«MEDICAL CARE IN THE WORKHOUSES IN BIRMINGHAM AND WOLVERHAMPTON, 1834-1914 by ALISTAIR EDWARD SUTHERLAND RITCH A thesis submitted to the University of ...»
Pickstone claims that the exclusion of patients requiring careful and intensive nursing from the ‘hospital section’ of the workhouse was common.144 When a nurse in the workhouse died two years later, the master, supported by the matron and medical officer, claimed three other nurses were incompetent and ‘not fit to trust old people with’. They requested that trained nurses be appointed in their place, to which the guardians agreed, but decided to advertise for ‘attendants trained in nursing, ages not to exceed 35 years’.145 Within two months, the master complained that none of the newly appointed ‘attendants’ would remain long in post unless they were placed on the same footing as the nurses in the infirmary, with their better diet and other BCL, BBG, GP/B/2/1/51, 12 December 1883.
BCL, ISC, GP/B/2/4/1/1, 3 October 1884.
TNA, MH12/13349, 3 December 1885.
BCL, GP/B/(ACC 2009/109), box 15.
J. V. Pickstone, Medicine and Industrial Society, Manchester, 1985, p.217.
BCL, HSC, GP/B/2//3/2/12, 23 June 1891; Workhouse Management Committee (hereafter WMC), GP/B/2/3/2/1, 10 July 1891.
Table 6.9: List of Nurses and Attendants Leaving Office in Birmingham Workhouse, July 1880 - October 1881146
privileges. The guardians approved this request and also reverted to the designation of nurses.147 In the early twentieth century, the post of assistant matron at the workhouse was advertised as requiring a qualified nurse and attracted 45 applications.
Emma King, the assistant matron at West Ham Workhouse, was appointed with an annual salary of £50, increasing over five years to £60.148 She died two years later of typhoid fever despite being admitted to the infectious disease hospital and was Three other nurses resigned, but no reason was given.
BCL, HSC, GP/B/2/3/3/13, 8 September 1891.
BCL, WMC, GP/B/2/3/2/4, 4 May, 29 June 1906; HSC, GP/B/2/3/3/22, 26 June 1906.
succeeded by Maud Plant.149 However, the appointment of a trained nurse as assistant matron did not mean that nursing in all the workhouse wards was of a high standard.
Mr E. B. Wethered, a LGB Inspector, was critical of the fact that only one nurse was employed on each of two of the female bedridden wards, with 34 patients in each ward who were ‘actually bedridden’. He considered there should be seven nurses on each ward to prevent the pauper assistants from having to perform nursing duties.150 The chronic nature of the majority of the patients in the workhouse may have contributed to the paucity of nurses and the difficulty with their retention.151 Several historians have commented on the less interesting nature of patients with chronic disability and the restricted variety of illnesses that their nurses experienced.152 Concurrent with the development of scientific medicine, there arose the view that the ‘chronic sick’ did not need skilled nursing.153 However, Anne Gibson, in her evidence to the Departmental Committee enquiring into the Nursing of the Sick Poor in Workhouses, stated that the ‘nursing of the chronic and aged sick’ was most important, ‘one of the highest and best proofs of a good nurse that she is able to deal with that type of care’.154 Unfortunately, she had authority only over nursing in the infirmary and not in the workhouse itself.
BCL, WMC, GP/B/2/3/2/5, 10 January, 5 February 1908.
Ibid., GP/B/2/3/2/6, 16 June 1911.
The extent of the chronic disease and the level of disability among workhouse inmates is analysed in chapter 2.
For example, Crowther, p.188; A. Digby, Pauper Palaces, London, 1978, p.172.
BPP, 1902 [Cd. 1367], p.56.
Introducing Nurse Training into Workhouses.
The earliest attempt to provide formal training to pauper nurses was made by the Epidemiological Society in the mid-1850s, with the award of certificates for satisfactory completion (see Appendix E). It foundered because of the inability of the inmates to benefit from training and the opposition of Florence Nightingale. The introduction of trained nurses at Liverpool Union’s infirmary, Brownlow Hill, was led by Agnes Jones, Florence Nightingale’s ‘best pupil’, and they were employed to work on the male wards only.155 They were funded for three years by a local merchant and leading nursing reformer, William Rathbone, who had been dissatisfied with the standard of nursing he had encountered on his visits to workhouses and approached Nightingale for assistance. One year after their introduction, the workhouse master reported a marked improvement in the standard of nursing and rehabilitation of the patients, and a better demeanour among the male patients. The visiting physician preferred the new system as it convinced him of the nurses’ ability to implement medical orders, as well as promote good morale on the wards.156 Although the scheme foundered after Jones’ death from typhus in 1868, similar training initiatives were subsequently set up at Highgate by St Pancras Union and at St Marylebone Union in London with funding from the Nightingale Fund.157 However, trained nurses could not be employed without the supervision of an officer who had undergone training. Such appointments were facilitated by an LGB order of 1897, which required the appointment of a superintendent nurse, who had undergone three years’ training, in any workhouse where three or more nurses were employed Abel-Smith, p.40.
