H02: Causes of admission and mortality in a nineteenth-century English workhouse infirmary, with a focus on dermatological conditions

Sofia Labbouz, Alice Manley and David Gawkrodger

Sheffield Teaching Hospitals, Sheffield, UK

Workhouses, intended to provide work and shelter for paupers, attracted the elderly and sick unable to get care elsewhere, but fell short on basic necessities. This project sought to examine the incidence of skin and other conditions and their associated mortality, using the admission book, which was likely completed by the manager of the Wakefield Workhouse Infirmary, between 1826 and 1857. We collated reason for admission, length of stay and sociodemographic factors for 726 paupers. From 74 residents in the 1830s, workhouse capacity increased to 103 in 1851. In 1831, 27 people (0·2% of Wakefield’s population) were admitted to the infirmary, with an equal split between males and females. Smallpox accounted for six admissions (0·8% of total; four females and two males, with an average age of 17 years, a mean stay of 20 days and no deaths). Scarlet fever accounted for 11 admissions (1·5% of total; six females and five males with an average age of 14 years, a mean stay of 18 days and two deaths). Admissions for fever, a catch-all category, accounted for 125 cases [17·2% of total; 50 males and 75 females with an average age of 22 years and 11 deaths (9%)]. In total, 539 individuals (74% of total) were admitted with a designation of typhus [285 males, 253 females and one with undocumented sex, with a mean age of 25 years and 87 deaths (16%)]. Of 33 other diagnoses, seven had skin manifestations, including measles and erysipelas, 14 respiratory and 12 neurological, rheumatic or gastrointestinal conditions. To summarize, cases of scarlet fever, smallpox and other dermatological conditions comprised 3·3% of all admissions from 1826 to 1857. ‘Typhus’ was the single biggest diagnostic category, accounting for 74% of admissions. There is doubt about the accuracy of some diagnoses, especially typhus, although those of smallpox and scarlet fever, being widely recognized by lay people, may be fairly accurate. The small number of smallpox admissions could reflect a successful vaccination policy, which became mandatory from 1853. These records show that the largest category of admissions was infectious disease and that equal numbers of males and females came into the workhouse, contrary to dogma suggesting a female preponderance. Purely dermatological conditions made up a minority of admissions, although skin signs were frequent in ‘fevers’. One unusual and unexplained observation of these workhouse data is the lack of cases with ‘the itch’ (scabies), often cited as a common cause for pauper admission, and one that would have been apparent to the admitting lay manager.