«MEDICAL CARE IN THE WORKHOUSES IN BIRMINGHAM AND WOLVERHAMPTON, 1834-1914 by ALISTAIR EDWARD SUTHERLAND RITCH A thesis submitted to the University of ...»
However, at the board meeting, Rev. Johnson had an amendment accepted that they should not do so within three months of their appointment.188 For adequate staffing at the infirmary of the new workhouse (opened in 1903), it was agreed that 6 charge nurses and 18 probationers would be required, an increase of 3 and 4 respectively.189 Within four years, an additional 2 charge nurses and 9 probationers were needed.190 In 1904, the LGB approved Wolverhampton infirmary as a training school for nurses and, six years later, the CMB recognised it as suitable Ibid., 28 January, 11 February 1898.
WALS, WBG, PU/WOL/A/27, 13, 20 May, 3 June 1898.
Ibid., 3 June 1898.
BPP, 1902 [Cd. 1366], p.155.
Ibid., PU/WOL/A/28, 8 June 1900.
WALS, HC, PU/WOL/E/1, 31 December 1902; WBG, PU/WOL/A/30, 2 January 1903.
WALS, General Purposes Committee (hereafter GPC), PU/WOL/E/1, 2 December 1903.
WALS, HC, PU/WOL/E/2, 12 November 1907.
for training in midwifery, allowing it to be included in the trainees’ programme.191 Because of the guardians’ concern that two probationers had resigned within three months due to physical incapacity to perform their duties, they required that all applicants pass a medical examination before appointment, carried out by the MO.192 Another issue hindering training was the conscientiousness of the trainees. In 1903, the superintendent nurse, Miss Carter, complained of ‘carelessness and neglect’ by several probationers, who were exhorted by the guardians to make more effort in the best interest of the patients.193 Two years later, the situation was reversed and after a two-hour meeting with the guardians, Miss Carter and probationers, she agreed to carry out her duties to the satisfaction of the guardians and the benefit of the nursing staff.194 The second complaint against probationers for not taking an interest in lectures or studying as they ought was made by the resident MO. Once again, a meeting with the interested parties resolved the situation.195 One probationer in particular, Annie Coyle, had neglected her studies, in addition to returning to duty late, making tea when on duty and leaving the ward unattended. She had previously been shown leniency, but was now dismissed.196 Dismissals of probationers had been rare since transfer to the new workhouse, with only one other nurse so disciplined.
The next year, Miss Carter resigned and was succeeded by Miss Annie Tyers, who had been night superintendent.197 Certificates of completion of training included an assessment of probationers’ proficiency, for example, in 1908 Nurses Wain and Prescott were both rated as ‘good’ for surgical nursing, medical nursing and WALS, WBG, PU/WOL/A/31, 29 July 1904; PU/WOL/A/34, 1 April 1910.
Ibid., PU/WOL/A/31, 28 July 1905; HC, PU/WOL/E/2, 9 March 1905.
WALS, HC, PU/WOL/E/1, 4 June 1903.
Ibid., 23 February 1905.
WALS, Special Committee, PU/WOL/P/1, 30 November 1906.
WALS, HC, PU/WOL/E/2, 25 July 1907.
obstetrical nursing. Prescott was given ‘good’ for conduct, but Wain was rated very good.198 The Conduct of Nurses and Patients Was the reputation of workhouse nurses for inefficiency, negligence and being under the influence of alcohol while on duty justified? There were a few instances of nurses returning to the workhouse from leave in a drunken state, as in the 1850s in Birmingham, and this usually led to their resignation. The WMO complained on a number of occasions of nurses not carrying out his orders or exhibiting rudeness.
Prior to the transfer to the new workhouse, the only report of drunkenness was that of George Bates, the nurse of the men’s fever ward in 1843, but his dismissal may have resulted more from his use of ‘violent language to the master’.199 Subsequently, only one nurse was dismissed after returning ‘drunk from leave’ in 1882. Surprisingly, four months after Nurse Jane Thompson’s dismissal, Nurse Cherton was merely reprimanded for the same offence.200 The only other incident involving alcohol consumption was Nurse Rogers’ contention that the superintendent nurse, Kate Nicholson, was ‘tight’ on the night that Nurse Harrison died in 1885. The guardians found the accusation was ‘without foundation’, and Nurse Rogers resigned.201 The only incident in Wolverhampton workhouse in the nineteenth century of a nurse being reprimanded because of ‘a state of intoxication’ was in 1873 and involved the male Ibid., PU/WOL/E/2, 5 March 1908.
