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Abstract
This article will demonstrate that poor law nurses made a major contribution to the professionalisation of nurses. It focuses on the northern Durham unions over the second half of the nineteenth century with special attention given to the Sunderland union, the largest urban union in the county. Using national and local records this article examines the changing face of the nurse in the union workhouse infirmary. It examines the use of paupers as nurses in the early decades of the New Poor Law and the gradual move towards the use and payment of non-pauper nurses. The research will show that guardians increasingly recognised the need for trained nurses to care for the sick which resulted from medical advances in the second half of the nineteenth century, and until 1897 the central authorities had no policy on nurses or nurse training leaving decisions on nurse developments at local level. This article examines the development of nurse training at the Sunderland workhouse hospital, a service that received praise in a parliamentary report. It is argued that the nurse training programme was an important step towards the professionalisation of nurses.
Acknowledgments
I would like to thank the North-East England Research Cluster Group of the Durham University History Department for their time and comments on this article.
Notes
1 Naomi Williams, ‘The implementation of compulsory health legislation: Infant smallpox vaccination in England and Wales, 1840–1890’, Journal of Historical Geography, 20, (1994), p. 408. Northumberland’s leading ports lay on the north shore of the River Tyne.
2 Elaine Denny, ‘The emergence of the occupation of district nursing in nineteenth century England’ [‘The emergence of the occupation of district nursing’] (unpublished doctoral thesis, University of Nottingham, 1999), p. 1; Stuart Wildman, ‘Local Nursing Associations in an Age of Nursing Reform, 1860–1900’ [‘Local Nursing Associations in an Age of Nursing Reform’] (unpublished doctoral thesis, University of Birmingham, 2012), p. 277.
3 Wildman, ‘Local Nursing Associations in an Age of Nursing Reform’, p. 249; Rosemary White, Social Change and The Development of the Nursing Profession; A Study of the Poor Law Nursing Service 1848–1948 [Social Change and The Development of the Nursing Profession] (London: Henry Kimpton Publishers, 1978), p. 202.
4 Denny, ‘The emergence of the occupation of district nursing’, p. 291.
5 Angela Negrine, ‘Medicine and Poverty: A Study of the Poor Law Medical Services of the Leicester Union, 1867–1914’ [‘Poor Law Medical Services of the Leicester Union’] (unpublished doctoral thesis, University of Leicester, 2008), pp. 98–122; Alistair Ritch, ‘English Poor Law Institutional Care for Older People: Identifying the ‘Aged and Infirm’ and the ‘Sick’ in Birmingham Workhouse, 1852–1912’, Social History of Medicine, 27.1, (2014), pp. 64–85; Steven King, ‘“We Might be Trusted”: Female Poor Law Guardians and the Development of the New Poor Law: The Case of Bolton, England, 1880–1906’, International Review of Social History, 49, (2004), pp. 27–46; Graham Thurgood, ‘A history of nursing in Halifax and Huddersfield 1870–1960’ (unpublished doctoral thesis, University of Huddersfield, 2008); Paul Carter, Jeff James and Steve King, ‘Punishing paupers? Control, discipline and mental health in the Southwell workhouse (1836–71)’, Rural History, 30, (2019), pp. 161–180.
6 Graham A Butler, ‘Disease, Medicine and the Urban Poor in Newcastle-upon-Tyne, c. 1750–1850’ (unpublished doctoral thesis, University of Newcastle, 2012); Margaret Armstrong, ‘The Medical Services of the New Poor Law in County Durham: 1834–1910’ (unpublished doctoral thesis, University of Durham, 2022).
7 Wildman, ‘Local Nursing Associations in an Age of Nursing Reform’, p. 4.
8 White, Social Change and The Development of the Nursing Profession, p. 3; Carol Helmstadter, ‘Shifting boundaries: religion, medicine, nursing and domestic service in mid-nineteenth-century Britain’, Nursing Inquiry, 16, (2009), pp. 133–143.
9 Steven King, ‘Nursing Under the Old Poor Law in Midland and Eastern England 1780–1834’, Journal of the History of Medicine and Allied Sciences, 70.4 (2015), p. 28.
10 Carol Helmstadter, ‘Robert Bentley Todd, Saint John’s House and the Origins of the Modern Trained Nurse’ [Robert Bentley Todd, Saint John’s House], Bulletin of the History of Medicine, 67.2 (1993), pp. 282–283.
