On 2 September 1857, a letter appeared in The Birmingham Journal under the heading of ‘A Voice from the Workhouse’ and signed anonymously ‘PAUVRIS’.
Sir. – I now have a subject of equal importance to bring before the public through the medium of your widely circulated columns....[A]mong(sic) the numerous persons of both sexes obtaining relief by being admitted into the Workhouse, it would be strange if there were not a great many who require the assistance of the doctor, or surgeon; such is the fact, there are, and there are also a goodly number who have been in the house for some time under medical treatment. For such cases we have a resident medical man, whose duty it is to attend them and of course to administer such medicines…as may … reasonably be supposed to restore them to health or else alleviate their ailments if complete restoration is hopeless. Of course as Medical Officer he should be the best judge what medicines to use, and what diet to put them on to accelerate their cure and should have the power of ordering accordingly. Does he do so, or can he? I flatly answer no. Reasons: the Board in their wisdom are much better judges of such matter, and almost come to the conclusion that all medicines than anything above the price of Epsom Salts or Magnesia, and some other trifling articles are quite unnecessary, and I presume fancy it is better to let nature have its course or rather the disease as the expense of burial (should death result) will be the last expense and consequently cheapest. The cost of medicines during the time of our late Resident Surgeon was a frequent matter of discussion, but he being a man who really did know his business gave patients what he considered would do them good and the consequent cost was much objected to. He however, has now left us for a better practice I trust, and we have one who exactly suits the Guardians being on the cheap principle, if there is any principle about it. It is really a misnomer to call a great deal of the stuff labelled “take two table spoons full every four hours” medicine at all. Well what is the result? A great saving, first in the amount of the Drug Bill, secondly instead of keeping the parties on hand or curing them so that they may go out, and if unfortunately obliged to return, costing the parish, a little more they go to the grave, and there is an end of the expense as regards them. Mind you I don’t mean to say they are killed, but they are not cured and die in the interim … Let not this thing be; see to it. Those that are whole need not a physician, but they that are sick; and why not have one without his hands tied behind him by the petty excuse that the drug bills are too heavy. A really clever medical man would not be fettered by any such parsimonious nonsense and conscientious Guardians should not presume to regulate what they know nothing about, but leave it to the Medical Officer if he is worth being called such. –Yours
PAUVRISFootnote 1Since Roy Porter pioneered writing medical history from the patient’s point of view forty years ago, medical historians have sought to capture patients’ experiences in ways other than through the clinical gaze.Footnote 2 However, Anne Hanley and Jessica Meyer in 2021 asserted that although the patient’s perspective had become integral to historical analysis, most notably in the study of medical institutions, this had not been as extensive as Porter had envisaged.Footnote 3 Nevertheless, the experiential turn in the 1990s did give further impetus to Porter’s approach by expanding it to the voices of the poor in general, but especially to those who came into contact with the English poor laws to uncover the extent to which they could influence their welfare provision.Footnote 4 In Steven King’s view, achieving a New Poor Law history from below requires a focus on the everyday experiences of the indoor and outdoor poor with ‘an ear to the voices of the poor themselves’.Footnote 5 He calls this movement for placing the pauper experience at the centre of the analytical approach one of the most powerful developments in recent historiography.Footnote 6
The Poor Law Amendment Act of 1834, commonly referred to as the New Poor Law, was enacted to reduce the costs of poor relief by abolishing outdoor relief and by deterring able-bodied paupers from entering a workhouse. A centralised administrative system was set up, establishing a government authority that carried out inspections and issued regulations to govern workhouse administration. The most notable enactment was the principle of ‘less eligibility’, namely that workhouses should provide a lower standard of living than a wage-earning labourer. However, as it was impossible to do so by providing harsher physical conditions, the enforcement of ‘less-eligibility’ could only be achieved by psychological means, such as the deprivation of identity and dignity and the surveillance of individual conduct.Footnote 7 The sense of depersonalisation was enhanced by means of strict discipline and supplying inmates with a workhouse uniform on admission, although their own clothes were returned on discharge. All inmates, even those who were old or sick, were subject to the rule of official regulations. This strict control of personal behaviour has, according to David Englander in his seminal paper in 2000, meant that paupers were ‘too often presented as helpless, hapless and hopeless sorts who on entering the workhouse relinquished their independence to become the victims rather than makers of history’.Footnote 8 The greater enforcement of the regulations after the New Poor Law may have meant that inmates in general had even less agency than previously.Footnote 9 Sick and disabled inmates may also have been subjected to further dependency within the doctor-patient relationship when confronted with medical officers who also had a disciplinary function within the institution and the right to inflict punishment. As their health care took place in a ‘deterrent’ setting, their ability to protest or complain over the quality of care they received or over their medical treatment is likely to have been severely limited.Footnote 10 However, as King et al have pointed out, as the experiences of the sick poor after 1834 are sparse, it is unclear how far this most vulnerable of sub-groups within the workhouse population were successful in asserting meaningful agency.Footnote 11 Any moral authority that outdoor paupers had in claiming relief on medical grounds before 1834 could easily dissipate on entering the workhouse. Making a complaint would be more difficult when workhouse medical care remained ‘hedged with a persuasive atmosphere of deterrence’ and always carried with it the threat of retribution.Footnote 12
The most commonly used research tool to uncover the voices of the poor has been letters written by or on behalf of paupers regarding requests for relief or complaining of mistreatment within the workhouse, approaches pioneered by Thomas Sokoll and David Englander at the end of the twentieth century.Footnote 13 Letters can provide an understanding of the lives and feelings of the dependent poor and can also highlight the complex strategies and devices used to persuade parish officers to provide help. A frequent device employed in requesting assistance was to get someone else to write in support of their claim, and a common theme was the ‘stark expression’ of the plight of the supplicant, at times combined with the impact of that plight becoming public knowledge.Footnote 14 One of the drawbacks of these earlier studies was that the majority of letters were from outdoor paupers requesting poor law relief and over a time frame limited to the Old Poor Law. As a result, pauper letters have not been as fruitful a source for illuminating the experiences of paupers in workhouses, since few were written by them either when inmates or later as a reflection of their experiences in the institution. Although King considers the historiography on the agency of workhouse inmates as ‘thin’, there are indications that older constructs of the poor as merely subject to workhouse regimes have been ‘wide of the mark’.Footnote 15
Pauper letters frequently invoked sickness on the part of the author or a member of the family as a reason for requiring assistance, implying that the writer had a moral right to medical care. However, there was an added dimension after the New Poor Law, as outdoor relief was permitted only for medical reasons. Medical complaints had such a prominent role in requests for relief that King considered sickness a ‘pivotal experience’ of people on the margins.Footnote 16 His conclusion from a study of 12,904 narratives by, or about, the poor covering every county in England is that the sick poor did have real agency.Footnote 17 Inmates, both individually and collectively, have been shown to protest when they, or their friends and peers, have experienced inadequate care, medical neglect, unjust discipline or unsatisfactory decisions regarding relief.Footnote 18
