«MEDICAL CARE IN THE WORKHOUSES IN BIRMINGHAM AND WOLVERHAMPTON, 1834-1914 by ALISTAIR EDWARD SUTHERLAND RITCH A thesis submitted to the University of ...»
provincial urban workhouses.58 Although institutional histories are plentiful within medical historiography, many have been of the celebratory type and workhouse infirmaries have been relatively neglected compared with the more prestigious voluntary and charitable hospitals.59 Nevertheless, histories of the workhouse have been one of the main approaches used to reach an understanding of the character and role of the poor law welfare system.60 The New Poor Law and the Workhouse The main objective of the NPL was the control of rising unemployment and vagrancy among able-bodied adults. The Royal Commission on the Poor Laws, which preceded it, has come under criticism from historians for incorrectly diagnosing the reasons for the increase in expenditure on poor relief.61 The act of 1834 established the principles of deterrence and rigid centralisation, designed for the management of
attempted to limit outdoor relief other than medical attention, by requiring every parish and union to provide institutions for paupers. The original intention of separate buildings for different types or classes of pauper never materialised and the general mixed workhouse gradually predominated across the country. It became the central Rose, p.4.
Examples include J. Woodward, To Do the Sick No Harm: A Study of the British Voluntary Hospital System to 1875, London, 1974; K. Waddington, Charity and the London Hospitals 1850-98; J. V.
Pickstone, Medicine and Industrial Society: a history of hospital development in Manchester and its regions 1752-1946; J. Reinarz, Health Care in Birmingham: The Birmingham Teaching Hospitals 1779-1939, Woodbridge, 2009.
S. Webb and B. Webb, Minority Report of the Poor Law Commission, Clifton, 1909, p.3;
Hodgkinson, p.1; Digby, Pauper Palaces, p.107; Driver, p.23; A. Digby, The Poor Law in Nineteenthcentury England and Wales, London, 1982, pp.9, 13; Crowther, Workhouse System, p.271.
Driver, p.3; Digby, The Poor Law, p.9.
component of poor law policy after 1834 and its layout and appearance were designed to make a powerful impact on the poor.63 The act also established the principles of ‘less eligibility’ for relief and of a lower standard of living for a pauper compared to a wage-earning labourer. It promoted the ‘workhouse test’, whereby a pauper would only receive relief if prepared to enter a workhouse, where conditions would theoretically have been worse than for the poorest in the community. The workhouse test was intended as a means of distinguishing those who were destitute from those who were seen as merely poor, in order to reduce expenditure from the poor law rates.
The enforcement of less-eligibility could only be achieved by psychological means, namely deprivation of identity and dignity.64 According to Driver, the workhouse was ‘designed to be a disciplinary institution, its inmates subject to the rule of official regulations’.65 Crowther describes the subsequent rapid development of centrally administered, heavily regulated workhouses as the ‘first national experiment in institutional care’.66 The majority of accounts of the workhouse system are in agreement that it depended on the classification of paupers, with complete segregation of all classes, of men from women and adults from children, with emphasis on strict discipline and monotonous daily routine in which the same activities took place at the same times each day.67 Paupers were supplied with the uniform in use in the workhouse they entered and their own clothes were returned to them on discharge. The dietaries were repetitive, the food was often adulterated and dietary restriction played a major role in the disciplinary system. One of the most important aspects was the reliance on the Driver, p.147; King, p.3; K. Morrison, The Workhouse, Swindon, 1999, pp. 43, 54.
Crowther, Workhouse System, p.3.