11 Denny, ‘The emergence of the occupation of district nursing’, pp. 18–19.
12 Helmstadter, ‘Robert Bentley Todd, Saint John’s House’, pp. 283–284.
13 Monica E Baly, Florence Nightingale and the Nursing Legacy (London: John Wiley & Sons, 2007), pp. 71–72, 84–100 & 214.
14 Maxine Rhodes, ‘Women in Medicine, Doctors and Nurses’ [‘Women in Medicine’], in Medicine Transformed, Health, Disease and Society in Europe, 1800–1930, ed. by Deborah Brunton (Manchester: Manchester University Press, 2004), p. 172.
15 Lynn Hollen Lees, The Solidarities of Strangers, The English Poor Laws and the People, 1700–1948 (Cambridge: Cambridge University Press, 1998), p. 278.
16 Baly, Florence Nightingale and the Nursing Legacy, pp. 218–219.
17 Steven Cherry, Medical services and the hospitals in Britain, 1860–1939 [Medical services and the hospitals in Britain] (Cambridge: Cambridge University Press, 1996), p. 34.
18 Carol Helmstadter, ‘Building a New Nursing Service: Respectability and Efficiency in Victorian England’, Albion: A Quarterly Journal Concerned with British Studies, 35.4 (2003), pp. 592–593.
19 1851 Census, HO107/2390, p. 165.
20 Samantha Williams, Poverty, Gender and Life-cycle under the English Poor Law 1769–1834 (London: The Boydell Press, 2011), p. 146.
21 Ruth G. Hodgkinson, The Origins of the National Health Service, The Medical Services of the New Poor Law, 1834–1871 [The Origins of the National Health Service] (London: The Wellcome Historical Medical Library, 1967), p. 169.
22 Steven King, Sickness, medical welfare and the English poor 1750–1834 (Manchester: Manchester University Press, 2018), p. 161.
23 Cherry, Medical services and the hospitals in Britain, p. 38.
24 Kim Price, Medical Negligence in Victorian Britain [Medical Negligence] (London: Bloomsbury, 2015), p. 124.
25 From 1869 the central authorities included resignations of all union officers in their annual reports.
26 Yolanda Collins and Sandra A Kippen, ‘The “Sairey Gamps” of Victorian Nursing? Tales of Drunk and Disorderly Wardsmen in Victorian Hospitals between the 1850s and the 1860s’, Health and History, 5.1 (2003), p. 44.
27 ‘On Nursing in Workhouse Infirmaries’, The British Medical Journal, 26 September 1896, pp. 857–862.
28 The National Archives (TNA), Public Record Office, MH12/3275, Sunderland, 1867–69, 10 July 1867. Guardians could not pay pauper inmates from the poor rates, so they removed them from the pauper list in order to appoint and pay them a wage.
29 TNA, MH12/3329, Teesdale, 1897–99, 27 November 1899.
30 Price, Medical Negligence, p. 9.
31 White, Social Change and The Development of the Nursing Profession, p. 36.
32 TNA, MH12/3272, Sunderland, 1855–56, 5 February 1856.
33 TNA, MH12/3272, 16 February 1856.
34 TNA, MH12/3272, 25 March 1856, the advertisement stipulated a salary of £20 per annum with board and rations and applicants had to state their age and occupation, with testimonials as to character and competency.
35 Hodgkinson, The Origins of the National Health Service, p. 556.
36 TNA, MH12/2994, Darlington, 1857–59, 1 February 1859.
37 TNA, MH12/3272, 2 April 1856 date stamped 3 May 1856.
38 Hodgkinson, The Origins of the National Health Service, pp. 557–558.
39 Rhodes, ‘Women in Medicine’, pp. 167–168.
40 TNA, MH12/3273, Sunderland, 1857–59, 11 August 1857.
41 M. A. Crowther, The Workhouse System 1834–1929: The History of an English Social Institution [The Workhouse System] (London: Methuen & Co Ltd, 1981), p. 165; Newcastle Courant, 14 April 1843, p. 1, c.1, advertisement for a master and matron. The master at the time of Sarah Stewart’s appointment as nurse was Joseph Hart and the matron was his sister Sarah Hart. Their predecessors were man and wife Alexander and Ann Baity.
42 TNA, MH12/3273, 26 September 1857, Sarah Clementson’s statement on 22 September 1857 to inspector Hurst.
43 TNA, MH12/3271, Sunderland, 1857–59, 22 August 1857.
44 TNA, MH/3273, 22 August 1857, see copy of Clementson’s report dated 3 August 1857 which portends the inspection reports of workhouse infirmaries, commissioned in the 1860s.
