The Lancet Reports on Metropolitan Workhouse Infirmaries, 1865-66: Greenwich.

GREENWICH INFIRMARY.

The workhouse, erected (in 1840) in the extreme east of the town of Greenwich, and on the river level, is a brick structure, consisting of several blocks arranged in the form of a square, with enclosed yards, which are reserved as exercise grounds for the inmates. The front of the house is on a line with the lower Woolwich-road, and has a north aspect. The site is on a northern slope; the buildings in the rear are on a higher level than those in the front. Except on the south (where there are excellent kitchen gardens, and an open space extending all the way to Blackheath), the whole house is closely surrounded with cottages and other erections. The entire site being below water-mark, the foundations are liable to be flooded; and it can scarcely be doubted that the house must be damp, and that the drainage has great difficulties to contend with. A private sewer has been constructed, and carried into the Thames. The water-supply, which is obtained partly from an Artesian well and partly from the Kent Water-works, is decidedly defective. This is evident on inspection of the wards, many of which have no adequate supply from their own taps, while several (e. g., the lying-in wards) have never been furnished with a water-service at all.

The infirmary is a detached block in the rear of the general house. It is three stories high, and has a north and south aspect. It shares of course in the defects as to site, construction, drainage, and water-supply, which have been mentioned as belonging to the workhouse generally. But its most crying fault is the state of its ventilation; this is something notable. There are eight wards for men, containing eighty-one beds; the average amount of cubic space in these wards, taken together, is but 477 feet per bed, and three of them actually afford less than 450. There are ten female wards, which contain 107 beds; the allowance of cubic space in these, taken together, is but 453 feet per bed, and three wards allow less than 450 feet (one of these actually providing only 393). In short, there is very serious overcrowding. Nor does the construction of the wards in any way tend to remedy this, for there are windows only on one side in some of the wards, and there is no possibility of good through-currents of air; consequently the atmosphere of the wards generally is foul, notwithstanding some attempts at ventilation through the ceilings. The roof-wards are especially objectionable in this respect. Moreover, there is a great deficiency in the number and convenient situation of the waterclosets, lavatories, and bathrooms; and, in fact, it may be said generally that the external features of the infirmary are decidedly bad. With regard to ward fittings and management, things are better: painting and whitewashing seem to be well looked after, the floors are clean, and the walls adorned with pictures and Scripture texts; the beds are comfortable, and the changes of linen sufficient; and there are water-beds, macintoshes, and other appliances for cases which need them. The provision for wet and dirty cases is objectionable: the excreta which soak through the straw beds on which such patients are placed collect in a pan underneath; this system must contaminate .the air of the ward, and be detrimental both to the subjects of it and to those around them. A blanket, with sponge and charcoal placed in contact with the patient, would absorb the offensive matters and destroy their effluvium.

The nursing arrangements are very improper, there being no paid nurse, except for the insane, throughout the whole establishment, although there are 198 beds in the infirmary, and over 200 other cases under medical treatment. There are twenty-six pauper nurses, of ages varying from thirty to seventy-six; they are distinguished by a special dress, and have allowances of tea, sugar, meat, and beer daily, and occasionally gin, but get no money payment. Sixteen of these do the whole duty of the infirmary by day and night, sleeping in the wards to which they are attached. Thus there is no nightnursing properly so called. It is right to say that as much care as is possible seems to be taken in selecting the fittest of the -pauper inmates for the duties of nursing.

The whole medical care of this large establishment devolves on a single medical officer, Mr. Sturton, who receives for the regular charge of 400 patients (and practically of many more), besides attendance on 60 midwifery cases yearly in the house, a salary of £200, out of which he has to find all drugs, except cod-liver oil and quinine. As a necessary consequence of his great overburdenment with work, it is impossible for him to carry out an adequate classification of patients. He visits the workhouse twice daily, except on Sundays, when he visits once.

Under the head of classification, the most important matter is the arrangement of the insane cases. Of these there are ninety-one females and about thirty males; the former under the care of two special female nurses, with salaries of £20 and £15 respectively; the latter under the charge of one paid male nurse, with a salary of £30. There are a padded room and a dark chamber for purposes of seclusion. The wards are in many respects good, and there are many humanizing appliances (such as pictures, books, birds, and a bagatelle board) to soften as far as may be the hardship to the poor patients of detention in such an establishment; but these arrangements must after all be considered very inferior to the advantages of a country residence, where pure air and an open prospect, together with proper out-door employment, would bring solace and health to many who are denied them under prevent circumstances. A very objectionable arrangement is made for the idiots, who are lodged in the lower wards of the infirmary; these are totally inadequate, we do not hesitate to say, to their wants, if the guardians, as we doubt not they do, desire them to recover. Of all cases which demand our sympathy and care, surely none are more worthy our best efforts to ameliorate their condition than those of the poor creatures whom Providence has thus sadly afflicted. The day has gone by for regarding any such as hopeless, and it is the duty both of guardians ami ratepayers to confer on these unfortunate beings every appliance which promises to effect amendment.

