«MEDICAL CARE IN THE WORKHOUSES IN BIRMINGHAM AND WOLVERHAMPTON, 1834-1914 by ALISTAIR EDWARD SUTHERLAND RITCH A thesis submitted to the University of ...»
guardians to provide whatever facilities they deemed necessary for ‘persons labouring under any disease of body or mind’ outwith the formal classification system.5 Thus, the central authority did not define a definitive medical policy in the early days of the New Poor Law (hereafter NPL).6 The expansion of medical relief from the late 1830s was a spontaneous development and influenced by administrative orders of the Commissioners rather than by the central authority. As Michael Flinn has put it, the NPL medical service was an ‘accident of history which only the most pressing social need could have engineered’.7 By the mid-nineteenth century, nearly three-quarters of the cases of pauperism in England and Wales involved sickness.8 The proportion of sick inmates rose from 10% in 1843 to between 34% and 48% in the mid to late 1860s, with the higher figure in London and the lower in provincial workhouses, and remained at this level into the early part of the twentieth century.9 Illness and injury accounted for a substantial proportion of admissions to workhouses, for instance 62% of adult males and almost 44% of adult females admitted to Medway Union workhouse between 1876 and
1881.10 Workhouses now began to adopt the role of hospitals and, by 1870, those in large towns had been transformed into ‘infirmaries for the sick’, widely regarded as the first public hospitals.11 By 1891, the public sector provided about 83,000 beds, compared with only 43,000 by voluntary hospitals.12 The increase in sick inmates BPP, 1844 (45), p.1.
A. Digby, The Poor Law in Nineteenth-century England and Wales, London, 1982.
A. Digby, Pauper Palaces, London, 1978, p.166.
Hodgkinson, pp.147, 465-67; J. Lane, A Social History of Medicine, London, 2001, p.64; M. A.
Crowther, Workhouse System, London, 1981, p.89.
D. G. Jackson, ‘The Medway Union Workhouse, 1876-1881: A study based on the admission and discharge registers and the census enumerators’ books’, Local Population Studies, 75 (2005), p.19.
D. Ashforth, ‘The Urban Poor Law’, in Fraser (ed.), The New Poor Law in the Nineteenth Century, London, 1976, p.148; Hodgkinson, p.451.
B. Abel-Smith, The Hospitals, London, 1964, p.200.
resulted from the recognition of the benefits of institutional medical care for those who could not be cared for at home, the poor state of health of many of the paupers admitted and the growing popularity of hospitals among the poor. Also, the Poor Law Board (hereafter PLB) officially reversed the policy of less-eligibility in relation to the sick in the late 1860s and its president, Gathorne Hardy, stated that the deterrent principle was no longer appropriate. The Medical Relief (Disqualification) Act of 1885 removed disfranchisement from those receiving medical relief. However, many provincial unions were slow to implement the change and in Birmingham the sick were still subjected to the workhouse test in 1888.13 Another major factor in the development of poor law institutional medical care for those who could not afford private treatment was the strict exclusion policies of voluntary hospitals, rejecting those with chronic or terminal disease as well as older patients.14 For instance, Birmingham General Hospital from its foundation refused admission to patients suspected to have itch and were reluctant to admit patients with chronic leg ulcers, as they were likely to have longer lengths of stay in hospital.15 Furthermore, when patients who had been admitted to voluntary hospitals were deemed ‘incurable’, they were not allowed to remain. This happened in May 1884 to Ann Hackett, who was transferred to Birmingham workhouse from the Queen’s Hospital because she was ‘crippled with rheumatoid arthritis and suffered spinal caries’. According to Cornelius Suckling, who was visiting physician at both institutions, her bedsores had been in a healthy condition and nearly healed at the time S. Webb and B. Webb, English Poor Law History Part II: Vol. I, London, 1929, pp.319-20; Flinn, p.65; Hodgkinson, p.542.
Crowther, pp.167, 180-81; Pickstone, p.223.