45 Scald head is a generic term that could refer to several scalp diseases including scabies. Scabies is associated with lice and bugs, which Clementson complained of.
46 TNA, MH12/3273, 3 August 1857, Clementson’s report to guardians.
47 M. W. Flinn, ‘Medical Services under the New Poor Law’, in The New Poor Law in the Nineteenth Century, ed. by Derek Fraser (Basingstoke: Macmillan, 1976), pp. 55–56.
48 The Newcastle Guardian, 15 August 1857, p. 5, col. 4; Durham Chronicle, 21 August 1857, p. 8, col. 1, ‘Shameful Neglect of Workhouse Inmates at Sunderland’; Alnwick Mercury, 26 September 1857, p. 3, col. 2; Durham Chronicle, 20 November 1857, p. 8, col. 1.
49 Lesley Hulonce, Pauper Children and Poor Law Childhoods in England and Wales 1834–1910 (Self-published with Kindle, 2016), Although self-published the book is an update of a PhD thesis. The book was peer reviewed for publication.
50 Bernard Harris, The Origins of the British Welfare State Society, State and Social Welfare in England and Wales, 1800–1945 (Basingstoke: Palgrave Macmillan, 2004), p. 50; Lees, The Solidarities of Strangers, p. 150.
51 Samantha A Shave, Pauper Policies, Poor Law Practice in England, 1780–1850 (Manchester: Manchester University Press, 2017), pp. 217–234, analyses the Andover scandal; Derek Fraser, The Evolution of the British Welfare State: a history of social policy since the Industrial Revolution (Basingstoke: Palgrave Macmillan, 2009), p. 60, reports ‘an image … of the workhouse as an instrument of cruelty’; Hodgkinson, The Origins of the National Health Service, p. 149, describes ‘the squalor, filth, neglect, and cruelty … in the early years of the New Poor Law’; Crowther, The Workhouse System, p. 160–162, reports ‘enumerable stories of the atrocious conditions in many workhouse infirmaries’.
52 Provincial workhouses (House of Lords, 28 November 1867), p. 112.
53 TNA, MH12/3273, 22 September 1857.
54 TNA, MH12/3273, 19 August 1857.
55 TNA, MH12/3273, 25 and 29 August 1857; TNA, MH12/3273, 7 September 1857.
56 Durham Chronicle, 11 December 1857, p. 5, col. 5.
57 Durham Chronicle, 20 November 1857, p. 8, col. 1.
58 TNA, MH12/3273, 6 May 1858.
59 TNA, MH12/3273, 10 May 1858; Ninth Annual Report of the Poor Law Board 1856 (London: HMSO, 1857), p. 19.
60 TNA, MH12/3273, 27 May 1858.
61 TNA, MH12/3273, 13 September 1858.
62 Hodgkinson, The Origins of the National Health Service, p. 169; Alistair Edward Sutherland Ritch, ‘Medical Care in the Workhouses in Birmingham and Wolverhampton, 1834–1914’ [‘Medical Care in the Workhouse in Birmingham and Wolverhampton’] (unpublished doctoral thesis, University of Birmingham, 2014), p. 254.
63 Crowther, The Workhouse System, pp. 165–166.
64 TNA, MH12/3274, Sunderland, 1860–62, 22 July 1861 report received 31 July 1861.
65 TNA, MH12/3274, 22 July 1861.
66 TNA, MH12/3274, 9 August 1861 & 11 September 1861.
67 TNA, MH12/3274, 15 September 1860.
68 TNA, MH12/3274, 30 August 1861, query by Poor Law Board; MH12/3274, 11 September 1861, response by guardians.
69 TNA, MH12/3274, 10 March 1862.
70 TNA, MH12/3278, 13 February 1873.
71 TNA, MH12/3278, Sunderland, 1873, 13 February 1873.
72 Price, Medical Negligence, pp. 124–125; Eighteenth Annual Report of The Poor Law Board, 1865–66 (London: HMSO, 1866), p. 16 & Appendix No. 2, p. 24.
73 TNA, MH12/3274, 8 November 1862.
74 TNA, MH12/3278, 7 March 1873.
75 TNA, MH12/3275, Sunderland, 1867–69, 16 & 25 July 1867.
76 TNA, MH12/3275, 17 April & 1 May 1867.
77 TNA, MH12/3278, 24 July 1873; MH12/3286, Sunderland, 1883, 24 September 1883; MH12/3301, Sunderland, 1895–96, 11 November 1895.