The fever and small-pox cases are sent, in compliance with the now almost universal custom, to the respective hospitals in carriages belonging to the house; and so far as this plan is an acknowledgment of the necessity of isolation of contagious cues its principle is good. But the removal to a distance, especially such a distance as London, is a most objectionable practice, as tending seriously to impair the patients' already feeble powers; and there can be no doubt that the guardians .are bound to erect a fever house of their own.

Itch cases are treated in a summary, effective, and economical manner. The experience of Mr. Kilby, the master, has taught him that one-half the tramps have this disease; and he suggests that if the masters of workhouses were allowed to treat these cases, the present universal prevalence of itch would cease. He gives his patients a bath as hot and as long continued as can be borne, dries the skin, and then paints it with the following lotion: Sulphur, eight ounces; quicklime, four ounces. Boil in a quart of water for two hours, stirring constantly with a piece of wood; make it up to a quart again; keep the bottle corked.

Syphilis is treated in a special ward; in addition to which the Government provide twenty beds in the Lock, London, in recognition doubtlessly of the claims of Woolwich as a naval depot.

On the subject of dietaries we speak at present with reservation, except as regards those of the sick. In this respect every liberality is exercised, the medical officer having full control. The house diet for adults includes 18 oz. of meat, 89 oz. of bread, 14 pints of gruel, 2 pints of peasoup, 3 lb. of potatoes, 28 oz. of pudding, and 34 oz. of butter, per week. The No. 2, or "full" diet for the sick, includes 6 oz. of cooked meat (without bone), lib. of potatoes, 12 oz. of bread, 1 oz. of butter, and 2 pints of tea, daily; but no beer without a medical order. Adults over sixty have tea and cocoa instead of gruel, and extra butter; no beer unless ordered. Children from two up to twelve years have one pint of milk daily, and quantities of meat, bread, and potatoes proportionate to the adult standard; but no butter (a great defect). Infants appear to be liberally treated, as far as we can judge from their nominal allowance.

The diseases chiefly treated in Greenwich Infirmary are those of old age, rheumatism, ulcerated legs, and phthisis, two-thirds of the cases being the last-mentioned disease. Many years ago dysentery was epidemic in the house, and it was said to have depended on the dampness caused by unnecessarily frequent washings of the floors; but it is more likely that the natural dampness of the situation (joined, perhaps, with other sanitary defects) was the true cause. The mortality is about 250 per annum.

Finally, we may mention one special point, because we can give the guardians deserved praise for it — viz., the existence of twelve separate bed-rooms and two common sitting-rooms, in a detached building devoted to aged married couples — an arrangement which reflects great credit on the establishment.

In concluding this report, we have to tender our special thanks to the medical officer and to the master for the kindness with which they supplied us with most valuable information. And now we will carefully define the points in which we take objection to the Greenwich Workhouse and its infirmary:—

1st. The site and construction of the house are irremediably bad, and it ought not to be used as a residence by any but healthy persons. But if the present site is to be retained —

2nd. The children (about fifty in number) require enlarged accommodation, and should have the insane wards given up to them, the lunatics and idiots being removed to the country.

3rd. In this and in other ways the overcrowding ought to be immediately remedied. At the time of our visit the workhouse contained 906 inmates, an excess of more than 100 over even the original very improper estimate of accommodation.

4th. The water-supply is so defective that either an unlimited contract should be entered into with the company, or steam-power should be employed for raising the water to the upper floors, and hot-water taps laid on everywhere.

5th. The roof-wards should be raised to the height of at least ten feet, and additional windows placed in them.

6th. The medical attendance is quite inadequate. Nominally about 400, but practically nine-tenths of the inmates (who number about 1000 souls), are under medical care; as a proof of which, rarely more than 100 in the entire house dine in hall, claiming that exemption on the ground of illness. At least three persons, one of whom should be a resident dispenser and house-surgeon, are now necessary to do the work which is thrust upon one officer. All payments for drugs ought to be made by the guardians.

7th. A staff of paid and trained nurses is absolutely necessary.

8th. The want of a parish fever-house is a gross abuse that ought to be instantly remedied.

9th. Lastly, the infirmary, if it is to continue in this neighbourhood, and to supply the wants of the Union, ought to be immediately rebuilt on modern principles, and on a much larger scale.

We trust that the guardians may listen to our suggestions. Should they decline to recognise the very serious responsibilities which rest upon them, they will fail to carry out what was doubtless the true intention of the framers of the Poor-law — viz., the promotion of true economy by means of a high-minded and liberal policy.

We are glad to observe an absence of some of the coarser defects of the worst workhouses. But after all, nothing can be much more unsatisfactory or discreditable than a workhouse in which 400 patients are treated by one underpaid medical officer and no paid nurses, while the ventilation and the water-supply are altogether defective and bad, and the most dangerous overcrowding is allowed to exist.