The Lancet Reports on Metropolitan Workhouse Infirmaries, 1865-66: Bermondsey.
In 1865-66, The Lancet — as part of a campaign to improve the conditions in London's workhouse infirmaries — conducted published a series of reports detailing the results of its visits to a number of the capital's workhouse. Below are extracts from the report on the Bermondsey workhouse, published on 4th November, 1865.
The large parish of Bermondsey, containing 100,000 inhabitants, adjoins the borough of Southwark, and is the seat of many of the principal manufactories of the metropolis. Many of the trades carried on here are of the class which cause nuisances; as, for instance, tanneries, skin and hide dressing establishments, and offensive chemical works, besides a great skin market. There are also many most noxious tidal ditches within the district, which are calculated to favour epidemic diseases, although in this respect there has been sonic improvement of late years, which may be chiefly attributed to the fears excited by the cholera epidemics of 1832 and 1848, the mortality in the latter year having been altogether unprecedented according to the experience of other districts.
The workhouse, a four-storied brick building with a basement, forms an almost square block, intersected by several airing yards, the south side being partially open, and the cast and north sides somewhat irregular. The building dates from 1791, but additions were made in 1844; it is surrounded by various erections, except on the south side. The western portion is devoted to the infirmary proper; the infirm wards are in the east. The soil is clay, with peat beneath. The whole site is below high-water mark, and formerly was part of the bed of the Thames. The consequence of this is that the house is often flooded, the water standing two feet deep in the basement! This accident can only be prevented by closing the mouth of the house-drain or sewer, in which ease there is of course no escape for rain-fall or sewage at such times. It is unnecessary to say a word more to condemn the site as utterly unfitted for a residence for the sick. The water-supply is derived from Thames Ditton, and seems to be pure and abundant; it is stored in brick tanks, which are periodically cleansed.
The house was built for 900 inmates, and at the time of our visit contained only 470. The classification is by no means complete; amongst other particulars we noted that there is no ward for the separation of "foul" cases. The children are all sent, when they reach the age of five years, to the Sutton Schools.
As regards the sick wards (seven in number, three for males, and four for females), we are able to speak generally in terms of commendation. There is a decided deficiency in the allowance of cubic space, as is the case in nearly all workhouse infirmaries; but a great deal of attention is paid to subsidiary ventilation, and a tolerably free circulation of air seems to be secured. Moreover, the wards are well lighted, and the arrangements for warming are good. The bedsteads and bedding, with the single exception of the employment of flock beds, to which we have objected on several previous occasions, are thoroughly good, and in particular there is excellent provision made for "wet" cases; the bed-linen is good and clean, and the personal cleanliness of the patients is thoroughly well cared for; in fact, it is evident that the master, Mr. Hodgkins, carries out good discipline among his subordinates. The waterclosets, lavatories, and water-supply to each ward also appeared well ordered and well kept.
The lying-in ward, in which from thirty to forty births take place annually, is strikingly free from odour, and the beds are clean; moreover, the labour-bed is well contrived for the purpose of preventing stains on the floor, as it stands on lead sheeting, with an elevated rim around its margin. There is some danger, however, that without close watching the boards beneath might rot and become offensive. We were assured by the medical officer, Dr. Cuolahan, who obligingly accompanied us, and gave us free access to his records and books, that he has not lost one case from puerperal fever or any other cause connected with parturition.
The wards for the infirm present a marked contrast with those for the sick; in fact, they are excessively bad. Two of them especially, which are called "Lazarus" and "Aaron" respectively, are very dirty, and deficient in both light and air. The occupants were the most thoroughly "pauperized" set we have seen in any of our visitations, herding together in a miserable manner in the midst of conditions which must render any medical treatment of their chronic diseases of little avail. Their watercloset and urinal (abutting on the deadhouse) stink so offensively as to poison the whole atmosphere of their airing-court, and must, doubtless, have had a share in aggravating the epidemics from which the establishment has formerly suffered.
The arrangements which are made for the accommodation of the wayfaring class, or "tramps," in Bermondsey, have already attracted the indignant notice of the Poor-law Board and the public press, and may be shortly and justly described as altogether brutal. The peculiar conditions of the parish render it inevitable that this class of paupers should exist in great numbers, the fluctuations of commercial and manufacturing operations frequently throwing many working people at once out of employment; and as these poor folk are not distinguished by provident habits, their application for casual relief follows as a necessary consequence. Of this the guardians must be well aware. Yet the fact is that, although as many as forty or fifty persons have been known to apply for shelter in a single night, the authorities have only provided accommodation for twenty-four persons, and even such shelter as they give is not fit for a dog. We use these words advisedly, and we are sure our readers will endorse them when they learn that the beds provided consist simply of bunks, or long orange-boxes, with a wooden log for a pillow, a blanket and rug to cover the sleeper, and not even a bit of straw for him to lie on! We believe that the guardians of Bermondsey are entitled to the distinction of being entirely singular in their mode of lodging the houseless poor.