BCL, HC, GP/B/2/3/1/1, 13 June 1843.
BCL, HSC, GP/B/2/3/3/8, 4 July 1882; ISC, GP/B/2/4/1/1, 10 November 1882.
BCL, ISC, 2/4/1/2, 4 September 1855.
nurse, Edwin Ladbrook, on his return to the workhouse one evening.202 The only dismissals took place in the early decades of the twentieth century. Richard Newell, the attendant in the male mental wards, also returned from leave intoxicated at 11 o’clock in the morning and was still in the same state at half past seven in the evening.203 Wheeley, the attendant on the male skin ward, did not pay his usual visit to the wards at eleven o’clock in the evening because of the ‘influence of drink’.204 It is impossible to know if alcohol was a factor in the many resignations by nurses, but the findings in Birmingham and Wolverhampton would support Anne Borsay’s and Billie Hunter’s assertion that tales of drunken and disorderly nurses are exaggerated.205 However, nurses were also dismissed for taking unapproved leave and returning late from leave without the consumption of alcohol being involved. After being in office only three weeks, male nurse William Stokes stayed away from Wolverhampton workhouse for two days in September 1868 and offered his resignation when asked for an explanation.206 His replacement, Francis Eveson, repeated the offence by taking one day’s leave within three months and he also resigned.207 Thomas Lamb, underkeeper of the men’s insane ward, and Ann Sholton, nurse of the lying-in ward, in the infirmary in Birmingham were more fortunate. Although they stayed out of the workhouse overnight in January 1844, they were merely reprimanded after expressing their contrition.208 Leaving work without permission and patients unattended was one WALS, WBG, PU/WOL/A/15, 13 June 1873.
Ibid., PU/WOL/A/33, 3 January 1908.
WALS, HC, PU/WOL/E/4, 4 January 1912.
A. Borsay and B. Hunter (eds), Nursing and Midwifery in Britain since 1700, Basingstoke, 2012, p.21.
WALS, WBG, PU/WOL/A/13, 25 September 1868.
Ibid., 19 January 1869.
BCL, HC, GP/B/2/3/1/1, 16 January 1844.
of the most severe problems in voluntary hospitals, but Helmstadter and Godden consider that such behaviour was characteristic of the early nineteenth-century workforce in general.209 Nursing staff were also charged with the more serious offence of assaulting patients. In 1854, Mrs Sarah Pugh, attendant in the female epileptic wards in Birmingham workhouse, resigned after she had severely beaten Caroline Morris in a dispute about the amount of money Morris had given to her for safe-keeping.210 Pauper under-nurse Woolley was removed from her position in the epileptic wards in 1877 after using ‘undue violence’, resulting in an inmate’s arm being broken.211 The following year, Nurses Ankers and Harris were found guilty of gross cruelty for tying an aged inmate to her bed because of her inclination to wander about the ward.212 Ten years later, Thomas Armitage, superintendent over the aged men, pushed Edward Heap over and dislocated his hip.213 There were no further reports of assault in Birmingham after the separate infirmary opened the following year. In Wolverhampton workhouse in 1843, an inmate, Hannah Deakin, complained that Nurse Careless had beaten one of her children. When evidence of violence was found to be visible on the child, the nurse was reprimanded and removed from the nursery.214 However, John Moore, a pauper attendant in the insane wards, who assaulted Thomas McDonald, was taken before the magistrates, suggesting male inmates were treated more severely than officers and female inmates in incidences of assault.215 When, in 1876, an inmate in the lunatic wards, John Grainger, was found to have bruises, the guardians were satisfied that they had resulted from necessary force exerted in compelling him to take food and medicines. However, they did find Helmstadter and Godden, pp.12, 18, 39.
BCL, VGPC, GP/B/2/2/1/1, 12 May 1854.
BCL, HSC, GP/B/2/3/3/6, 13 November 1877.
Ibid., 30 April 1878.
BCL, WMC, GP/B/2/3/2/1, 15 June 1888.
WALS, MJ, PU/WOL/U/2, 9 September 1843.