The AHRC project ‘In Their Own Write’ (hereafter ITOW) was set up to fill the gap in the literature relating to the narratives of paupers from the New Poor Law period (1843–1900) and has resulted in several publications.Footnote 19 It investigated pauper letters, witness statements, letters to newspapers and other correspondence relating to a subset of 102 unions out of over 600 contained within the Poor Law Union collection in The National Archives. The majority of pauper letters sent to the central authority by outdoor paupers were in connection with the difficulty in obtaining relief. In a further subset of fourteen unions, just under one fifth came from indoor paupers, as did just over one third of letters of complaint.Footnote 20 Most writers had attempted to deal with issues at a local level before contacting the central authority as the court of last resort. They displayed knowledge of the laws, rules and regulations of the poor law and had a sense of having a right to relief.Footnote 21 One third of letters and petitions and a half of witness statements had sickness, disability and/or medical welfare at their core. Prior to the project there had been a relative invisibility of pauper efforts to contest attitudes and decisions of medical officers, but sick paupers were now shown to be as vehement in contesting medical officers’ practices as those of non-medical personnel.Footnote 22 The examination of the material in The National Archives revealed that the poor and their advocates had agency and they knew it.Footnote 23 Carol Beardmore has used letters and statements unearthed by the ITOW project from physically infirm inmates to the central authority complaining about their treatment. From their opinions on the quality of the care they received and from the types of complaint they made, she concluded that the experience of disabled inmates was little different from that of able-bodied residents and both groups exhibited agency in the same way.Footnote 24
An alternative approach to investigating pauper agency within institutions has been by examining behaviour, offences committed by indoor paupers and punishments meted out to them. David Green investigated behaviour in London workhouses in the early decades after the New Poor Law using the reports of court cases. These revealed the various forms of offences that were committed by inmates, both individually and collectively, to challenge the authority of workhouse officials. Misbehaviour was a common occurrence, averaging 1.3 committals per 100 inmates. Other forms of protest included drunk and disorderly conduct, wilful damage and refusal to work. Protests were carried out by a diverse range of inmates, although sick inmates in particular were not mentioned. Misbehaviour was not limited to male inmates, as girls and older women were frequently involved in various types of misconduct including wilful damage. Green concluded that despite attempts by the Poor Law Commissioners to promote strict discipline, workhouses did not foster the ‘docile bodies’ that the workhouse system was designed to promote. The indoor poor were not powerless to challenge authority, and individual agency clearly had a part to play within the disciplinary apparatus of New Poor Law workhouses.Footnote 25 Samantha Williams has studied acts of defiance by workhouse inmates and the punishments inflicted upon them in eleven unions across England in the year 1881 through the lens of punishment books in which workhouse masters logged details of breaches in discipline. She asserted that paupers behaved badly in response to the stifling rules and regulations and so undermined poor law policy. Paupers behaving badly revealed significant agency in the face of considerable power from the centre and showed that they were not mere subjects in workhouse regimes.Footnote 26 Rather than resort to misbehaviour, workhouse inmates could assert agency in a more positive way; for instance, by refusing to accept charitable gifts particularly likely to be offered as culinary treats at times such as Christmas. Those offering what Laura Foster calls ‘bourgeois philanthropy’ were most likely to take refusal as a personal affront. She stresses that middle-class philanthropy could be disrupted by paupers who refused to enact their role of grateful guest.Footnote 27
In the historiography of pauper welfare to date, sick inmates have featured only occasionally apart from Williams’ paper where inmates suffered from disability rather than illness. So, it is far from clear to what extent ill inmates were in a position to protest or complain over the quality of care they received or over their medical treatment. There is slim evidence they could be as combative in confronting authority as healthy inmates, but the more likely assumption would be that they were less able to exert influence over the authority of medical officers due to their dependence within the doctor-patient relationship.Footnote 28 As Woodward and Richards have pointed out, to be sick is a social phenomenon that afflicts one’s relationship with others. The position of the sick person within the social structure of a society where doctors have a more powerful social status must pose a deterrent effect. Although the doctor-patient relationship has varied over time, doctors during the nineteenth century assumed a dominant role.Footnote 29 Moreover, there is little information to compare the situation within workhouses with other medical institutions, as few hospital histories have provided any insight into the interactions and struggles that took place inside the institution. The transformation from the eighteenth-century medical knowledge and practice whereby each individual had their own unique pattern of bodily events to the early nineteenth-century concept based on organic pathology and centred in hospital resulted in a new role for the sick-man, according to Jewson. Now redefined as a patient, he or she was designated a passive and uncritical role in the consultative relationship, became more acquiescent, and had little opportunity to exercise control over the activities of medical staff.Footnote 30 Moreover, as Mulcahy has emphasised, by questioning a doctor’s judgement, a patient has had to step out of the sick role.Footnote 31
However, Kim Price has shown that sick paupers did at times make formal complaints to the central authority and accusations of medical neglect could, and did, lead at times to disciplinary action against the medical officer. Price has estimated that around 7 per cent of workhouse medical officers were either forced to resign or dismissed in the second half of the nineteenth century, with a greater number in the 1870s at the time of the commencement of the crusade against outdoor relief.Footnote 32
This article addresses this issue using the New Poor Law records of Birmingham Parish and Wolverhampton Union, augmented by newspaper reports, national poor law records and letters written by and on behalf of inmates. All these sources, other than original letters filed in records, will be subject to a degree of bias by the recorder of the guardians’ minutes or by the newspaper reporter. Indeed, the latter may be as keen, if not keener, to show the poor law in a bad light rather than to protect the reputation of the guardians. That said, they do give testimony to the experience of life within the workhouse for sick paupers and reveal the character, execution and limits of pauper agency in shaping the provision of medical care. I will analyse patients’ complaints regarding their medical treatment and care, whether made by themselves or by fellow inmates, or by petitions made collectively to the guardians, either directly or via workhouse staff. The first section below will consider their disagreement with the medicine available to them, while the following one will detail several complaints by inmates of Wolverhampton workhouse regarding the quality of care provided by the medical officers. Then we turn to the role that medical officers had in deciding fitness for work and its effect on some paupers, and follow that in the section after by considering the punishments medical officers could mete out to those who complained. The misbehaviour of inmates with chronic conditions, at times a response to punishment, and the ability to take matters in their own hands to get the treatment they wished take up the last two sections.
