among paupers in the expanded new Birmingham workhouse.
Three months after it opened in 1852, eight paid nurses were providing care but this was increased by three, a few months later, when the children were transferred to the workhouse from the Asylum for the Infant Poor.117 When Charlotte Davis, nurse in the women’s ‘sick ward’ resigned four years later, Fanny Giles, a nurse on the BCL, HC, GP/B/2/3/1/1, 2 January 1844.
Ibid, 13 June 1843, 26 March; BBG, GP/B/2/1/5, 3 February 1846; GP/B/2/1/6, 29 May 1849.
BCL, HC, GP/B/2/3/1/1, 5 November 1844, 26 February 1845.
BCL, BBG, GP/B/2/1/7, 19 March 1850; CEB, 1851.
BCL, BBG, GP/B/2/1/11, 16 June, 22 September 1852.
equivalent male ward, was put in charge of both, a move that was challenged by the PLB. However, the guardians defended the action by claiming she could manage both wards efficiently and the PLB sanctioned it for a period of six months, following which the board expected a report on her performance.118 Perhaps it was this issue that prompted the guardians to request the clerk to ascertain staffing levels and salaries from other workhouses built to accommodate 1,000 inmates or more (Table 6.7). As Birmingham came out well, no changes were made.119 A further comparison of nursing standards is possible from the survey conducted by Edward Smith, MO to
commented that the appointment of paid nurses had been generally accepted as appropriate, as only four workhouses in the capital were without them. Furthermore, the WMOs found pauper nurses ‘old, ill-trained and unreliable’, necessitating salaried nurses.121 The provinces fared less well, as 11 workhouses had no paid nurses, but these were usually the smaller institutions, with less than 100 beds.122 The ratio of the number of inmates on the MOs’ books to that of paid nurses at the time of the visit varied greatly, from 15 patients to one nurse to as high as 255 in London and between 4 and 132 in the rest of the country. Paradoxically, the workhouses where few nurses were employed produced the highest ratios in London, but the lowest in the provinces, as this occurred in the smallest workhouses, usually with fewer than 150 inmates.123 The ratios available for the workhouses in Table 6.7 are: Birmingham 26 (22 nurses for 582 patients), City of London 17, Greenwich 98, Lambeth 166, Leicester 14, Liverpool 38, Manchester 59, Marylebone Street 22, Nottingham about 75 and Ibid., GP/B/2/1/18, 7 May, 16, 23 July 1856.
BCL, Returns relating to the numbers of Officers and Servants, GP/B/16/2/1, 15 October 1856.
BPP, 1866 (372); 1867-68 (4).
BPP, 1866 (372), pp.23-24.
BPP, 1867-68 (4), pp.26-157.
Ibid.; BPP, 1866 (372), pp.24, 31-32.
Table 6.7: Paid Nurses in Selected English Workhouses, 1856
Portsea Island 49.124 Birmingham came out best in terms of paid nurse staffing of the provincial workhouses with more than 500 inmates and only three London workhouses were better staffed. Nursing numbers in Birmingham had risen to 13, but pauper help was still being used, with 45 assisting in the infirmary wards by day and 15 at night, so relieving the paid nurses of household tasks, such as cleaning the wards.125 The contrast with Wolverhampton is stark, with four paid nurses, 238 patients and a ratio of one nurse to 60 patients, with only eight provincial workhouses having a higher rate. Smith found it impossible to believe that the number of paid Ibid.; Smith noted the nursing experiment using trained nurses was taking place at the time of his visit and gave it a favourable mention.
BCL, VGPC, 2/8/1/5, 25 March 1866.
nurses was sufficient, with two nurses for around 160 cases of ‘ordinary sick’ and two attendants for nearly 70 lunatics.126 Despite Birmingham’s level of nurse staffing being among the best in the country, the guardians became concerned in 1874 over the large number of resignations by nurses.
They consulted one nurse, Martha Gilbert, and the master and decided there was no one particular reason, but it was possible that the salaries they were offering were lower than in other poor law institutions. Furthermore, there was by this time more alternative nursing work as the town had around seven voluntary hospitals. They requested information from six large workhouses and subsequently increased salaries by between £2 and £7, with the largest increase for those on night duty (Table 6.8).127 These salaries were in line with those at the General Hospital in the 1870s, where a Head Nurse received between £20 and £25 and an Under-Nurse £13 and £18.128 However, some nurses remained loyal to the workhouse for many years. When Jane Smith, nurse in the female bedridden ward, was forced to resign because of longstanding ill health and ‘advancing age’ (although only in her mid-fifties), she was granted ‘an annual emolument’ of £40 in light of her 25 years’ service.129 In late 1877, a sub-committee was set up to consider the medical and nursing arrangements in the workhouse. On the MO’s advice, the sub-committee recommended appointing additional nurses for the female venereal ward, female bedridden ward, male infirmary and the male and female epileptic wards. Members of the inquiry agreed to BPP, 1867-68 (4), pp.152-53.