Quoted in J. Woodward, To Do the Sick No Harm, London, 1974, p.47.
of transfer.16 Claudia Edwards has demonstrated that elderly individuals were overrepresented among admissions to Shoreditch poor law Infirmary, compared with their proportion in the local population, whereas the reverse was true at Bristol Royal Infirmary, a voluntary hospital.17 As a result, 80 per cent of hospital beds for physical illness in 1861 were in poor law institutions, but, perversely, historians’ interests have been focussed more on the voluntary hospital sector.18 This disproportionate neglect may have arisen because of the difficulty in identifying medical details within poor law records, particularly relating to sick inmates, who were not identified as a separate group in official statistics until after 1913.19 The poor law records available vary over the study period considerably in the amount of information they contain related to sick inmates. For instance, in the early years of the NPL, detailed statistics are recorded for patients treated in the Birmingham infirmary, but, paradoxically, as both Birmingham and Wolverhampton infirmaries developed a more acute medical role, less detail appears in the guardians’ minutes regarding medical care.20 Although a large proportion of patients in workhouses suffered from chronic illnesses, identification of this group is difficult. However, Birmingham provided dedicated wards for inmates with disability, labelled ‘bedridden wards’, allowing the more disabled section of the ‘non-able-bodied’ class to be more visible. This chapter considers the types of patients that were admitted with physical illness, with the exception of communicable diseases, which are covered in the next Birmingham Central Library (hereafter BCL), Infirmary Sub Committee (hereafter ISC), GP/B/2/4/1/2, 16 May 1884.
C. Edwards, ‘Age-based Rationing in nineteenth-century England’, Community and Change, 14, 2 (1999), pp.227-65, 240-41.
R. Pinker, English Hospital Statistics, 1861-1938, London, 1966, pp.61-62; B. Harris, The Origins of the British Welfare State in England and Wales, 1800-1945, Basingstoke, 2004, pp.98-99.
K. Williams, From Pauperism to Poverty, London, 1981, p.203.
The nature of medical treatment carried out in the infirmaries is dealt with in Chapter 5.
chapter. It considers whether the provision for both the acutely ill and the chronically sick in the workhouses in Birmingham and Wolverhampton was different in the two
admissions increased as the century progressed, how did the guardians meet this increasing need for medical care and did the additional infirmary beds merely reflect
Romola Davenport and Leonard Schwarz have suggested the predominant function of eighteenth- and early nineteenth-century workhouses was the care of those admitted in the end stage of their lives, as the majority of deaths occurred shortly after admission.21 To what extent did the workhouse perform other medical functions, such as active medical treatment for those with short-term acute disease? What was the nature and intensity of the illnesses suffered by workhouse patients and how well did the care provided compare with the general standards of medical care at the time?
What were the medical conditions and levels of dependency of inmates with physical disability in two workhouse infirmaries in the West Midlands? As the infirmaries developed a greater role in treating acute illness, what was the impact on sick inmates who remained in the residual portion of the workhouse? Before addressing these issues, it is necessary to analyse the context in which the two workhouses were located.
J. Boulton, R. Davenport and L. Schwarz, ‘Mortality, Medicine, and the Workhouse in Georgian London, 1725-1824’, in J. Reinarz and L. Schwarz (eds), Medicine and the Workhouse, Rochester, pp.58-60.
The Poor Law in Birmingham and Wolverhampton This section analyses the provision for the indoor poor in the two towns and the context in which the workhouses provided medical care. It explores the size of the workhouses, local voluntary hospital provision, the nature of the towns and their economic circumstances. A local act of parliament in 1783 established Birmingham Parish as a Poor Law Incorporation and, in 1831, a new local act enabled ratepayers to elect 108 guardians of the poor.22 The first workhouse, originally said to resemble ‘a gentleman’s house’, was built at a cost of £1,173 in 1733, at a time when the population of Birmingham was just over 20,000 (Appendix F).23 Minutes of the board of guardians reveal 369 inmates in May 1785 and 442 at Easter 1812.24 At the end of the eighteenth century, 300 children were residing in placements throughout Warwickshire because of lack of accommodation in the workhouse.25 An Asylum for the Infant Poor was erected in Summer Lane in 1797 to bring them under one roof within Birmingham. The number of inmates in the workhouse itself did not surpass 500 until after 1847. The workhouse was extended twice later in the century, but continued to prove inadequate for the increasing number of the poor requiring indoor relief. Although a larger building was proposed in the early 1780s, it did not get built for 60 years.26 When the new Birmingham workhouse opened in 1852, it had accommodation for 1,610, including 17 officers, 80 tramps and 310 beds in a W. Hutton, An History of Birmingham, 6th edition, Birmingham 1835, p.375.
Hutton, p.216. The first and second editions of Hutton’s History record the workhouse as being the home of 400 paupers, whereas later editions state 600 paupers. In light of the number of inmates recorded in the minutes of the board of guardians in the 1780s, the lower figure appears the more appropriate.
BCL, Birmingham Board of Guardians' Minute Book (hereafter BBG), GP/B/2/1/1, 30 May 1785;
GP/B/2/1/2, 2 March 1813.