Crowther, Workhouse System, pp.193-221; Higgs, pp.18-21.
surveillance of individual conduct, as was common in projects of moral regulation in the nineteenth century. Discipline was instilled into the inmates by regimentation and regulating every minute of the day.68 The principles of the workhouse system had a direct influence on the structure and design of the new union workhouses. Furthermore, the changes in the architectural structure over the second half of the nineteenth century reflected the prevailing attitudes to poverty, the directions of the central authorities and the type and class of pauper for which the accommodation was intended. The effectiveness of the system as a deterrent depended upon ensuring strict physical segregation of the different classes of pauper within the building.69 The grouping of parishes into larger unions meant that buildings of a considerable size were required and their forbidding appearance and disciplinary regime were intended to impress on the poor the virtues of ‘independent’ labour.70 They enhanced the sense of depersonalisation by diminishing the more personal contact between paupers and poor law officers that had been usual in the parishes. Many workhouses provided sick rooms or wards for inmates who were unwell and larger ones often had designated infirmaries. The Metropolitan Poor Act of 1867 was the stimulus for the erection of separate poor law infirmaries throughout London, managed independently from the workhouses.
Outside the metropolis, separately managed facilities for the sick were only likely to be found in the large workhouses of the industrial cities. Ruth Hodgkinson is of the Driver, p.10; Lees, p.147; this system has been likened to the regulation of the lives of citizens in Thomas More’s Utopia, published in 1516, see P. Spierenburg, ‘Four Centuries of Prison History’ in N.
Finzsch and R. Jütte (eds), Institutions of Confinement, New York, 1996, p.21.
opinion that most of the reforms to establish separate treatment for the sick had taken place by 1871.71 One of the earliest social histories of the workhouse was published in 1974 by Norman Longmate.72 The tone of his study is set by his early statement that the purpose of the workhouse was to terrorise the poor and he could remember it as a child being ‘feared and hated’.73 Similar comments appear in later accounts. For instance, Michelle Higgs is of the opinion that the fear of the workhouse became an integral part of workhouse mythology, and Simon Fowler questions why workhouses were detested so much by those who had to use them.74 However, Digby cautions that this view of the workhouse reflects popular mythology more than historical reality and that the conception generally held today of workhouse life places too great a reliance on a relatively small number of adverse reports.75 Her study of the workhouses in Norfolk, Pauper Palaces, instigated a difference of opinion regarding the quality of poor law institutional care within the historiography of the workhouse.
In The Workhouse System 1834-1929, a comprehensive analysis of the poor laws and the working of the workhouse, Crowther also offers a more balanced picture. She describes the workhouse as invariably a place of irresolvable tension by attempting to be both a place for deterring able-bodied paupers while a refuge for the old and the sick.76 She emphasises the variability and diversity within parishes, where the Hodgkinson, pp.686-88.
Longmate, The Workhouse, London, 1974.
Higgs, p.9; Fowler, p.7.
Digby, Pauper Palaces, pp.ix, 177.
Crowther, Workhouse System, p.3.
conditions in workhouses were influenced by the size of the union, the wealth of local ratepayers, the calibre of the local guardians and the activity of pressure groups.77 There are conflicting views over how effective the workhouse was as a deterrent toward those seeking relief. Both national statistics and those from a London Union reveal considerable activity of entry and discharge, even among older men. It is possible that the unskilled working class may have used the workhouse for their own purposes, when it suited them, without any fear of disgrace.78 Although conditions improved toward the end of the nineteenth century, the dreariness within the institution remained and the real stigma attached to entering the workhouse may have been that of associating with the ‘disreputable poor’.79 Such close contact with those deemed ‘undesirable’ would have had a deterrent effect, particularly on older people, who constituted a large and important group of inmates, but one that has been relatively neglected within workhouse records. Crowther has pointed out that no regular census of inmates by age group took place prior to 1913, though she cites the finding of the Royal Commission on the Aged Poor, stating that 46.5% receiving poor law relief were over 60 years of age and nearly half were in workhouses.80 However, the main concern of the Royal Commission in 1834 was the increase in the number of able-bodied paupers and it only gave brief mention to older paupers, as old age was not recognised as a social problem.81 It did accept ‘aged and impotent persons’ as ‘proper objects of relief and expected that they would accept the workhouse as ‘a Ibid., p.6.
