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«MEDICAL CARE IN THE WORKHOUSES IN BIRMINGHAM AND WOLVERHAMPTON, 1834-1914 by ALISTAIR EDWARD SUTHERLAND RITCH A thesis submitted to the University of ...»

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This study has uncovered a few areas where the care in workhouse infirmaries appears to be similar to that in voluntary hospitals. For instance, some nurses in Birmingham moved between two types of institution, but how many did so and how frequently? The other similarity between care in the infirmary and hospital was the treatment of pneumonia by a visiting physician to both types of institution in Birmingham. Once again, this is an isolated example and whether it occurred in other cases can only be determined by additional studies. Furthermore, little has been uncovered regarding the treatment prescribed for infectious diseases and for patients admitted with acute conditions, other than nutritional supplementation. Medical therapy was rarely recorded in the separate infirmary in Birmingham, and it may be possible to uncover this detail by investigating similar poor law institutions. Copies of prescriptions uncovered were typical of the time in being impossible to decipher (see the case records of the patient in Appendix C) and would require a dedicated investigation. In addition to a paucity of detail on medical treatments, little is understood on how medical care affected the lives of sick inmates. However, figures for admissions and discharges in Birmingham and Wolverhampton suggest a significant number of those receiving indoor medical relief were able to return to their communities in an improved condition, if not cured. The stories of applicants for outdoor medical relief, mostly under the OPL, have begun to be revealed by historians, but the voices of sick inmates after the NPL remain unheard. This study has produced a few of their experiences, mainly through complaints about treatment, and further microhistories are required to create a more complete narrative.27 Future research should be directed toward comparing the overall standard of medical care in workhouse infirmaries with that practised within non-poor law medical institutions, as this study has challenged the view that indoor medical relief was consistently inferior until the late nineteenth century. Finally, local arrangements for the provision of institutional care and isolation as tools in the prevention of the spread of infection within a community and the poor law’s role within them needs further exploration.

Furthermore, it does not accord with the traditional understanding of poor law medical care as a narrative of progressive improvement toward the establishment of the National Health Service in 1948. Instead, the story demonstrates the variability of medical care within the same workhouse over time and between two institutions in adjacent towns. The standard of care improved significantly by the beginning of the twentieth century, as occurred in Birmingham’s voluntary hospitals over the same period.28 In this sense, the workhouse infirmary had responded to advances in medical science and nursing education that had taken place throughout the nineteenth S. King, ‘“Stop this Overwhelming Torment of Destiny”: Negotiating Financial Aid at Times of Sickness under the English Old Poor Law, 1800-1840’, Bulletin of the History of Medicine, 79 (2005), pp.228-60; S. King, T. Nutt and A. Tomkins (eds), Narratives of the Poor in Eighteenth-Century Britain, Vol.1, London, 2006; S. King, ‘Regional Patterns in the Experiences and Treatment of the Sick Poor, 1800-40: Rights, Obligations and Duties in the Rhetoric of Paupers’, Family and Community History, 10 (2007), pp.61-75; A. Gestrich, E. Hurren and S. King (eds), Poverty and Sickness in Modern Europe: Narratives of the Sick Poor, London, 2012, pp.23-24.

J. Reinarz, Health Care in Birmingham, Woodbridge, 2009, pp.240-47.

century. By demonstrating the complex nature of institutional medical care for the destitute, this study advances the new perspective of workhouse medicine that emerged in the essays published in Medicine and the Workhouse.29 The workhouse infirmary emerges as the provider of an important element of medical care for the poor in its own right in the nineteenth and early twentieth centuries and not merely as a stepping-stone to later developments. Furthermore, despite the constraints of being stigmatised as paupers and subjected to authoritarian discipline, sick inmates experienced conditions that were better than those portrayed by the pessimistic interpretations of the older historiography of the NPL.