The peep which these facts give us into the psychology of the Bermondsey authorities quite prepares us for the discovery that the nursing department, including night-nursing, in defiance of common sense and the recommendation of the Poor-law Board, is committed exclusively to twenty-two pauper inmates, who are remunerated merely by improved diet, and, in some cases, a special dress. But we were not a little astonished and pained to find both the master and the surgeon arguing in favour of this state of things, which the general voice of the medical profession, equally with the Poor-law Board, has loudly condemned; and we know of no better argument to convince all reasonable persons that the central board should, without delay, be armed with powers sufficient to enable it to compel this disgraceful state of things to cease.
With regard to the quality of food supplied and the cooking, we are able to speak on the whole with satisfaction. But when we examine the amounts of nourishment allowed (except to the sick, with respect to whom the medical officer is allowed all proper freedom of action), our satisfaction ceases. 15 oz. of meat, 24 oz. of potatoes, three pints of soup, 84 oz. of bread (besides gruel for the able-bodied, and tea, sugar, and butter for the aged and infirm) per week, is an altogether insufficient allowance, and, to the infirm class especially, must be considered as hard treatment.
The medical officer of Bermondsey Workhouse has arduous duties; for, in addition to 100 sick and infirm in the house, he has medical charge of a parish district. For all the labour involved in these two offices, and for all drugs and extras, he receives £150 per annum! He attends the house daily, recording his visits, and also the whole of his orders and directions, in a book, which is well and regularly kept.
The diseases admitted into the infirmary are chiefly chronic affections of the heart and lungs, diseases of the brain and nervous system, scrofulous affections, and ulcers of the leg — disorders attributable, to a large extent, to privation and distress. The cholera outbreaks of 1832 and 1848 told severely on the Bermondsey poor, and in all probability a new epidemic would have similar effects; meantime the workhouse, in its present condition, could not with safety receive cases of this terrible malady, and indeed is in a state to foster epidemic diseases generally. In 1863, a wardsman contracted "typhus" (or more probably typhoid) fever, in consequence, it was believed, of sleeping near the deadhouse and the offensive closet already denounced; and subsequently a nurse was attacked, and died in the Fever Hospital. There can be no doubt that the infirm department constitutes a potential "fever-nest" of a very dangerous kind. An analysis of the mortality for seven years has been kindly made for us by the officials, and shows the following causes of death. The total mortality was 855; of these, 95 came under the zymotic class (including 34 cases of Asiatic cholera* in the last epidemic), 167 under tubercular diseases, 139 under diseases of the brain and nervous system, 174 under diseases of the respiratory organs, 156 under "decay of nature," 35 under heart diseases, 23 under diseases of the digestive organs, 10 under kidney diseases, 9 under uterine disorders, 8 under cancer, 6 under dropsy, 5 under abscess, 6 under premature birth, 6 from deficient supply of breast-milk, 4 from diseases of the joints &c., besides 10 sudden deaths, of which the causes are not specified. There is nothing on the face of this table of deaths which seems to challenge particular observation; yet we cannot but think that an exact analysis, if such were possible, of the causes of the various deaths from "diarrhoea," "tabes," "convulsions," &c., might reveal serious mischief resulting from an improper dietary. We are strongly tempted to entertain this idea by one feature of the diet-tables as yet unmentioned — viz., the reckless disregard which they evidence of the necessity of supplying milk in good quantity to young children; in this point of view the dietary of Bermondsey is extremely reprehensible, only half a pint of milk-and-water per diem (with an additional allowance, twice a week, of half a pint of rice-milk) being allowed to children between two and five years.
This is a very grave defect, and one which can scarcely fail to be very mischievous.
To conclude: —
1. The infirmary of Bermondsey occupies an entirely improper site, and ought to be rebuilt in an elevated situation.
2. In view of the needs of the parish, a separate fever-house should be built adjoining such new infirmary.
3. Properly trained and paid nurses are required.
4. The medical officer ought to receive the amount of his present salary for the workhouse duty alone, the guardians also finding all drugs, &c.;
5. The sanitary arrangements of the infirm department are scandalously bad, and require immediate and thorough revisal.
6. Altogether new arrangements are needed for the casual poor, who are at present treated with great cruelty and neglect.
* During the months of July, August, and September, 1849, there were 61 deaths in the infirmary, 28 being Inmates.
The following Letter appeared in the Times of November 9th:—
To the Editor of the "Times."
