Pauper nursing: a positive inducement to pauperism.
Dr Sue Hawkins, honorary researcher at Kingston University.
What connects free school meals and pauper nurses? Both have been accused of promoting dependence on state aid. Last week, in the debate on provision of free school meals, one MP defended the Government’s refusal to back the plan, saying ‘generous, unconditional, universal benefit entitlements trap people in dependency on the state’. Meanwhile, going back 150 plus years, a workhouse master made similar allegations about the use of pauper nurses to care for inmates.
George Carr, governor of Liverpool workhouse, was assessing William Rathbone’s proposal in 1864 to replace pauper nurses with trained nurses. Carr had great reservations about the pauper nurse system, despite its having been in place for decades. He believed it destroyed ‘the value of the workhouse test and tends to reconcile [pauper nurses] to pauperism’. The workhouse test was supposed to ensure that no inmate should have a better standard of living than the labouring poor outside, but in Carr’s view of pauper nurses the opposite was true. As far as he could see pauper nurses were ‘better fed – have more freedom of action … and can make their places ‘emolumental’– thereby holding out a positive inducement to pauperism’. Or, in the words of the modern-day MP, they were trapped in dependency on the state.
Rathbone’s plan, which he presented to the Liverpool Workhouse in 1864, was to replace pauper nurses with a system of trained nurses, which he would pay for himself. His letter, a copy of which which sits in The National Archives in the MH 12 series of correspondence between Unions and the central London authority, was sent anonymously and signed ‘A Liverpool Gentleman’. He was determined to keep his involvement secret, insisting not even the workhouse committee should know. ‘I consider it most important for the success of the experiment that it should be quietly worked out by you with the authority and aid of the Guardians’, he instructed them.
Rathbone’s anonymous letter (TNA MH 12/5977/20721)
The Vestry was a little taken aback by Rathbone’s approach and immediately asked Carr to review the proposal and make recommendations. Carr had mixed views. He was not wedded to the system of pauper nurses, agreeing with the presumption at the centre of Rathbone’s letter that the current system was defective, and from his description of how the hospital operated, it not difficult to see why. As Carr pointed out, there was no ‘hospital’ as such: instead the five ‘portions’ which constituted the ‘hospital’ and were scattered throughout the workhouse, in close proximity to healthy wards. These five ‘portions’ were further subdivided into 11 sections, each with an ‘intelligent’ paid head nurse and a staff of pauper nurses. Sick and healthy inmates wandered in and out of the ‘hospital’ wards at will, with few barriers to prevent intermingling. In Carr’s assessment there could be no doubt that the pauper nurses were ‘unreliable, inefficient and [in many cases] … very worthless’. He was sure that things would be much better if they were to be replaced with trained nurses, ‘of character’.
Carr was a cautious man and could envisage a whole range of problems which might arise if the new scheme was introduced.
Firstly, he was worried that there would be great difficulty in ‘finding and keeping up a supply of suitable nurses’ to do the work. And it seems he was right to be concerned. Historians have argued that Rathbone did indeed have difficulty finding enough suitable women to staff the hospital under the new scheme. They struggled to appoint a suitable superintendent (eventually settling on Agnes Jones) while the Nightingale School (the only source of trained nurses at this time) struggled to meet demand from institutions across the country for their trained nurses (Dingwall, Rafferty and Webster, An Introduction to the Social History of Nursing).
Related to this first concern, Carr also predicted it would be hard to provide suitable accommodation for this new breed of nurse. Pauper nurses returned to their wards and lived among their fellow inmates when not on duty; educated, respectable women could hardly be expected to live in these conditions. So, how would Carr be able to find suitable accommodation for these new members of staff, and even if he could, how long could respectable women be expected to stay in such unrespectable conditions? Others clearly shared these concerns, as this section of his report was highlighted by someone for further attention.
Carr’s letter with section on accommodation highlighted (TNA MH 12/5977/20721)
Not surprisingly Carr wondered how the new system would work, given the very loose structure of the existing hospital arrangements. It would be necessary to completely separate the hospital departments from the healthy inmates, he thought, ‘without which the scheme … could hardly succeed’. Yet he could not envisage how this would be achieved.
In the end it was the finances which concerned him most. It was unclear how many trained nurses would be required, or how much they should be paid, and what allowances they would require; or how much would need to be spent on suitable accommodation. Presumably, generous though Rathbone’s offer appeared to be, Carr doubted it would cover all the potential additional costs the proposal entailed.
The size of the project (and the risk of failure) was daunting and Carr concluded that although there were many things in its favour ‘I feel unwilling in view of the difficulties to be overcome, some of which I have indicated, to incur the weighty responsibility of recommending such a course on my own unaided judgement.’ In typical bureaucratic style, he recommended a subcommittee be formed to examine the proposal in detail.
The subcommittee was much braver and offered their wholehearted support. They estimated the cost would be higher than the sum Rathbone had offered but argued that the increased cost may be offset by savings related to the shorter lengths of stay in the hospital which resulted from improved nursing. Accommodation, at least as good as that at London hospitals, could easily be found (although they did not say where) and they brushed Carr’s doubts about supply of suitable candidates aside, assuming the Nightingale School would cover all their needs. However, with a note of caution (perhaps as a nod to Carr) the subcommittee finally recommended that although the proposal made by ‘Liverpool Man’ should be accepted, the scheme should be introduced as a trial in the male wards only.
Thus Rathbone’s proposal was accepted by the Vestry. They wrote immediately to London, asking permission to initiate the scheme, reassuring the Board that while Rathbone would cover all the expenses, the ‘whole of the arrangements including the appointment and dismissal of nurses and the assigning them of their duties, will be under the exclusive control of the Select Vestry and the Nurses themselves will be treated in all respects as officers and servants of the Workhouse’. In other words, there would be no threat of interference with workhouse rules, or of disobedient individuals being introduced into the institution.
Carr was convinced that ‘the displacement of these [pauper nurses by trained] women would be followed by the immediate application for discharges by a large per centage of them’, once the privileges of their position were removed. Thus the workhouse test would be returned to a state of equilibrium and the dependency on poor relief would be broken. Whether this happened, or whether the pauper nurses were simply reabsorbed back into the mass of workhouse inmates is unknown.
I have never heard this argument against pauper nurses before: they are usually decried, as Carr said, for being ‘unreliable, inefficient and worthless’. The idea that they also perpetuated reliance on the poor law is an interesting take on an otherwise well-worked topic.
This blog is based on series of letters (TNA MH 12/5977/20721) held at The National Archives which were discovered during work on ‘In Their Own Write’, a project to find pauper voices within the collection of correspondence between the local unions and the central London authority (MH 12). Find out more about ‘In Their Own Write’ through the project website: https://intheirownwriteblog.com/about/ or follow it on Twitter: @theirwrite.