J. Reinarz and L. Schwarz (eds), Medicine and the Workhouse, Rochester, 2013.

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Prevalence of Selected Infectious Diseases in Birmingham Workhouse on the Last Day of the First Week of Each Quarter for the Years 1877-1880 and 1894

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Diarrhoea is included in the total number of infectious diseases as it appeared this way in the records:

fever labelled as typhus would have included the infection later separately identified as typhoid.

–  –  –

Elizabeth Wood’s Clinical Chart, Birmingham Infirmary, 1885 Source: British Parliamentary Paper, 1886, (19-Sess. 2), p.27.

Elizabeth Wood’s Temperature Chart, Birmingham Infirmary, 1885 Source: British Parliamentary Paper, 1886, (19-Sess. 2), p.29.

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Qualification and Certificates for Nurse Training in Workhouses Source: Interleaved in Wolverhampton Archives and Local Studies, Wolverhampton Board of Guardians, PU/WOL/A/9, 1854-57.





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Situation of First Workhouse in Lichfield Street, Birmingham, 18101 Source: The National Archives, MH12/13286.

The Asylum for the Infant Poor and the General Hospital can be seen in Summer Lane.

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Situation of Second Birmingham Workhouse and Infirmary, 18882 Source: Old Ordinance Survey Maps, Birmingham (Winson Green & Hockley), 1888, Alan Godfrey Maps, reprint 2012.

The Borough Smallpox Hospital can be seen within the workhouse grounds and the Borough Fever Hospital on the opposite side of the canal, along with the Borough Lunatic Asylum.

–  –  –

Plan of Second Wolverhampton Union Workhouse, 1902 Source: Wolverhampton Archives and Local Studies, DX/120/10/10, Block Plans of Workhouse (New Cross), 1902.

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Plan of Isolation Hospital in Second Wolverhampton Workhouse, 1900 Source: Wolverhampton Archives and Local Studies, DX/120/10/4, Block Plans of Workhouse (New Cross), 1900.

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1840 7476 6.7% 716 10% 1102 2.3% 409 37% 7.7% 16% 1861 8889 4.2% 1404 16% 3563 3.2% 663 19% 4.3% 14% 1871 9768 4.2% 1701 17% 5332 4.5% 696 13% 4.3% 15% 1881 7586 3.1% 2320 31% 7815 6.1% 912 12% 3.0% 22% 1891 4495 1.8% 2672 59% 5312 3.9% 915 17% 2.5% 24% 1901 3599 1.5% 2290 64% 4581 3.0% 1142 25% 2.4% 21% 1911 5319 2.4% 3091 58% 3962 2.4% 1203 30% 2.1% 35% Source: K. Williams, From Pauperism to Poverty, London, 1981, p.158; British Parliamentary Papers, 1840 (629), p.6, 1840 (543), p.2, 1861 (324B), pp.3, 42-43, 1871 (140 B.I.), pp.5, 6, 32-33, 1881 (60 B.I.), pp.iii, 30-31, 1890-91 (130 B.I.), pp.ii, 30-31, 1901 (73-I), p.ii, iii, 34-35, 1911 (263-I), pp.ii-iv, 14.

Data for 1840 for Birmingham is based on the average weekly number of paupers for the year ending Lady Day, and for Wolverhampton the number for the quarter ending Lady Day. Pauper numbers for all other years are one-day counts on 1 July.