Disputing medication
It was not the first time that the author of the letter in The Birmingham Journal that began this article had written to the newspaper about conditions in the workhouse, as he starts the letter by saying: ‘I had occasion some time ago to address you on the subject of the treatment of the poor in the Workhouse, with respect to the system then present of locking them up like prisoners and am happy to say that appeal was nobly responded to, and entirely answered the end intended’.Footnote 33 On this occasion he was accusing the guardians of parsimony in relation to the cost of medical treatment and the newly appointed medical officer of bowing to the guardians’ wishes to restrict drug use and did so in strong language. Birmingham Parish was unusual in that the cost of drugs and medicines was paid for by the Board of Guardians rather than by the medical officer out of his salary.Footnote 34 The guardians immediately set up an investigation by the Visiting and General Purposes Committee with the remit to look ‘into the proper practice and the responsibility of the workhouse medical officer in relation to the medical treatment of pauper patients’. The resident medical officer, John Wilmshurst, submitted a written statement to the enquiry and confirmed verbally that since his appointment in May that year the guardians had never interfered in his medical treatment or controlled what he could prescribe so that he had been able to use ‘the most expensive medicines’. What he had done was change the practice of ordering drugs so that he did it himself rather than by the dispenser.Footnote 35 It is likely that this change in the prescribing habits of the new medical officer had been interpreted by ‘Pauvris’ as an attempt by the guardians to take the opportunity to influence a new member of staff in order to reduce drug costs. The editor of The Birmingham Journal accepted the guardians’ conclusion that the charges in the letter were ‘untrue and unfounded’ and disclosed the author of the letter to be G. L. Wattleworth, an inmate of the able-bodied men’s ward in the workhouse. The newspaper had consulted a ‘correspondent well qualified to give an opinion on the question at issue’, who had confirmed that the guardians were ‘guiltless of parsimonious cruelty’ with regard to the medical treatment of the sick poor.Footnote 36
However, the article in the paper went on to say that the subject was important to the sick and infirm poor in the workhouse and ‘we must be excused if we if we do not leave it until we convince ourselves that the whole letter is untrue and without foundation’.Footnote 37 Wilmshurst was so concerned that this implied there was not enough evidence to clear him of Wattleworth’s allegations that he requested the guardians to conduct a ‘special and full enquiry’.Footnote 38 There had also been allegations made by Daniel Smith, a previous inmate, regarding medical treatment that were to be included in the new enquiry. The guardians’ remit to the Visiting and General Purposes Committee allowed them to consult with ‘eminent local practitioners’ to aid their deliberations. They began by interviewing Wilmshurst, the workhouse master, and Daniel Smith, but after sitting for three and a half hours, adjourned the proceedings to the following week. Although Smith did not turn up on that occasion, the enquiry continued without him, taking evidence from the workhouse chaplain and three nurses, each from different wards.Footnote 39 The guardians concluded that ‘the Medical Relief Department of the workhouse is efficiently, carefully and humanely conducted’ and the charges of Wattleworth and Smith were ‘absolutely false’.Footnote 40 Despite the guardians’ denial, Wattleworth had achieved a significant degree of success with the letter. He gained considerable support from The Birmingham Journal that came at a time when both local and national press had become involved in the movement for workhouse reform.Footnote 41 It helped to achieve a second and quite lengthy enquiry that drew in opinion from both inside and outside the workhouse. He caused Wilmshurst considerable concern in terms of his reputation and standing in the community that could have future implications if he wished to go into private practice, but possibly also to his emotional wellbeing.Footnote 42
Two years earlier, in January 1855, two inmates in Wolverhampton workhouse, William Stanley and John Dyer, made a similar complaint to members of Wolverhampton workhouse visiting committee. They claimed that the medical officer, Richard Nugent, used the same medicine for between twenty and thirty different cases in the fever wards of the infirmary. They considered that not everyone’s sickness was alike and therapy should have been prescribed according to individual complaints and constitution. It is uncertain whether Stanley was, or had been, in the fever wards at the time, but Dyer was, as he died there two days after the visit. Nugent dismissed their criticism and claimed that ‘this class of case’ would never be satisfied however they were treated, exhibiting his disdain for paupers and reflecting a typical attitude at that time towards those in a lower social class. Members of the visiting committee felt they did not have sufficient knowledge to comment on the character of different medications and recommended no action.Footnote 43
However, Stanley and Dyer displayed an understanding of the therapeutic basis of early eighteenth-century medical treatment that each patient presented a unique challenge.Footnote 44 But, by the middle of the nineteenth century, standard therapies for the treatment of fevers, such as high doses of alcohol to lower temperature, had become the norm. Both they and Wattleworth obviously believed in the efficacy of nineteenth century therapeutics, which, according to John Harley Warner, ‘did work’, but not by current medical criteria.Footnote 45 As was the case in most workhouses, the cost of drugs prescribed by the medical officer at the time was met by him out of his salary, and it is likely he used the cheapest possible. Following Stanley and Dyer’s complaint, the board of guardians discussed whether to change the arrangement and meet the cost themselves, but deferred making a decision. It was not until late 1874 that they agreed to do so, no doubt influenced by the fact that the Local Government Board would recompense them for half the cost.Footnote 46
Wolverhampton workhouse medical officers