WALS, WBG, PU/WOL/A/16, 14 May 1875.
the ward attendant guilty of beating Grainger with a pillow and removed the attendant from the ward.216 Miss Steward, one of the assistants on the female insane ward, was reported in 1899 by the superintendent to have treated a patient roughly. The wardswoman, Elizabeth Thomas, said she had seen Steward strike a patient several times and place a pillow on her face. Steward denied this, but admitted she had had difficulty pacifying the patient. No action was taken, as Thomas’ account could not be corroborated.217 Many of the instances of possible assault took place on the insane wards, where patients’ behaviour could be very difficult to control at times, but staff members were also at risk of injury. For instance, in 1862, Charles Smith was admitted to the epileptic ward in Birmingham workhouse, with an attendant to keep a close watch on him. However, at five o’clock in the morning, he knocked the man over, kicked down a door, picked up a table and attempted to strike the attendant with it.218 In Wolverhampton workhouse in 1907, there was an unprovoked assault by a patient on three nurses, two of which sustained serious injuries. The patient was charged with unlawful wounding and intent to do grievous bodily harm. Nurses Blackmore and Walker were allowed an additional two weeks leave after they had made a satisfactory recovery.219 The few reported incidents of maltreatment of sick inmates by nurses suggest that general callousness towards patients was not prevalent in the workhouses of Wolverhampton and Birmingham.
Ibid., 9 June 1876.
WALS, WVC, PU/WOL/H/2, 1 December 1899.
BCL, VGPC, GP/B/2/8/1/4, 1 August 1862.
WALS, WBG, PU/WOL/A/33, 20 December 1907.
Summary Standards of nursing care in workhouses depended on a number of factors. The number of nurses employed was less important than the ratio of nurses to sick inmates. In this respect, there was a significant deterioration in Wolverhampton workhouse as the century progressed. Although the guardians appointed additional staff to the insane wards, the number of nurses to care for the 80% increase in patients with physical illness remained at two. Birmingham guardians provided a higher standard of care, with a ratio of nurses to patients as good as the leading local voluntary hospital. Although, paradoxically, they reduced the number of nurses when moving to the new workhouse with a greater number of beds in the infirmary, they almost immediately appointed additional nurses and continued to do so as the number of sick inmates increased. What has become clear from the situation in Birmingham is that there was often little distinction between paid and pauper nurses, other than a salary differential (Table 6.6), and pauper nurses could move into the higher paid bracket, particularly after the guardians were prevented from paying them in cash.
Some of the nurses appointed in 1849 had children resident in Birmingham’s poor law institution for children and paid towards their keep from their wages. It is likely that they, themselves, would have been inmates if not employed as nurses. Abel-Smith quotes Louisa Twining’s comment in 1885 that she had visited most London workhouses and the majority had no paid nurses.220 However, the investigation by Birmingham guardians in 1856 showed that five large workhouses in London paid their nurses, as did six in the provinces.
L. Twining, quoted in Abel-Smith, p.10.
The accepted generalisation that nurse turnover was high is borne out in both Wolverhampton and Birmingham, although more so in the former. However, with a greater number of nurses employed in Birmingham infirmary, the workhouse records did not detail routine replacement of nurses. In addition, the larger complement would have less impact on continuity, when compared with Wolverhampton. The introduction of nurse training in workhouses did not resolve the problem of high turnover, as many left before completing their training. Guardians accepted probationers readily after pauper nursing was prohibited, for they were less costly than trained nurses. Initially, they may have been regarded as a form of cheap labour as formal theoretical learning was not introduced until early in the twentieth century.
As Sue Hawkins has emphasised, nurse training in the nineteenth century had as much to do with building character and instilling discipline, as with acquiring nursing skills.221 However, Birmingham workhouse did subject its early probationers to an examination in 1883. According to Christopher Maggs, there was a qualitative change in attitude to those caring for the sick from 1881.222 It was accompanied by a demand by nurses for greater professional recognition, the markers of which were the development of specific body knowledge and the beginning of the campaign for nurse registration.223 On a local level, this was identified by the provision of a uniform.
Nursing gained the status of a suitable occupation for single, middle-class women.
However, it had become closely associated with the qualities of caring that were
accommodated male participation in general nursing and male nurses were deemed Hawkins, p.77.
Maggs, ‘Nurse Recruitment’, p.23.
C. E. Hallett, ‘Nursing, 1830-1920: Forging a Profession’, in A. Borsay and B. Hunter (eds), Nursing and Midwifery in Britain since 1700, Basingstoke, 2102, pp.59, 62.
E. Gamarnikow, ‘Nurse or Woman: Gender and Professionalism in Reformed Nursing 1860-1923’, in P. Holden and J. Littlewood (eds), Anthropology and Nursing, London, 1991, p.110.
suitable only for mental health nursing.225 For instance, no training school in London