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Primary sources not in print Birmingham Central Library, Archives and Heritage Service Birmingham Parish GP/B/1/1/1-7 Orders, 1837-1912 GP/B/1/2/1/1-12 LGB Letters, 1870-1911 GP/B/2/1/3-80 Minutes of Birmingham Board of Guardians, 1826-1912 GP/B/2/1/81-89 Minutes of Birmingham Union Board, 1912-1921 GP/B/2/3/2/1-6 Minutes of Workhouse Management Committee, 1887-1912 GP/B/2/3/1/1 Minutes of House Committee, 1842-1845 GP/B/2/3/3/1 Minutes of House Sub Committee, 1867-1910 GP/B/2/3/11/1 Minutes of Workhouse Inquiry, 1877-1878 GP/B/2/3/14/1-2 Minutes of House Committee, 1912-1917 GP/B/2/3/15/1-3 Minutes of Western Road House Sub Committee, 1912-1915 GP/B/2/4/1/1-5 Minutes of Infirmary Sub Committee, 1882-1888 GP/B/2/4/4/1-4 Minutes of Workhouse Infirmary Management Committee, 1888-1906 GP/B/2/4/4/5-6 Minutes of Infirmary Management Committee, 1906-1912 GP/B/2/4/5/1-4 Minutes of Infirmary House Sub Committee, 1898-1906 GP/B/2/4/8/1-2 Minutes of Infirmaries Committee (Hospitals), 1912-1917 GP/B/2/8/1/1-10 Minutes of Visiting and General Purposes Committee, 1852GP/B/2/8/2/1-4 Minutes of General Purposes Committee, 1912-1921 GP/B/2/12/3/1 Minutes of Special Committee, 1912-1914 GP/B/5/1/1 LGB Returns, 1877-1880 GP/B/5/1/2-8 LGB Returns, 1894-1911 GP/B/16/2/1 Returns relating to the number of Officers and Servants, 1856 MH/344/12/1 Register of insane, 1845-1850 GP/B/(ACC2009/109), Incident Book, 1885-1886, 1909-1911 Box 15

Birmingham Union

GP/B/2/1/81-89 Minutes of Birmingham Union Board, 1912-1921 GP/B/2/3/14/1-2 Minutes of House Committee, 1912-1917 GP/B/2/3/15/1-3 Minutes of Western Road House Sub Committee, 1912-1915 GP/B/2/4/8/1-2 Minutes of Infirmaries Committee (Hospitals), 1912-1917 GP/B/2/8/2/1-4 Minutes of General Purposes Committee, 1912-1914 GP/B/2/12/3/1 Minutes of Special Committee, 1912-1914 Birmingham General Hospital HC/GH/1/3/2-15 Annual Reports, 1857-1875 HC/GH/1/3/16 Annual Report, 1884 HC/GH/1/3/17-22 Annual Reports, 1891-1909 Census Enumerator’s Books, Birmingham Workhouse, 1841-1901 Wolverhampton Archives and Local Studies Wolverhampton Union PU/WOL/A/2-36 Minutes of Wolverhampton Board of Guardians, 1839-1914 PU/WOL/B/1-2 Minutes of Assessment Committee, 1862-1894 PU/WOL/C/1 Minutes of Finance Committee, 1899-1912 PU/WOL/D/1 Minutes of General Purposes Committee, 1899-1912 PU/WOL/E/1-5 Minutes of House Committee, 1900-1914 PU/WOL/G Minutes of Workhouse Accommodation Committee, 1895-1896 PU/WOL/H/1-2 Minutes of Workhouse Visiting Committee, 1892-1900 PU/WOL/L Resolutions passed by the Guardians, 1878-1892 PU/WOL/O/1 Minutes of Dispensary Committee, 1899-1912 PU/WOL/P/1 Minutes of Special Committees, 1900-1912 PU/WOL/S/1 Minutes of New Workhouse Committee, 1898-1899 PU/WOL/T Minutes of Workhouse Accommodation Committee, 1886-1888 PU/WOL/U/2 Master’s Journal, 1842-1845 DX-120/4-16 Block Plans of Workhouse (New Cross), 1900-1904 Borough of Wolverhampton L91 Wolverhampton Red Books, 1892-1913 L614 Report on the Health of the Borough of Wolverhampton for the year, Census Enumerator’s Books, Wolverhampton, 1841-1901 The National Archives Local Government Board and predecessors: Correspondence with Poor Law Unions and Other Local Authorities. Warwickshire Poor Law Unions. Birmingham.

–  –  –

Local Government Board and predecessors: Correspondence with Poor Law Unions and Other Local Authorities. Staffordshire Poor Law Unions. Wolverhampton.

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1866 (372) Metropolitan workhouse infirmaries, &c.