78 TNA, MH12/3277, Sunderland, Aug 1871–72, 18 November 1871.
79 TNA, MH12/3277, 30 December 1871, in Sunderland poor law infirmaries were termed hospitals and Sunderland voluntary hospitals were termed infirmaries, unlike most parts of the country.
80 TNA, MH12/3277, 9 February 1872.
81 Tom Crook, Governing Systems: Modernity and the Making of Public Health in England, 1830–1910 (Oakland: University of California, 2016), p. 39; Hodgkinson, The Origins of the National Health Service, p. 286; Flinn, ‘Medical Services under the New Poor Law’, p. 52.
82 Price, Medical Negligence, p. 39 & pp. 130–133, nurse figures taken from an extract of the BMJ’s investigation of fifty provincial unions.
83 TNA, MH12/3276, Sunderland, 1870-July 1871, 1 June 1870.
84 TNA, MH12/3278, 28 June & 14 July 1873.
85 TNA, MH12/3281, Sunderland, 1877, 8 December 1877.
86 White, Social Change and The Development of the Nursing Profession, p. 41.
87 Price, Medical Negligence, p. 124.
88 Cherry, Medical services and the hospitals in Britain, p. 36; Price, Medical Negligence, p. 135.
89 Twenty-Third Annual Report of the Local Government Board, 1893–94 (London: HMSO, 1894), Appendix B, p. 101.
90 Rhodes, ‘Women in Medicine’, p. 172.
91 Rhodes, ‘Women in Medicine’, pp. 171–172; Cherry, Medical services and the hospitals in Britain, p. 34.
92 TNA, MH12/3302, Sunderland, 1897–98, 10 September 1897.
93 TNA, MH12/3302, 28 September 1897 & 11 October 1897.
94 TNA, MH12/3302, 11 October 1897.
95 TNA, MH12/3302, 17 March 1898.
96 Thirty-Sixth Annual Report of the Local Government Board 1906–7 (London: HMSO, 1907), p. 345.
97 Cherry, Medical services and the hospitals in Britain, p. 35, Table 3.2.
98 TNA, MH12/2958, Auckland, 1895–96, 3 December 1896.
99 TNA, MH12/3301, Sunderland, 1895–96, 3 October 1895; 1901 Census, RG13/4739, 1.
100 Price, Medical Negligence, p. 134.
101 Ritch, ‘Medical Care in the Workhouses in Birmingham and Wolverhampton’, pp. 41–42.
102 Price, Medical Negligence, p. 135.
103 Negrine, ‘Poor Law Medical Services of the Leicester Union’, pp. 113–114.
104 TNA, MH12/3302, 18 August 1897, 4 November 1897 & 21 February 1898.
105 Price, Medical Negligence, p. 129, quoting from ‘Workhouse Nursing’, The British Medical Journal, 1.1934, (22 January 1898), p. 235.
106 Thirty-Sixth Annual Report of the Local Government Board 1906–7, pp. 344–345.
107 TNA, MH12/3065, Easington, 1900–01, 16 July 1900.
108 TNA, MH12/3065, 27 November 1900.
109 TNA, MH12/3065, 1 December 1900, contains Willis’s reference from the Gateshead union with the Local Government Board’s notes of 4, 6, 8 & 10 December 1900. The Board concluded that they need only approve the appointment without the need for any dispensation.
110 Eighth Annual Report of the Poor Law Commissioners (London: HMSO, 1842), Appendix A, pp. 75–78, Article 4 of the order requires guardians to pass the necessary resolution. There was no such requirement in the nursing order of 1897 which had fewer articles and was much less restrictive. The medical order of 1842 contained 19 articles and over 3,000 words, whereas the nursing order contained 6 articles and less than 1,000 words.
111 White, Social Change and The Development of the Nursing Profession, p. 71.
112 Negrine, ‘Poor Law Medical Services of the Leicester Union’, pp. 203 and 208; Ritch, ‘Medical Care in the Workhouses in Birmingham and Wolverhampton’, p. 293.
113 Christine Bellamy, Administering central-local relations 1871–1919: The Local Government Board in its fiscal and cultural context (Manchester: Manchester University Press, 1988), p. 155.
114 White, Social Change and The Development of the Nursing Profession, pp. 102–103.