BCL, BBG, GP/B/2/1/1, 30 March 1796.
J. Reinarz and A. Ritch, ‘Exploring Medical Care in the Nineteenth-century Provincial Workhouse: a view from Birmingham’, in J. Reinarz and L. Schwarz (eds), Medicine and the Workhouse, p.143.
detached infirmary (Appendix G).27 Built in the corridor style on an extensive site, its ventilation system attracted particular attention at the time.28 Its 1,926 inmates made it the second largest workhouse in a survey of 48 provincial workhouses in the mids, compared with 3,194 in Liverpool, 1,475 in Portsea Island and a median value of 215 inmates for all 42 workhouses (Appendix H).29 In 1870, it ranked seventh among the one per cent of English workhouses with more than 2,000 inmates, when 93% had less than 500 inmates.30 Birmingham Parish was completely urban in nature, smaller geographically than the Borough of Birmingham and its population was 75% of that of the borough in 1851.
Its size remained unchanged as the borough expanded by the inclusion of neighbouring areas, receiving city status in 1889. The population of the parish in 1901 showed an increase of 30% on 133,215 persons recorded at the 1851 census, while the borough increase over the same period was much larger at 123% from a base of 233,841.31 In the 1890s, the parish was the second most densely populated provincial poor law authority, with 82 persons per acre, compared with Manchester’s 88 persons.32 After the NPL, Birmingham Parish continued to function under the local act, which restricted the influence of the Poor Law Commissioners (hereafter PLCs), although they had gained greater control over the guardians by the 1850s.33 However, poor law records always referred to the Birmingham authority as a Parish J. A. Langford, Modern Birmingham and its Institutions, Birmingham, 1871, pp.381-82.
BPP, 1867-68 (4), pp.26-157.
BPP, 1870 (468 - I), pp.4-25.
P. A. Tolley, ‘The Birmingham, Aston and Kings Norton Boards of Guardians, and the Politics and Administration of the Poor Law, circa 1836-1912’ (unpublished PhD thesis, De Montfort University, 1994), p.396.
C. Booth, The Aged Poor in England and Wales, London, 1894, p. 96 Tolley, pp.322-23; the issue of the relative independence of Local Act Unions is discussed by Driver, pp.42-57.
rather than a Union, until it amalgamated with the neighbouring unions of Aston and King’s Norton in 1912 to form a greater Birmingham Union.
Birmingham Corporation was not constituted until 1838, but by 1890, it was described as the ‘Best governed city in the world’.34 A report into large towns in 1844 referred to Birmingham as ‘one of the most healthy’, a claim supported by the mortality statistics at that time.35 However, the death rate increased relative to other large towns in the 1870s, prior to the reforms carried out by Joseph Chamberlain to improve gas and water supplies and sanitation, and rid the city centre of slum housing.36 The rapid industrial expansion in the town in the late nineteenth century resulted in a highly diversified economy, which lessened the impact of industrial action in any one trade.37 Manufacturing was centred on the metal or hardware industries, such as buckles, buttons, pins and jewellery, known at the time as ‘toys’.
The production of small metal items or trinkets led Edmund Burke, in 1777, to refer to Birmingham as ‘the toy-shop of Europe’.38 The manufacture of guns, swords and iron screws were among the other staple industries, while the production of iron and brass bedsteads in England was chiefly confined to the Birmingham neighbourhood.39 The brass trade developed into the chief industry of the town, but the risk of pulmonary disease due to the inhalation of dust from the industrial process was so high that the R. Woods, ‘Mortality and sanitary conditions in late nineteenth-century Birmingham’, in R. Woods and J. Woodward (eds), Urban Disease and Mortality in Nineteenth-century England, London, 1984, p.177.
E. Hopkins, Birmingham, The Making of the Second City 1850-1939, Stroud, 2001, p.94; Woods, p.177.
A. Mayne, The Imagined Slum. Newspaper representation in three cities, 1870-1914, Leicester, 1993, p.60.
J. T. Bunce, ‘The Social and Economical Aspects of Birmingham’ in S. Timmins (ed.), Birmingham and the Midland Hardware District, London, 1866, p.688.
S. Timmins, ‘The Industrial History of Birmingham’, in Timmins (ed.), Birmingham and the Midland Hardware District, p.216.
E. Peyton, ‘Manufacture of Iron and Brass Bedsteads’, in Timmins (ed.), Birmingham and the Midland Hardware District, p.624.