1866 (469) Workhouses (metropolis).

1866 [3660] Dietaries for the inmates of workhouses.

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1876 (202) Wrexham Union (use of stimulants).

1877 (260) Workhouse unions, England and Wales (diseases).

1881 (60B.I) Poor rates and pauperism. Return (B.).

1883 (108) Workhouses (consumption of spirits, &c.).

1886 (206) Workhouses (consumption of spirits, &c.).

1886 [3660] Dietaries for the inmates of workhouses.

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1892 (292) Workhouses (consumption of spirits, &c.).

1895 (28) Sanitary districts (accommodation for infectious diseases).

1895 (44) Workhouses (consumption of spirits).

–  –  –

Newspapers Birmingham Daily Mail Birmingham Daily Post Wolverhampton Chronicle Wolverhampton Journal Illustrated, Volume II, 1903 Printed sources, pre 1910 Aitken, W. C., ‘Brass and Brass Manufactures’, in Timmins, S. (ed.), Birmingham and the Midland Hardware District. London: Frank Cass & Co. Ltd, 1866.

Anonymous, ‘Birmingham’, The Lancet, i (1874), p.109.

Anonymous, ‘Birmingham Workhouse Infirmary’, The Lancet, i (1889), p.47.

Anonymous, ‘Birmingham Workhouse Infirmary. A Case of Peritonitis Following Parturition’ The Lancet, ii (1891), pp.1276-77.

Anonymous, ‘Charge Against the Medical Staff of the Birmingham Workhouse’, British Medical Journal, ii (1881), p.993.

Anonymous, ‘Dr. Edward Smith’s Reports on the Treatment of the Sick in Selected Provincial Workhouses’, The Lancet, i (1868), pp.166-68.

Anonymous, The Lancet, ii (1888), pp.1244-45.

Anonymous, ‘Obituary. Edmund Bancks Whitcombe’, British Medical Journal, i (1911), p.1353.

Anonymous, ‘On Nursing in Workhouse Infirmaries’, British Medical Journal, ii (1896), pp.857-62.

Anonymous, ‘Reports of the Old Cholera Haunts and Modern Fever Nests of London’, The Lancet, ii (1865), pp.656-58.

Anonymous, ‘The Lancet Sanitary Commission for Investigating the State of the Infirmaries of Workhouses’, The Lancet, ii (1865), pp.14-22.

Anonymous, ‘The Lancet Sanitary Commission for Investigating the State of the Infirmaries of Workhouses. Country Workhouse Infirmaries. No. IV. Wolverhampton Workhouse, Staffordshire’, The Lancet, ii (1867), pp.555-56.

Anonymous, ‘Weeding the Workhouse’, The Lancet, ii (1892), p.638.

Booth, C., The Aged Poor in England and Wales. London: Macmillan and Co., 1894.

Buchan, W., Domestic Medicine, 16th edition. London: printed for W. Strahan: T.

Cadell, 1799.

Bunce, J. T., ‘The Social and Economical Aspects of Birmingham’ in Timmins, S.

(ed.), Birmingham and the Midland Hardware District. London: Frank Cass & Co.

Ltd, 1866.

Burton-Fanning, F. W., The Open-air Treatment of Tuberculosis. London: Cassell, 1909.

Davies, J. R., ‘On the radical cure of Varicocele’, The Lancet, ii, (1861), p.60.

Davies, R., ‘Birmingham Workhouse Infirmary’, British Medical Journal, i (1858), p.677.

Davies R., ‘Birmingham Workhouse Infirmary’, British Medical Journal, i (1859), p.284.

Davies, R., ‘Remarks on the Operative and Mechanical Treatment of Prolapsus Uteri’, The Lancet, i (1864), pp.407-8.

Gairdner, W. T., ‘Facts and Conclusions as to the Use of Alcoholic Stimulants in Typhus Fever’, The Lancet, i (1864), 291-94.

Graham, T. J., Modern Domestic Medicine, 10th edition. London: Simpkin and Marshall, 1848.



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