The Lancet Reports on Metropolitan Workhouse Infirmaries, 1865-66: Camberwell.
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 Camberwell workhouse.
The union of Camberwell is situated to the south-west of London, and includes Dulwich, Peckham, and part of Norwood, in addition to the parish of Camberwell. It has an area of seven square miles, and a population of 77,488 persons. Since the formation of the union, the cost of Poor-law administration has doubled; it is now about £30,000 per annum.
The workhouse is a long, narrow building of brick, two stories high, besides the basement. It was erected in 1818; but some additions were made in 1847. It is situated on a northern slope, with an east and west aspect. The offices are on the south. A free circulation of air is rendered impossible by the masses of buildings which surround its three sides; this makes the situation a bad one, although the gravelly nature of the soil would otherwise recommend it as being favourable to the escape of surface-water. The drainage appears to be good; and the house and yard pipes well trapped with bell or syphon. The water-supply is from a well in the premises, and is raised by steam-power to the respective floors.
The house was built for 550 inmates. On the occasion of our visit (in May), however, it contained only 382, and yet appeared full. What its condition would be supposing that the nominal standard of population were reached it is difficult to say, and it may be devoutly hoped that such on event never takes place. Efforts at classification have been mode, necessarily with only partial success: still there are "fever," "small-pox," "and "bad leg" wards, for isolating these diseases; there are wards for separating lunatics; and there is a separate building for the imbeciles.
The "sick wards" proper are three in number (two male and one female) having twenty beds for men and seventeen for women. Although the height of these wards is fourteen feet, the superficial area is insufficient, and the beds are therefore placed too close to each other — namely, less than two feet, and in some cases only seventeen inches, apart. In all the sick wards there is practically a want of space, and both light and ventilation are deficient; for there is very little direct sunlight on these rooms, and they enjoy no free currents of air. The lying-in ward is a specially bad example: it possesses no means of ventilation except when the windows are open. It is needless to say, after the above description, that the sick wards have a musty smell, and are unfit for the purposes to which they are applied. Happily for the inmates, the floors are kept scrupulously clean and well purified with disinfectants, and the walls are frequently whitewashed; precautions which have probably saved the wards from epidemic infection. The bed-furniture is in all respects creditable to the house and to the care of the officials. Most of the beds are of horsehair, and many of those for the aged patients are of feathers. No flock beds are found in the house: an example which, as we have remarked in our General Report, might well be followed in all workhouses; horsehair being more economical, as well as more comfortable and more conducive to health. All matters of personal cleanliness are duly and decently observed; and the ward-management generally reflects credit on the master and matron, who have satisfactorily filled their responsible offices for the last fifteen years. Water-beds, air-cushions, and macintoshes are abundantly supplied and frequently used. In the important matter of waterclosets the wards are, on the whole, well supplied; the water-service is copious, and the condition of the closets good; they are also for the most part conveniently placed. They should, however, be somewhat more numerous; a desideratum which will doubtless be remembered when the inevitable rebuilding of the house takes place.
Passing from the "sick wards" we come next to that part of the infirmary which contains a large majority of the entire population of the house — the wards, namely, for the aged and infirm, who numbered in January last, 346, and ought, all of them, to be considered as under medical care, since their declining health demands skilful supervision and nursing. The infirm wards, like those for the sick, are very deficient in superficial space, light, and ventilation, and we believe this to be a great misfortune. Many of these infirm persons, by receiving proper medical attendance and suitable comforts, might be rescued from their life-long invalidism, and placed in circumstances of improved health, which would benefit not merely themselves, but even the interests of the ratepayers, while the guardians would doubtless derive pleasure from the execution of an important duty.
One portion of the house really does deserve to be retained, and, indeed, is worthy of great praise: we refer to the new building for imbeciles, which has evidently been a favourite scheme of the guardians. This building stands entirely apart, has a north and south aspect, and is well lighted and ventilated. The wards are carpeted down the middle; the walls are tinted and adorned with pictures and scripture texts. Besides this there are various out-door and in-door amusements, including skittles, backgammon, &c. — arrangements which are as commendable as they are unusual.
These wards are surely a proof that the Camberwell guardians understand their duty. We fancy, too, that they have practically realized the fact that this kind of liberality in the treatment of insane patients pays. Believing this to be the case, we would earnestly desire that the same enlightened principles of treatment may be applied to the aged and infirm, with whom we believe it would be equally productive of good results. Especially also we would urge the carrying out of the principle of intelligent liberality in regard to the nursing department. At present there is but one paid nurse, who looks after the sick wards with the assistance of four pauper nurses. This arrangement must be condemned as altogether insufficient. Again, in the matter of diets, there is need for the further exercise of liberality, though we believe the error to be unintentional; thus, although the extras are completely under the medical officer's control, the fixed full diet for the sick is decidedly deficient in animal food, twenty-seven ounces of meat per week being, in our opinion, a very insufficient allowance.
Still more necessary is it that the guardians should revise the pay and position of the medical officer. Mr. King receives a salary of £105, to which are added extras (for midwifery and insane cases), amounting to another £50, or thereabouts. For this remuneration he has to visit daily, to find all the drugs, and to attend some fifty-four midwifery cases, besides the special attendance required by the insane. The number of patients on the sick-list was about 200; but this did not include numerous cases under occasional medical inspection, and which should be duly classed in the medical books, and receive systematic attendance. We may state that from numerous patients we received expressions of their deep gratitude for the kindness of the medical officer, and we may conclude our reference to this gentleman by remarking that he appears to possess every freedom of action in the discharge of his duties.
From the very carefully kept medical books we learned that chronic bronchitis is the most frequent complaint amongst the inmates (and also the most fatal, causing two-thirds of the whole mortality); next in frequency are the cases of varicose ulcer of the leg. Rheumatism is also very common.
The following are our final conclusions as to this workhouse:—
1st. The entire infirmary, excepting the new wards for imbeciles, ought immediately to be either rebuilt or greatly modified, being at present unfit to meet the claims of the union.
2nd. The old and infirm ought to be classed and treated as sick.
3rd. The ard is entirely unfit for its purposes, and requires complete revision in the respects above indicated.
4th. Properly trained and paid nurses ought to be appointed to the charge of the sick.
5th. The status and pay of the medical officer ought to be reconsidered, and a qualified medical assistant should be appointed, to act under the direction of the present officer. The drugs ought to be supplied and dispensed at the guardians' cost.
6th. The dietaries should be revised, and more animal food allowed.
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