'Sick, aged and infirm': adults in the new Birmingham workhouse, 1852-1912

Abstract

This study has explored the role of a large urban workhouse and its separate infirmary in Birmingham in the provision of indoor medical care for adult paupers between 1852 and 1912. Due to the difficulty in distinguishing between the medical and social care of older people, it has examined the provision for all older inmates. Birmingham guardians were forward thinking in appointing resident medical officers and paid nurses earlier than other unions, but retrograde by continuing to apply the workhouse test to sick patients longer than others. Workhouse medical officers in Birmingham worked long hours, provided care for many more patients than doctors in voluntary hospitals, and stayed in post for an average of four and a half years. Nevertheless, some strove to provide high standards of treatment. Patient narratives have been identified, showing that positive experiences of medical care did occur. Despite being the largest group of adult inmates, older people were relatively neglected compared with able-bodied inmates until the later part of the nineteenth century, when better standards of living were introduced. The development of the infirmary into an acute hospital created conflict between the two institutions and resulted in the workhouse’s role being limited to the care of patients with chronic conditions.