The traditional narrative of poor law medical care emphasized a sharp divide between the old and new poor laws that has allowed historians to make broad-brush comparisons of the quality of care before and after 1834. Those who regard care as better under the Old Poor Law focus mainly on outdoor medical relief, whereas those who favor New Poor Law medicine concentrate on workhouse care. However, a new appreciation of workhouse medicine has emerged that stresses the continuity from the old to the new forming a continuous line of development throughout the nineteenth century. Utilizing letters written by paupers requesting relief, Steven King has demonstrated that medical welfare was a significant call on poor law resources. While the workhouse was a relatively small element, it was the single most important form of institutional provision for the sick poor. By the end of the Old Poor Law, there had grown a substantial patchwork of support for sick paupers and this core function of the old continued to grow under the new. Assessing quality of the care from a single parameter is problematic as care is multifactorial, involving adequate staffing levels of suitably trained personnel, the provision of adequate facilities, nourishment and treatments, and safety from harm. Thus, it is from these perspectives that the standard of care in Birmingham and Wolverhampton workhouses will be examined.

The preceding chapters clearly demonstrate that both workhouse infirmaries played an important part in the provision of medical care for paupers after the New Poor Law. This included those with short-term acute illnesses and those who had sustained accidents, the type of patients that historians have suggested were not to be found in workhouses. In Birmingham this also took place before 1834 and changed little afterwards as the parish continued as before under its local act. In Birmingham and Wolverhampton, almost one third of patients had acute medical and surgical conditions in 1869, a greater proportion than in inner London workhouses. Another group of patients who needed admitting urgently were those with disturbed behavior due to mental illness. Both Wolverhampton and Birmingham arranged transfer to asylums for the majority of these patients as best they could against a background of the lack of availability of local institutions and a lack of available beds within them. There is no evidence that financial considerations were implicated in preventing asylum admission.