White, pp.33-34; BPP, 1867-8 (4), p.112.
and that matrons in the separate infirmaries be trained nurses and have overall control of the nursing staff. Five years after the appointment of a superintendent of nurses at Birmingham workhouse in 1878, three probationer nurses were appointed at an initial annual salary of £10, increasing over three years to £18, plus the provision of a uniform. The superintendent, Kate Nicholson, suggested that those who passed the MO’s examination, which consisted of a written paper and viva voce, should be rewarded by being appointed to the first substantive nursing post to become available.158 More probationers were taken on over the next four years and, in November 1887, their number was increased to 20 in light of the anticipated opening of the new infirmary and the total abolition of pauper nursing.159 The guardians sought the LGB’s permission to engage up to 20 staff nurses (annual salary, £20-£25), 10 assistant nurses (£20), and 50 probationers (£10-£18) in the new infirmary with a total bed complement of 1,665.160 They appointed as matron Miss Annie Gibson, who held the appointment of superintendent at Brownlow Hill Infirmary in Liverpool and was, therefore, one of Agnes Jones’ successors. She was paid £130 per annum and given the remit to ‘take control of the sick in the wards’ under the supervision of medical staff and to maintain good order among the nurses and inmates.161 According to Rosemary White, Gibson became a powerful figure, with well-considered ideas, and one of the most influential members of the poor law medical service.162 She instigated a scheme for training paying probationers within the infirmary and the fee per trainee of £28 per annum generated £900 in revenue for the guardians in 1893, with up to 25 pupils at a time BCL, ISC, GP/B/2/4/1/2, 2 November, 6 December 1883; GP/B/2/4/1/4, 18 May 1888.
Ibid., GP/B/2/4/1/4, 4 November 1887.
BCL, IMC, GP/B/2/4/4/1, 21 December 1888.
Ibid., 17 August 1888; BBG, GP/B/2/1/57, 29 June, 19 September 1888.
White, pp.96, 100.
undergoing training.163 As a result, assistant nurses were no longer employed, with charge nurses increased by two to 22.164 Gibson may have obtained the idea for the scheme from that of the Nightingale school in London in the late 1860s as she had trained at St Thomas’ Hospital, where women from the higher social classes could pay for training. It was these ‘lady-pupils’ who later were at the forefront of reform.165 By 1896, Birmingham infirmary was training 32 paying probationers. In a return of nursing staff in workhouses in England and Wales in 1896, Birmingham was the only one that declared additional fee-paying nurses and it is likely the scheme was unique within the poor law nursing service, although a similar scheme had been in operation at the General Hospital for at least two decades.166 Of the 73 paid nurses, 35 had received training prior to their appointment, in contrast to Wolverhampton workhouse, where none of the three nurses, caring for 165 sick and bedridden inmates, had received prior training and where 43 inmates assisted in the personal care of patients.167 The nurse-to-patient ratio in Birmingham infirmary was 1:13, compared with 1:55 in Wolverhampton workhouse. In Birmingham, it was almost as good as at Withington Infirmary in Manchester (1:10), where the nursing was described in a report in the British Medical Journal as of the same standard as in general hospitals, but poor by comparison with the General Hospital, Birmingham (1.4 in 1898).168 However, a few years later, the training scheme was discontinued, but Birmingham infirmary continued to take pupils from the Workhouse Nursing Association, receiving a solitary fee of £20 for each trainee.169 The General Hospital BCL, IMC, GP/B/2/4/4/1, 20 June 1889; GP/B/2/4/4/2, 26 January 1894.
TNA, MH12/13365, 26 February 1892.
BPP, 1896 (371), p.28; Wildman, p.23.
BPP, 1896 (371), pp.26-29.