Sir, As the attention of the public is now concentrated on the condition and management of the metropolitan workhouse infirmaries, I shall be much obliged by your allowing me to correct some errors which are reproduced in a leading article in the Times of Tuesday from the report of THE LANCET commission on Bermondsey Workhouse.
Dealing with the data which you had before you, your comments on that report were undoubtedly just, and although, so far as I am personally concerned, I have, as the report shows, scarcely any ground for dissatisfaction with the result of the commissioner's inquiry, yet I feel bound, in the cause of truth and justice, to lay before you a plain statement of facts.
Two of the infirm wards, called "Lazarus" and "Aaron," are described as being very dirty. This is really not the case, for the ceilings and upper half of the walls are perfectly white, and the lower half of the walls is painted a stone colour. The bedsteads and bedding are precisely the same as those in the infirmary, and the floor is as clean as the frequent application of brush and soap can make it. The occupants of these wards are not "herded together" — each has a separate bed, and, although they are stigmatized as a "pauperized set," extra diet with porter or wine is allowed to most of them. Their ailments, as a general rule, do not easily admit of curative treatment, as they are accompaniments of effete life. The water-closet and urinal give out, of course, characteristic effluvia within their precincts, but it is too much to say that they "stink so offensively as to poison the atmosphere of the airing-court, and constitute a fever nest of a dangerous character." During the last nine years no case of fever had occurred in these wards, nor has there been an epidemic of any kind, except measles and scarlatina, in the workhouse.
I have now before me reports on the workhouse by Dr. Sutherland, who was sent down specially by the Board of Health with the view of ascertaining its condition as regards cleanliness and ventilation, by Mr. Farnall, and by the Lunacy Commissioners, the following extracts from which show the result of their inspection. The house is described as being "remarkably clean and well kept." The wards "perfectly sweet and healthy, and in all respects in good order." "The rooms and yards perfectly clean, as also the beds and bedding." "The inmates are contented and clean in their persons."
The chaplain, the rector of the parish, the Roman Catholic clergyman, and the city missionaries have from time to time borne testimony to the cleanliness of every ward in tie house. I will merely allude to the question of nursing in order to dismiss it with the remark that a paid nurse has for several years past exercised an intelligent surveillance over this department.
The general diet would be "insufficient," and that of the infirm be considered "hard treatment" indeed, if the quantities specified by THE LANCET Commissioner were correct. In the return of weekly amounts I find that about 2½lb. of pudding, cheese, and bread, as well as soup, are entirely omitted. This dietary table was framed by the late Mr. Grainger, and sanctioned by the Poor-law Board. The dietary table of the children can scarcely be thought insufficient when it will be found to consist of half a pint of tea and 4 oz. of bread and butter for breakfast; 4 oz. of roast mutton, with potatoes, on three days; 8 oz. of suet pudding on two clays, and half a pint of rice milk on two days, for dinner; and milk, with bread and butter, for the evening meal. Their healthy appearance and general exemption from those diseases which are caused by innutritious diet show that in this respect they are not neglected. To the great credit of the local authorities there have been no "tidal ditches" within the district of the workhouse for a great many years, and I believe I may with confidence state that there is not one now in the parish. The basement floor of the house is sometimes flooded at spring-tide, but I am informed that when the main drainage is completed this will be prevented.
With the sleeping arrangements for the vagrants I have nothing to do, but I can say, without fear of refutation, that THE LANCET Commissioner is mistaken as to the source from which this class arises. Every person acquainted with Bermondsey must know that there are no "peculiar conditions of the parish rendering inevitable the existence of this class of paupers," as the persons who may chance to be thrown out of employment by the "fluctuations of commercial and manufacturing operations" are invariably those who either enter the house or receive out-door relief; consequently the inference in the commissioner's report that the guardians should have provided against such a contingency is incorrect' Probably the guardians may understand their obligations under the provisions of the Act, but they are now making ample arrangements for the accommodation of the wayfaring class, and I have no doubt that the management of that department will be carried out with kindness and consideration.
The Board of Guardians of this parish have been rather roughly handled by the public press, and if all that has been said against them were true they might reasonably be classed among the worst types of humanity. But I submit that such is not the case. They are men who are known to be actuated by benevolent and philanthropic sentiments, and who, with laudable anxiety, seek to efficiently discharge the duties of their important position for the comfort of the poor and to the satisfaction of the public.
Apologizing for thus occupying so much of your valuable space,
I have the honour to be,. Sir, your obedient servant,
Nov. 8. Medical Officer of the Bermondsey Workhouse.
Cuolahan's letter was answered by Dr. Carr, the author of the Lancet report, as follows:—
To the Editor of the "Times."