When Stanley and Dyer raised their complaint, the visiting committee had been inspecting the house regarding medical attendance and care. Their report to the guardians resulted in a letter of ‘admonition’ to Nugent. However, in March of that year, Benjamin Lane visited the master’s office to make his complaint in person that he had applied to the medical officer on two occasions for medicine without getting any. Lane had been admitted to the able-bodied ward with a chronic affliction of his knee and was given a flannel at his request to wrap round it. But when he developed a severe bowel complaint with pain in his side lasting four to ten days, he had not received any medication despite requesting it. He explained this at a meeting of the Board of Guardians where he was questioned in the presence of the master, the medical officer and the nurse who were all able to cross-examine him. It took some courage to do this in front of what must have been an intimidating audience. Nugent explained that he had prescribed a plaster although the nurse forgot to administer it, but denied that Lane had applied to him for medicine for a bowel complaint. The guardians judged Nugent’s explanation unsatisfactory and referred the matter to the Poor Law Board. The poor law inspector who carried out an enquiry found that Lane had developed diarrhoea a few days after admission, but was not given any treatment and issued Nugent with a censure because of ‘culpable inattention to your duties’. He pointed out the importance of Nugent listening to the complaints of the sick with patience. Although his complaint was originally made to the workhouse master, Lane had the courage to state his case to the board of guardians and stood his ground despite questioning by individual board members, the clerk to the board, and the medical officer. He appears to have gained the support of the guardians, as they seemed more inclined to believe his account than Nugent’s.Footnote 47
Richard Nugent appears to have failed to heed the poor law inspector’s warning, as two months later, Mary Shaw made a complaint to the master about his harsh treatment of her during his examination. As she remained confined to bed, a group of four guardians went to her bedside and took a statement from her that was read at a board meeting with Nugent presentFootnote 48:
I came into the workhouse a fortnight to-day. I was taken ill yesterday with a pain at my stomach, about one o’clock. About an hour after I sent for the nurse, who gave me two pills. I felt that if I could vomit I should be better. I then told the nurse to send for the doctor. He came between eight and nine o’clock to me, in the presence of the nurse. When he came he asked me what was the matter. I told him I was ill, and thought I should not last till morning, without I had some help. He threw the clothes off the bed to below my knees, and felt about my chest very hard…I was in great pain and groaned. He said, “Make the worst of it whilst I am here.” I complained of my head. He said, “If I hear another word, I’ll be d … (sic) if I do not shave your head and put a blister on.” He ordered me some medicine. I am now better. He said it was nothing but humbugging, sending for him for nothing but a pain in the stomach … [F]our other women in the room can corroborate the above.Footnote 49
Shaw’s statement was corroborated by Nurse Cox and Ann Goodwin, a wardswoman, who had both been present when Nugent visited. Nurse Cox confirmed that Nugent ‘came directly’ after he was called, but was in a very bad temper. She then left to fetch a mustard plaster; so only Goodwin had been present to witness Nugent saying he would shave Shaw’s head and apply a blister. Nugent, in self-vindication, said that he was ‘very much irritated’ at being called to a case similar to a man in the afternoon, ‘a case which any old nurse could have treated’. When drawn to his attention that his threat about shaving the woman’s head was made during the absence of the nurse, he denied having ever used such language. The board stopped short of dismissing him, instead issuing a final warning and asking him to apologise for his language. He again denied having used the language imputed to him, but said that if the board were of opinion he had used it, he was ‘sorry for it’.Footnote 50 In this instance it was the doctor’s unsympathetic bedside manner that was the cause of the complaint, something that has continued as a common source of complaints into the twenty-first century.Footnote 51
Nugent’s predecessor as medical officer, Charles Cooper, was not so fortunate. Several allegations of medical neglect were made in the later months of 1851, including neglecting to see a sick child before she died on the morning after admission and a badly burned nine-year-old boy until 26 hours after his admission.Footnote 52 The guardians censured him in the hope it would ‘secure his attention to [his] duties’. However, in July the following year the Rev. J. Coling, curate of St Marks, wrote to the guardians that in the course of his duties in the workhouse, several inmates had complained to him of great neglect by the medical officer involving several midwifery cases. The Board of Guardians interviewed some of those involved, including Susannah Jones who had recently been confined in the workhouse, and referred the matter to the Poor Law Board. A subsequent enquiry by a poor law inspector concluded that the charges against the medical officer were inconclusive, but requested his resignation in the interests of the union, and he complied.Footnote 53 His departure may have been classed as voluntary, when in reality it was a forced resignation, and this may account for the fact that the proportion of forced resignations nationally was small.Footnote 54 The complaints against both Cooper and Nugent no doubt arose from a system whereby they had workhouse duties, but needed a thriving private practice in addition to make a living.
Too sick to work
The workhouse was designed to be a disciplinary institution with all inmates, including those who were old or sick, subject to the rule of official regulations and work was central to the imposition of discipline.Footnote 55 Workhouse medical officers were integral to the disciplinary process in deciding fitness for work and fitness for punishment. This could conflict at times with their duty of care in providing medical treatment to sick inmates and adhering to the ethics of their profession.Footnote 56 Their ‘gatekeeping’ role involved identifying malingerers and withholding treatment from them, but misjudgements could lead to their dismissal or forced resignation.Footnote 57 Joseph Rogers, President of the Poor Law Medical Officers’ Association, was adamant that malingering and deception were a common daily occurrence by inmates of workhouse infirmaries.Footnote 58 However, Williams, in her review of union punishment books, found few offences related to inmates pretending to be sick, though the refusal to work was one of the most often recorded.Footnote 59 Green also found conflicts over imposition of work to be common to most groups within the workhouse, particularly when inmates were forced to do work that they felt was beyond their physical capacity.Footnote 60
On 16 June 1862, the Birmingham Daily Post included the following among ‘Notices to Correspondents’: ‘Instead of publishing the complaint of John Hayward, we have forwarded it to the Chairman of the Board of Guardians, and, if the charges can be substantiated, the man grieved shall have prompt reparation’.Footnote 61 Hayward requested the newspaper to ‘give publicity through you(sic) columns to a very cruel case of pauper persecution that has lately taken place at the new Workhouse, Birmingham Heath’ in order to expose ‘a system of cruel torture and starvation regularly carried out by the Guardians…and their subordinates’. He referred to the treatment of Thomas Swingler, ‘a victim of chronic rheumatism’, who entered the workhouse on the 10th of January. The medical officer assessed him as able-bodied, and he was allocated to work in the ‘shoemakers shop’. He attempted to carry out the work rather than ‘run the risk of being finished by the doctor, who had most grossly insulted him’ and other men advised him ‘to avoid the Medicine as much as possible as he was doomed’. He continued to do his best at work in order ‘to avoid the doses’.