M. A. Crowther, ‘The Later Years of the Workhouse’, in P. Thane (ed.), The Origins of British Social Policy, London, 1978, pp.44-45.
place of comparative comfort’.82 The first annual report of the PLCs classified indoor paupers into seven groups, separating men and women and dividing both into either able-bodied or ‘aged and infirm’; the latter were previously known as the ‘impotent poor’.83 Throughout the nineteenth century, the proportion of those aged over 60 years remained between seven and eight per cent of the population of England and Wales.84 The percentages of the population aged 65 and over in poor law institutions showed a steady increase from about 13% in 1851 to about 23% in 1901, although the proportion declined to 20% in 1911, similar to the level found in 1891.85 By 1891, one-third of workhouse inmates were aged 65 and over, although only a small proportion of the population over the age of 65 entered workhouses.86 Nevertheless, they formed the second largest group of inmates after children in workhouse populations in the mid-nineteenth century and, in time, the workhouse became ‘the institution of the aged’.87 Relatively little has been recorded in respect of older paupers who were sick and disabled, because of the difficulty of identifying them within the poor law records and of differentiating between those requiring medical treatment and those needing social care.88 Age-related rationing of medical care was S. G. Checkland and E. O. A. Checkland (eds), The Poor Law Report of 1834, Harmondsworth, 1974, pp.338, 425.
British Parliamentary Papers (hereafter BPP), 1835 (500), p.60.
Smith ‘The Structured Dependence of the Elderly as a Recent Development’, Ageing and Society, 4 (1984), p.414; Laslett ‘The Significance of the Past in the Study of Ageing’ Ageing and Society, 4 (1984), p.382.
D. Thomson, ‘Workhouse to Nursing Home: Residential care of elderly people in England since 1840’, Ageing and Society, 3 (1983), p.49.
P. Thane, ‘Geriatrics’, in W. F. Bynum and R. Porter (eds), Companion Encyclopaedia of the History of Medicine, London, 1993, p.1109; M. Martin, ‘Medical Knowledge and Medical Practice: Geriatric Medicine in the 1950s’, Social History of Medicine, 7 (1995), pp.458-59; Digby, Pauper Palaces pp.162-64; P. Townsend, The Last Refuge, London, 1962, p.23. For an in-depth account of older disabled inmates, see A. Ritch, English Poor Law Institutional Care for Older People: Identifying the prevalent in the nineteenth century and sick older people were frequently refused admission to voluntary hospitals, as they were considered to be suffering from chronic or incurable diseases.89 As this discrimination extended to Shoreditch Workhouse Infirmary, Claudia Edwards has suggested that poor law medical care for ‘the elderly’ may have been less generous than some historians have suggested.90 Provision for Sick Inmates Prior to 1834, sick inmates frequently remained in their beds within the workhouse dormitories. Only larger workhouses provided sick rooms or wards for inmates who became unwell, while very few had designated infirmaries. Sick wards were included in the plans of the model workhouses included in the first annual report of the PLCs and one type involved an infirmary in a separate building sited to the rear of the main workhouse.91 Dedicated infirmaries, consisting of a number of small rooms, became more popular by the 1860s and, at times, were located in sites at a distance from the workhouse, especially in London. In the later nineteenth century, many adopted the pavilion style, praised by Florence Nightingale, which allowed a high degree of segregation and through-ward ventilation. As workhouses catered for the chronic sick on a long-term basis, this necessitated provision of large infirmaries and the ‘Aged and Infirm’ and the ‘Sick’ in Birmingham Workhouse, 1852-1912’, Social History of Medicine, 27 (2014), pp.64-85.
T. R. Cole and C. Edwards, ‘The 19th Century’, in P. Thane (ed.), The Long History of Old Age, London, 2005, p.233; Woodward, p.45; B. Abel-Smith, The Hospitals, 1800-1948, London, 1964, pp.206-7.
C. Edwards, ‘Age-based rationing of medical care in nineteenth-century England’, Community and Change, 14, 2 (1999), p.251.
recommended size of 500 to 600 beds was often exceeded. By 1900, some had expanded to over 1,000 beds.92 A significant step in the development of infirmaries was the passing of the MPA in