Anonymous, ‘On Nursing in Workhouse Infirmaries’, British Medical Journal, ii (1896), pp.857-59;
C. J. Maggs, The Origins of General Nursing, London, 1983, p.90.
BCL, Infirmary House Sub Committee (hereafter IHSC), GP/B/2/4/5/1, 23 October 1899.
had also discontinued its intake of paying probationers two years previously.170 In 1902, Birmingham was training 88 probationers, with 27 in their first year, 32 in their second and 29 in their third and final year.171 After the Central Midwives Board (hereafter CMB) was established that year, lectures by a medical authority were introduced to allow nurses to qualify for its diploma and training was extended to four years to allow for the additional number of deliveries required by the board to be carried out.172 Nurse training could not commence in Wolverhampton workhouse before a Superintendent Nurse had been appointed and the guardians did not decide to do so until 1893, when they advertised for a ‘thoroughly competent’ woman as ‘Head Nurse’ to be responsible for nursing throughout the workhouse and to ‘re-model’ the nursing arrangements. From 14 applicants, they selected Miss Anna Menon, remunerating her annually with £35.173 At the time of her application, she was a staff nurse at Walsall Cottage Hospital, but had received her training at Whitechapel Infirmary, London.174 When the LGB approved the appointment of probationer nurses early the following year, it added the rider that the nurse staffing should be reevaluated to ensure it was ‘put upon an efficient footing’.175 From the 105 applications, the board interviewed 10 candidates and appointed 4 probationers to serve two-year appointments at a salary of £10 annually. An additional two were appointed five months later, but only because of pressure exerted on the guardians by Wildman, ‘Nursing at the General Hospital’, p.23.
BPP, 1902 [Cd. 1367], p.158.
BCL, IHSC, GP/B/2/4/5/4, 26 March 1906.
WALS, WBG, PU/WOL/A/24, 9 June and 21 July 1893; Workhouse Visiting Committee (hereafter WVC), PU/WOL/H/1, 19 May, 9 June 1893.
WALS, WC, 26 July 1893.
WALS, WBG, PU/WOL/A/24, 2 February 1894.
the LGB to improve staffing levels.176 The board voted against Miss Menon being allowed to be present during the interviews, a factor which may have played a part in the large number of probationers leaving before completing their training.177 However, this was not peculiar to Wolverhampton; for instance, 30% of probationers left before competing their training in Kensington Infirmary between 1890 and
1915.178 The difficulty the guardians experienced in making appointments was that there were no criteria of suitability to assist them. The Departmental Committee into the Nursing of the Sick Poor in Workhouses in 1902 faced a similar problem and could only recommend that potential probationers should be of a minimum age of 21 years, of good character and health and have intelligence.179 From the initial appointment of probationers to the opening of the new workhouse 10 years later, 12 resigned, although reasons were only given on two occasions. Nurse O’Reilly was accused of ‘neglect of duty’, while Gertrude Hill suffered an accident during a gale.180 In addition, two probationers were deemed not fit to carry out their duties because of their state of health and one was assessed as unsuitable for nurse training by the MO.
Early the next century, the MO in Birmingham workhouse reported that Dora Copeland had a cardiac murmur and ‘must give up nursing’.181 The training complement of probationers in Wolverhampton workhouse had been increased to 12 by 1896 and the length of training increased to three years.182 Two years later, three additional probationers were accepted from the Trained Nurses Ibid., 16 February, 6 July 1894; WC, 20 June 1893.
BPP, 1902 [Cd. 1366], p.9.
WALS, WBG, PU/WOL/A/25, 9 October 1896; WVC, PU/WOL/H/2, 1 October 1897.
BCL, IHSC, GP/B/2/4/5/3, 9 February 1903.
WALS, WVC, PU/WOL/11/2, 24 March, 24 July 1896.
Institution, each with a payment of £10.183 In the same year, the Superintendent Nurse resigned and her appointed successor did likewise before taking up her appointment. She was replaced by Miss Maud Carter, in her late 20s, at an annual salary of £40.184 There was also difficulty in appointing trained nurses at this time, with no applications for the post of charge nurse and so one of the probationers was upgraded.185 This was not unique to Wolverhampton, as about a quarter of poor law medical institutions reported difficulty in recruitment around this time.186 At the end of the century, the nurses not in training had been increased to 10 for day duty and 5 for night duty to care for 226 physically ill patients (nurse to patient ratio of 1:15, one of the lowest in Staffordshire).187 In 1902, the House Committee debated the advisability of probationers being involved in the venereal wards, although they were under the supervision of charge nurses. They concluded that attendance on these wards was a necessary part of their training to become a ‘fully informed nurse’.