When Swingler felt a little better and could tolerate the situation no longer, he wished to leave to seek light employment, but did not feel able to because of the poor state of his clothing. His unwillingness to leave brought him into conflict with the workhouse master, Mr Massey, who threatened him with harder work. As Swingler continued to stay in the workhouse, he was moved to stone breaking by Massey, and when he could not break the required weight of stone, he was put on reduced rations, being given ‘a few bad potatoes for dinner’ and no supper. He appealed to the local Poor Law Commissioner and wrote to the Poor Law Commission, but when he got no satisfaction, he ‘determined to leave the house rather than fall into the hands of the doctor again’ and did so ‘in a destitute condition as ragged as a colt without a shelter or a means of getting a livelihood’. Hayward maintained that Swingler’s treatment was ‘only one of many cases that can be brough (sic) forward if desired to prove a complete system of Bullying, starving, drugging and even Maltreating is carried on with the silent sanction of the Board of Guardians’.
When invited to the investigation by the Visiting and General Purposes Committee at a time convenient for Hayward to attend, he requested that Swingler accompany him. Both were interviewed, as well as the master, the workhouse medical officer, the yardsman, plus the wardsman and three inmates of the able-bodied men’s ward. Hayward and Swingler both appeared to be unwilling to pursue the allegations, and Hayward declined to provide evidence to support his general accusations as he claimed he had not been given permission by those involved. He agreed that the investigation had been carried out in a satisfactory manner and admitted he thought Swingler ‘rather sensitive’. As a result, the committee concluded that the charges were ‘not founded on fact’.Footnote 62 It is not too surprising that Hayward backed down when faced with a formidable panel at the enquiry, but, nevertheless, he did achieve a lengthy investigation by the guardians even if he got no further. His complaint centred around the medical officer’s decision that Swingler was fit to work, but it also demonstrates inmates’ fear of the medicines that he prescribed; so, they regarded him clearly as part of the disciplinary establishment and could do them harm. The letter displays strategies that were commonly used in paupers’ letters, such as the emphasis on previous respectability and extending the complaint from one individual to the workhouse in general.Footnote 63 By November Swingler was back in the workhouse and wrote to complain once again to the Poor Law Board to express his dissatisfaction with the Birmingham guardians’ enquiry and to complain about his treatment. On this occasion he gives his reasons for his inability to work as ‘eyes being weak’ and ‘weakness of the loins’.Footnote 64 He enquires if ‘men shall be punished for not performing that which is impossible’; again, the rhetoric of asking the central authority about the rights of paupers that was common to their letters. For fear of further punishment, he asks the Poor Law Board not to inform Birmingham guardians that he had written to them; we will return to the question of punishment later.Footnote 65
The issue of fitness to work arose again in Birmingham towards the end of the century. At its meeting on 28 February 1896 the workhouse management committee considered correspondence from the Local Government Board requesting their observations on the letter written to them by Hugh Thomas Leonard, an inmate of the men’s able-bodied ward, regarding the death of another inmate. He requested the central authority ‘to cause an enquiry to be made as to the death of Henry Fisher, a man who was an Inmate of the Able bodied(sic) ward until 1 hour and 30 minutes prior to his death’. When Fisher, who was 35 years of age, was examined by the medical officer on arrival at the workhouse, he was passed fit for the able-bodied ward and ‘put by the Labour Master to saw wood under an open shed’. Other inmates were surprised by this ‘as he looked so ill’. Fisher had complained to the medical officer he was too ill to work, but was initially told to carry on, though he was later moved ‘into the chip shop to bundle wood so that he might be able to sit down’. After he had been in the workhouse for about seven weeks, he became very ill, and Leonard advised him to remain in bed and ask to see the medical officer. The labour master insisted Fisher had to get out of bed to go to the doctor, but when he was unable to do so, he was taken by the labour master who had checked his temperature. On his way there, ‘cries of shame were raised by the men in the Yard who saw the sight and many said he has not got long to live’. The medical officer ordered him to the Infirmary, but he died within an hour of getting there. Leonard continued in his letter to say, ‘I should not think. (sic) Sir that in all the cases that have come under you(sic) notice. You(sic) have ever found one worse than this’. He mentioned that other cases had occurred, but ‘hardly so cruel and bad as this one’ and suggested that an enquiry would be ‘the only remedy’.Footnote 66
The special sub-committee charged with the investigation interviewed Leonard, the medical officer and the labour master, with all of them present throughout. They concluded that they could not acquit Alexander McDougall, the medical officer, of an error of judgement in disregarding the request of the labour master to see Fisher, as they felt he should have taken prompt action and that the labour master had also made an error of judgement in taking Fisher to the medical officer instead of fetching the doctor to see him. The guardians subsequently requested a Local Government Board enquiry during which Leonard insisted he had not made a complaint, but wished for an enquiry as to whether there were grounds for a complaint. McDougall defended his actions by saying that he saw Fisher, a slightly built hotel waiter, on admission in October and considered him fit for the labour ward as he did not show any signs of illness. On the other hand, the men in the wood sawing shop felt he was very weak and incapable of doing the work. McDougall explained that a later examination showed Fisher had signs of ‘a slight phthisis with rough breathing’ and was prescribed cod liver oil and a cough mixture.Footnote 67 When seen in the probationary ward he had great difficulty breathing and was transferred to the infirmary, but died within five minutes of arrival. His death was recorded as cardiac failure. The Local Government Board inspector came to the same conclusion as the investigating committee with regard to the medical officer, but exonerated the labour master. However, no action against McDougall appears to have taken place.Footnote 68
The Birmingham Mail praised Leonard’s courage and independence as otherwise the circumstances surrounding Fisher’s death would never have become known outside the workhouse.Footnote 69 In this instance Leonard stood up to those in authority in telling his story and achieved some success against the medical officer. Interestingly, Fisher’s death prompted letters to the Local Government Board requesting an enquiry from several national trade unions, demonstrating the influence that press coverage could exert on poor law practices.Footnote 70
Punishment