BCL, House Sub Committee (hereafter HSC), GP/B/2/3/3/4, 17 November 1874, 9 February, 23 February 1875.
Wildman, ‘Nursing at the General Hospital’, p.22.
BCL, HSC, GP/B/2/3/3/5, 18 April 1876; the amount was based on her salary, plus a notional amount for board and lodgings.
recommend appointing a superintendent of the nursing staff, who would be ‘well qualified by training and education’ and who would supervise the ‘whole of the Table 6.8: Increases in Annual Salaries for Nurses in Birmingham Workhouse,
Nursing of the Sick’, despite the senior MO’s view that a professional nurse was not necessary. Kate Nicholson, who was in her mid-20s and younger than most of her nursing staff, was appointed to the post in the following year.130 However, turnover of staff remained high, with 21 nurses and attendants leaving over a 15-month period out of a nursing establishment of 28. Two were dismissed for misconduct and two men because they were married, the guardians preferring single men. As a result, Edward Marshall was replaced by 31-year-old Samuel Bradburn, who had worked as a nurse at Manchester and Sheffield Unions after a period as a rubber worker.131 Edward Riley, nurse in the male surgical and venereal wards, resigned in December 1881 because the work was ‘too much’ for him.132 Thirty years before, William Key, attendant on the male epileptic ward, resigned in similar circumstances as he found BCL, Workhouse Inquiry Sub Committee, GP/B/2/3/11/1, 23 March 1878; VGPC, GP/B/2/8/1//7, 3 May 1878; BBG, GP/B/2/1/46, 31 July 1878; CEB, 1881.
TNA, MH12/13336, 31 January 1881.
TNA, MH12/13338, 15 December 1881.
the ‘confinement prejudicial to his health’, and joined Birmingham police force.133 The most common reasons for female nurses resigning in 1880-81 were to get married
important factor in the loss of nurses, at variance with Sue Hawkins’ claim that it was not a significant drain on nursing departments based on finding less than 3% annually resigning for this reason at St George’s Hospital, London.135 Despite the WMO’s and Nicholson’s request for more nursing staff, the guardians agreed only to a temporary increase in staff, as the number of sick inmates had ‘considerably decreased’.136 However, the following year, Nicholson managed to get the newly constituted ‘Infirmary Sub Committee’ to agree to five additional nurses for the male and female surgical wards, the male venereal ward and for night duty on the male and female epileptic wards. The committee also agreed to provide uniforms for nursing staff, as a means of controlling the spread of infection during the current smallpox epidemic, although it is not clear if this was a temporary measure. However, when probationers were appointed for the first time a year later, uniforms, consisting of print dresses, aprons, collars and caps, were provided, but were only supplied after probationers had completed their trial period of four weeks. Assistant nurses and charge nurses were also provided with uniforms that would distinguish their grade from each other and from the probationers.137 In 1899, Wolverhampton guardians were spending around £80 annually on uniforms.138 The appointment of probationers in Birmingham increased the nursing staff to 37, although the number of patients had remained TNA, MH12/13298, 31 December 1851.
BCL, VGPC, GP/B/2/8/1/8, 28 October 1881; CEB, 1881.
Ibid., 25 November 1881.
BCL, Infirmary Sub Committee (hereafter ISC), GP/B/2/4/1/1, 28 July 1882; GP/B/2/4/1/2, 2 November 1883; GP/B/2/4/1/4, 6 January 1888.
WALS, WBG, PU/WOL/A/28, 9 March 1900.
static.139 Although pauper nurses were still employed at night, the main duties were keeping the fires burning, giving ordinary drinks to patients and being present on the wards while the night nurses undertook rounds.140 At the end of 1885, the guardians took the unusual step of appointing Lydia Rogers as ‘Head Night Nurse’. She was a 28-year-old unmarried nurse working in St Bartholomew’s Hospital in London before her appointment in Birmingham.141 Between 26 January and 11 March 1889, 33 nurses were transferred to the new infirmary, as the relevant patients were gradually moved.142 However, not all patients were transferred and those with venereal disease and in the bedridden wards remained in the workhouse. Similarly, chronic and venereal patients were not transferred from