Sir, I much. regret that the medical officer of the Bermondsey Workhouse should think it consistent with his duty to appear as the apologist for the abuses which it has been my unpleasant task to disclose in reporting on that house on behalf of THE LANCET. Any one who has read or will take the trouble to read the report of the Commission as a whole will easily see that I have been not only willing but anxious to afford the fullest credit to the guardians and their officers for everything which could be fairly commended, and I am very sure that in every particular my statement will be found not only just and accurate, but leaning throughout to a favourable view of the condition of things in the Bermondsey Infirmary. The medical officer complains that I have described the firm wards "Lazarus" and "Aaron" in too unfavourable in terms. I have, however, to repeat that I find them bad and deficient in light and air, the ceilings being low and the wards defective in cubic space. The light is admitted only on one side, and, the wards are strikingly dark and desolate. The chronically infirm inmates, whom the medical officer truly describes as suffering from the affections of "effete life," were herding miserably together in the neighbourhood of the little daylight admitted into the room, and were without occupation or amusement. The wards were without any kind of engravings, and I saw no books, papers, or other indication of intelligent care. These wards presented a marked contrast to others which I inspected in this house, and of which I have spoken in terms of commendation. But these wards, let me add, have been represented to the guardians by the master and by the medical officer himself as "being indifferently ventilated, the backs having a building abutting on them," an euphemistic and formal way of stating the defects of which I have described the results in plain English.
THE LANCET report states "Their water-closet and urinal (abutting on the dead-house) stink so offensively as to poison the whole atmosphere of their airing-court, and must doubtless have had a share in aggravating the epidemics from which the establishment has formerly suffered." The medical officer admits that they give out "characteristic effluvia within their precincts." To this admission let me add that it is within my knowledge that the wardsman, whose room is in close contact with these acknowledged sources of zymotic disease, contracted fever at a date prior to my visit, and was sent to his friends. Subsequently a nurse also was taken with fever, and about the time of my visit in May last a nurse was sent to the Fever Hospital and died there. These facts may serve to indicate the propriety of designating the nuisances described as "potential sources of fever." Again, I have stated that "the nursing department, including night nursing," in defiance of common sense and the recommendation of the Poor-law Board, is committed exelusively to 22 pauper inmates, who are remunerated merely by improved diet, and, in some cases, a special dress. The medical officer "merely alludes to the question of nursing in order to dismiss it with the remark that a paid nurse has for several years past exercised an intelligent surveillance over this department."
I don't think, Sir, that those who are acquainted with the evils of pauper nursing, and a deficiency of night-nursing, will be disposed to dismiss the matter quite so easily. And, as to the alleged efficiency of the one paid officer for the purpose in question, let me quote the following extract from a return to an order of the House of Commons, dated May 25th of the present year, corresponding with the period of my visit: — "Mary Jane Scott" is there described officially as "more of an assistant to the matron than a nurse. She superintends the work of the female able-bodied inmates, attends to the duties required to be performed on their admission, &c." Your readers will probably be able to judge from these comparative statements of the validity of the grounds on which the medical officer comes forward to defend the status quo at the Bermondsey Infirmary. Perhaps I should add that it is within my knowledge that the medical officer and the master have expressed a formal opposition to the introduction of paid nurses — a reform which I and my colleagues concur with the Poor-law Board in considering as one of primary necessity.
As to diet, the especial defects which I pointed out in the tables (of which I enclose a printed copy) are especially the smallness of the quantity of meat for adults only 15 oz. per week for people chronically feeble and infirm and the deficiency of milk for children from two to five years only half a pint of "milk and water" daily, with half a pint of rice-milk twice a week. I have no hesitation in repeating the statement that milk ought to enter much more largely into the diet of the children. The dietary for the use of the infirm requires total revision in this as in most of the other houses.
On the subject of the badness and wetness of the site, it is, perhaps, only necessary for me here to quote the very words of the medical officer that "the basement floor of the house is sometimes flooded at spring-tides."
I am glad to see that he does not attempt to defend the arrangements for the reception of the houseless poor, which I have felt compelled to characterize in my report as "not fit for a dog," the "beds "consisting of bunks or long orange-boxes, with a wooden log for a pillow, and not even a bit of straw for the sleepers to lie upon. It may be consistent with the opinions of the medical officer to describe his guardians as actuated by "philanthropic and benevolent sentiments," &c., but I think it will be generally felt that the above arrangements leave still an ample verge for the exercise of those qualities.
I am, Sir, your obedient servant,
THE AUTHOR OF THE REPORT OF "THE LANCET" COMMISSION ON THE INFIRMARY OF THE BERMONDSEY WORKHOUSE.
Following the above correspondence, The Lancet carried out a second visit to the Bermondsey workhouse and reported a similar range of faults to those described in its initial article.
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