Making a medical complaint always carried the risk that some form of retribution would follow, and the fear of it could inhibit inmates from complaining about their medical care. The first annual report of the Poor Law Commissioners in 1835 laid out a list of offences for which an offender could be put on a reduced diet or be placed in a separate room. These were ratified in the General Consolidated Order of 1847, which added absconding or leaving the workhouse other than through the main entrance as offences and leaving with the workhouse clothes as theft.Footnote 71 In their study of punishment books at Southwell Workhouse, Paul Carter and colleagues found that absconding was the most common infringement committed.Footnote 72 Williams’ examination of union punishment books found that some form of alteration of an offender’s diet was the most common form of punishment, as we have seen in the case of Thomas Swingler, although confinement in a refractory ward or lockup was also used. The order also instructed medical officers to certify in writing that punishment would not be injurious to the health of inmates who were under any form of medical care or supervision.Footnote 73
In March 1871 several able-bodied inmates of Birmingham workhouse wrote anonymously to the Poor Law Board complaining of not being permitted leave in order to obtain employment. They were unwilling to give their names because ‘if he knew the(sic) were he would for punishment put them on Bread and Water for a time’.Footnote 74 If retribution was deterring these able-bodied inmates from complaining, how much more likely would it have been to deter those who were sick and so in a more vulnerable position? Medical officers could order unpleasant medical treatments, such as blistering and shower baths, to punish bad behaviour. For instance, when Richard Nugent said to Mary Shaw that he would ‘put a blister on’ when she complained of headache, it appeared to be a threat for complaining, although applying blisters to painful parts of the body was a common therapeutic practice at the time. Treatments in regular use for mental illness could be employed to punish bad behaviour. Both warm and cold shower baths were thought to have therapeutic properties, but the use of baths as treatment and as punishment inevitably became intermingled.Footnote 75
Medical officers could also use the threat of certifying complainants as lunatics. For instance, John Bytheway wrote several letters to the Local Government Board in the early 1870s to complain about his treatment in Wolverhampton workhouse. Aged 68 years and ‘constitutionally weak’ due to lung disease and partially blind, he had entered on the first occasion in October 1870 because of a severe illness. After the Local Government Board informed the guardians of his complaint of ‘ill treatment’, he claimed he was ‘dragged into the lunatic ward’, where he spent around twelve weeks before making ‘my escape’. When he was admitted to the workhouse three years later, he complained that he had been certified as a lunatic by the medical officer for writing to the central authority. He suggested it was the practice to put any inmate who complained into the lunatic wards and requested the Local Government Board to arrange for his mental state to be assessed by a Commissioner in Lunacy. Instead, the guardians referred him to one of the district medical officers, who found him to be ‘perfectly sane’.Footnote 76 The designation of inmates as lunatics would allow medical officers to justify using treatments for mental illness for punishment, as we will see in the case of Ellen Peters.
Ellen Peters was admitted on 14 April 1881 to the venereal ward in Birmingham workhouse and transferred three months later to Nurse Giles’ ‘imbecile ward’. She was subsequently moved between the two wards until September, when she was sent to the main part of the workhouse, from where she was able to take her leave after a few days. On 6 October she was re-admitted ‘suffering from disease’ in an ‘incoherent and hysterical’ condition, initially to the venereal ward, but again moved to the imbecile ward, although she returned each day to the venereal ward for treatment. On one occasion she had tried to abscond and went about a quarter of a mile from the ward before being brought back and sent to Giles’ ward. While there she was subjected to spells in the padded room lasting for two days at a time, to shower baths for which she had to be dragged by two people, and also to blisters. When told she was to be punished for trying to escape, she denied she had done anything and said if she were to be punished, she would do something. So, she picked up a poker and smashed three panes of glass in the kitchen window, resulting in her removal to Giles’ ward. On one occasion there, she threatened to strike the nurse with a poker and later in the month was committed to prison for one month for refractory conduct.Footnote 77
Peters’ treatment came to the notice of the guardians after the medical officer complained to them that a nurse on the imbecile ward had refused to admit Peters because of her violent nature. The initial internal enquiry concluded that there were irregularities in the medical department and referred the matter to the Local Government Board. At their enquiry, widely reported in the local press, the workhouse master confirmed that Peters had always been classed as a sane person. As she was no longer an inmate, a summons had been left for her at a recent address, but she could not be contacted to attend the hearing. Jane Burns, a nurse on the venereal ward during Peters’ stay, told the enquiry that Peters had tried to abscond several times and she believed Peters’ violence was occasioned solely through her desire to get out of the workhouse. Sarah Jane Peel, who had been an inmate in the ‘sick and epileptic’ wards until the middle of August, had written to the guardians after seeing a report in the newspapers.Footnote 78 She told the enquiry she had seen Peters being ill-treated by Nurse Giles and crying when put in the padded room, and she thought patients were put there for punishment. Nurse Giles confirmed that Peters had been put in the padded room on three occasions and subjected to a shower bath once. Mary Jane Skett, an inmate of the epileptic ward, who had been admitted to the workhouse in 1877 at the age of twelve, said she had received shower baths and blisters, but she had deserved them for misbehaviour and had no complaint. The medical officer had told her the blisters were administered as punishment.Footnote 79
The Local Government Board’s inspector concluded that ‘no case of cruelty has been proved’. In doing so, he was justifying the use of harsh mental health treatments for punishment of recalcitrant inmates. Peters’ punishments appear to have begun after her first attempt to leave the workhouse without permission. Her only recourse against this perceived injustice was through disorderly conduct that set up a vicious cycle of repeated punishments and reactions. Her refusal to attend the enquiry can be seen as another form of protest. Workhouse staff, both current and previous, and inmates had little option but to attend, while Sarah Jane Peel, a previous inmate, now in domestic service, actively chose to become involved. The experiences of Bytheway and Peters exemplify the conflicting roles of medical officers between treating illness and meting out punishment.
It may well have been fear of retribution that made Mary Edwards choose to delay her complaint of neglect of medical treatment against the Wolverhampton workhouse medical officer until after she had left the workhouse in January 1849. She then spread her dissatisfaction among various tradesmen in the town. This proved a very effective action as the medical officer became so concerned over his reputation and the potential effect on his private practice that he requested the guardians to investigate the complaint. They found him exempt of blame and considered Edwards had been treated with ‘every care and attention’ she deserved.Footnote 80
Inmates’ behaviour
According to Samantha Williams, inmates’ bad behaviour was a response to the ‘stifling rules and regulations’ of the workhouse regime.Footnote 81 Between 1835 and 1842, 9,225 inmates of English workhouses, just under 1 per cent, were committed to prison, the majority (68 per cent) for some form of misbehaviour. Around a quarter (23 per cent) were jailed for absconding with or without the union’s clothes. Over the same period, seven inmates in Wolverhampton workhouse and twenty-six in Birmingham were committed for a behavioural offence.Footnote 82 From the 1870s to the early twentieth century, the proportion of workhouse inmates committed to jail was usually in the range of 1.5 to 2.5 per cent with a peak at the turn of the century of 3.5 per cent.Footnote 83 James Daniels, warrant officer for Birmingham guardians, reported that each year in the five years from 1879 he had locked up between 42 and 65 tramps and inmates as a result of disorderly conduct at a time when the workhouse population was between 2,000 and 2,500, in keeping with the national proportion.Footnote 84
Although Green, using reports of court cases found that all classes of inmates committed offences, sick and disabled inmates were not specifically included in his categories. Most of those committed would have been able-bodied inmates, but it is possible some may have suffered chronic illness or disability. Patients with venereal disease had a reputation for disruptive behaviour within workhouses and for absconding. For instance, in February 1843 May Perry and Fanny Porter, who were prostitutes in the venereal wards of Wolverhampton workhouse, scaled the walls on a Saturday evening to go into town. They returned during the night, but unable to get back into the ward, walked around the yard till morning. The following year, Ellen Wells and Ann Ashley, also prostitutes, absconded from the venereal wards in workhouse clothing. Both were apprehended and appeared before magistrates, charged with stealing workhouse clothes. In 1843 Thomas Nokes, admitted with venereal disease, absconded along with James Chadwick in workhouse clothes. The master suspected they had planned to meet up with two young women who had also been inmates.Footnote 85 Paupers with venereal disease were foremost among those who entered and left the workhouse on a regular basis. A Local Government Board enquiry into the control of venereal disease in the early twentieth century found that workhouse officials accepted ‘their coming and going as they please’.Footnote 86 It was not only paupers with venereal disease who absconded, as one man admitted with smallpox to Birmingham workhouse during the epidemic in the early 1870s did so.Footnote 87
Patients in the venereal wards were prone to disobeying the strict workhouse rules in other ways. Maria Horton, a patient in Birmingham workhouse, alleged in March 1846 that she had contracted venereal disease from Mittram Flewitt, one of the dispensers. Horton, who was in her late 30s and had been in the workhouse for eleven years, attended the house committee’s enquiry and claimed she had caught venereal disease from ‘a person in the House, Mr Flewitt one of the dispensers in the Infirmary’, as she had had ‘no connexion with any one else since she had been in the House’. This had happened on several occasions, but the last time was ‘on Deritend Wake Tuesday out of the House’. They had arranged to meet in Snow Hill and gone to a house in that street. She had ‘had the disease’ for six months without informing anyone, but was now so ill, she had asked ‘Hill who goes out leeching’ to tell the medical officer. She ‘would swear that Mr Flewitt was the cause’ and that he had given her money to buy medicine. Martha North, an inmate, confirmed to the enquiry Horton’s version of events. When interviewed, Flewitt refused to comment. The house committee decided that, as Horton’s assertions were not supported and her statements very contradictory, no person’s character should be ‘injured by her testimony’. This was more a verdict of not proven than not guilty. The committee also decided that the door between the infirmary and the surgery should be kept locked, possibly influenced by other reports of ‘improper conduct’ by Flewitt.Footnote 88 Horton showed considerable courage to state her case in front of guardians, though it is difficult to see what she was trying to achieve. Although she had been an inmate for a number of years, it is not clear whether she had been in the venereal wards prior to her liaisons with Flewitt. Horton’s association with Flewitt demonstrates how inmates and workhouse officials could react with one another.
On the move
Tramps regularly moved in and out of the same workhouse or between workhouses, staying one night in exchange for a period of work, but not usually to seek medical treatment as in the case of William Buck. He left Cannock workhouse on a Saturday in December 1902 feeling ill and arrived at the casual ward of Wolverhampton workhouse (a distance of about 11 miles) late on Sunday evening. He requested a visit from the medical officer the next morning as he was feeling more unwell, but was never seen. He left Wolverhampton early Tuesday morning despite the labour master’s attempts to get him to stay and despite having evidence of a rash. When he turned up at Walsall workhouse (a further seven miles) on Wednesday evening, he was diagnosed as having severe smallpox with his face so swollen that he could hardly see. Wolverhampton guardians received a letter from the Local Government Board requesting the workhouse medical officer’s explanation. It turned out that the medical officer had been unwell and there was a misunderstanding between him and his deputy over when he would return to work. Buck was unfortunate, but despite his state of health, he chose to move on rather than wait in the hope of being seen at Wolverhampton. It is not clear who instigated the complaint to the Local Government Board, but Buck did demonstrate a considerable determination to obtain a medical consultation.Footnote 89
A similar situation happened to Emma Higgins in 1887. She travelled with her three children the seven miles from Dudley workhouse to Wolverhampton in the middle of winter in order to get a medical consultation as her request to see the workhouse medical officer in Dudley had been refused. When she arrived at the tramp ward in Wolverhampton, she was admitted along with her children because of ‘contagious disease of the eyes’.Footnote 90 In 1894, Mrs Clara Faulkner complained to the master of Birmingham workhouse that, when attending the infirmary lodge to request admission, she was harshly treated by Dr Clarke, one of the resident medical officers. As a result, she had left and walked with her husband to the General Hospital where she gained admission. The workhouse infirmary management committee took statements from Mrs Faulkner and two probationary attendants present at the lodge when she arrived and forwarded these to Dr Clarke. He attended the committee’s next meeting and apologised for having given cause for the complaint.Footnote 91
It took some courage for paupers to decide to leave a workhouse because they were dissatisfied at not being treated and walk long distances to another, but it was even more courageous to move from being treated as an inmate in one to another a distance away in order to receive better treatment. But this happened with Emma Rose and Emma Bayliss. At a meeting of Birmingham Board of Guardians on 18 November 1857, the chairman informed members that he happened to be at the workhouse a few nights before when two girls had applied for admission. On questioning, they replied that they had been inmates in the venereal ward at Kidderminster workhouse and had come to Birmingham for better treatment. He admitted he had believed this story to be ‘a tissue of lies’, but drew members’ attention to the following statement by one of them, Emma Rose, aged 23 years, who was now an inmate in the workhouse. She admitted to belonging to Kidderminster and had been in the workhouse there for three months ‘in bed all the time’ suffering from venereal disease. She claimed she had repeatedly asked the medical officer for treatment, but did not receive any during her second and third month there. When examined by Mrs Priddy, ‘the Nurse of the Sick Wards’, in the previous week, she was told her condition had worsened since admission and she was ‘in a very bad state indeed’. The nurse had told her that if she went to Birmingham workhouse, she ‘should be sure to get cured’ and advised her to move. When she arrived in Birmingham along with Emma Bayliss, they had spent the night in the street and applied for admission to the workhouse the following morning.Footnote 92
An enquiry by the guardians to Kidderminster Union elicited a denial by Mrs Priddy that she had said Rose would be treated better in Birmingham. She claimed it had been Elizabeth Edwards who had been in the same ward as Rose and that had said ‘she had had more good done to her in six weeks’ in the Birmingham workhouse than in two years in Kidderminster. The medical officer of Kidderminster workhouse reported that Rose had been under constant treatment, but had not required any internal remedies. When Rose spoke to Mrs Priddy about going to Birmingham, she had responded, ‘How could a poor naked creature like you go to Birmingham?’ Despite this, Rose did manage to make the journey of around 19 miles, presumably walking the whole way, to obtain what she thought was better treatment than at Kidderminster, a claim that the chairman of Birmingham guardians found hard to believe.Footnote 93 But paupers felt they could take matters into their own hands in a positive way by travelling between workhouses, often over long distances and enduring considerable hardship, to obtain the medical help they felt they required.
Patients’ voices
Workhouse patients’ voices have been mainly portrayed through the letters they have written to the central authority regarding their discontent with their medical care. This study exploring patients’ experiences in the realm of the institutional arm of the New Poor Law reveals the degree of agency that sick paupers could express in a number of other ways in addition to letter writing. Although it avoids portraying their contact with medical care through the medical gaze, it is difficult to escape entirely from viewing it through the gaze of officialdom due to the reliance on poor law records. However, the reports in the press of official enquiries and boards of guardians’ meetings give an extra dimension to patients’ voices. Workhouses had no formal complaints procedures, unlike voluntary hospitals that had regular inspections by the House Visitors.Footnote 94 The central authority issued guidance to guardians on enabling paupers to write to them, although they would always refer any complaint to the local guardians to investigate and refuse to deal with local matters unless requested by guardians. Under such circumstances, it is not surprising that inmates chose a variety of ways to make their complaints heard. Their voice was most powerfully heard in their letters to newspapers, as in the case of ‘Pauvris’, even though it was toned down when confronted with poor law officials. Writing to the central authority delayed investigation of a complaint, and more immediate action was possible by speaking to workhouse staff or visitors. That some, such as Lane, were able to repeat their accusations in front of guardians, the master, nurses and the medical officer who was the subject of his complaint took some courage. But those who made their complaints directly to workhouse officials appear to have stood their ground more than letter writers when confronted by guardians. Making a complaint regarding medical care carried a considerable risk of punishment, especially when the methods that could be employed by medical officers, such as blisters and shower baths, were harsh. This is possibly why some chose to use an advocate to write on their behalf or to wait until they themselves had left the workhouse to state their case. Fitness for work has been found to be one of the most contentious issues giving rise to complaints, but only two instances were recorded, both in Birmingham and more than 30 years apart.
How effective were sick inmates’ complaints? Some were summarily dismissed; for instance, Mr Hancox’s allegation of medical neglect in Wolverhampton workhouse in 1852 was dismissed after the medical officer’s explanation, as was Patrick Reddington’s in 1877 and Mr and Mrs Blower’s in 1881 at the same workhouse. Thomas W Brown wrote to the Local Government Board in 1887 complaining the medical officer had neglected to see him while in the epileptic ward in Birmingham, but the guardians rejected it as he had not complained during his stay.Footnote 95 However, as King et al have pointed out, for paupers to have agency does not need complete success or a positive quantifiable outcome, as even the smallest gain will suffice. The majority of letters and other approaches to Birmingham and Wolverhampton guardians and workhouse staff did achieve enquiries that at times were extensive, whether carried out locally or led by the central authority. These resulted at times in medical officers being reprimanded for their conduct or subjected to calls for their forced resignation. Many enquiries received wide publicity in the local press that would help garner support for workhouse reform. In their analysis of the ITOW project, Jones and King found there were victories.Footnote 96 In my study, Charles Mole pushed for a coroner’s inquest following the death of his brother, George, from a fit during the night in the epileptic ward in Birmingham in 1856, as he had found there was no night attendant in the ward. The guardians agreed that night attendants drawn from the pauper inmates would then be employed.Footnote 97 Jones and Carter also noted in pauper letters that they demonstrated a strong idea of the standard of care they expected. This comes out in the letter of ‘PAUVRIS’ and in the complaint by Stanley and Dyer, who also managed to challenge the medical officer over the principles of prescribing.Footnote 98
What does not appear to have been reported previously is sick paupers taking positive action to either seek the medical care they felt they needed or improve on the care they were receiving. And doing so by moving between workhouses or to voluntary hospitals. As a tramp, Buck would have been accustomed to being on the road, but he had the option of staying in Wolverhampton until he was seen by the medical officer. Emma Higgins is less likely to have been accustomed to being on the road with her children and still chose to move when they could not get treatment. More surprising was Emma Rose moving from one workhouse to another in search of better treatment, as she saw it, when she appears to have been suffering quite badly from venereal disease. She was not alone, as Emma Bayliss went with her, and Elizabeth Edwards had also been treated in Birmingham at one time for the same condition. Beardmore has shown that disabled and frail inmates exhibited a similar degree of agency to able-bodied paupers.Footnote 99 This study confirms that workhouse inmates with chronic disease had significant agency, but so had those with acute illness. Mary Shaw was so unwell that guardians attended her bedside to hear her allegations regarding a consultation with an uncaring medical officer before bringing them before the full board. Stanley and Dyer were patients in the fever ward from where they made their complaint and where Dyer died shortly after. Not only were sick paupers willing to contest their treatment when their expectations were not met, but they also took matters into their own hands by travelling to different workhouses. They were not powerless to resist institutional dominance and challenge medical authority and at times gained significant outcomes. Despite the disadvantages they faced within the medical consultation, they were able to assert meaningful agency.
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