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The Lancet Reports on Metropolitan Workhouse Infirmaries, 1865-66: St Margaret & St John, Westminster.

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 St Margaret & St John, Westminster, workhouse.

ST. MARGARET'S AND ST. JOHN'S, WESTMINSTER

The Vestry of St. Margaret and St. John, Westminster, is peculiarly close corporation; it possesses a Local Act, which allows it to snap its fingers at the Poor-law Board (a congenial privilege of which it freely avails itself); and it elects the board of "governors of the poor" from its own number. The board sits at the Petty France workhouse, but detaches a committee of eighteen to manage the Kensington house.

The conduct of the board, in its official capacity, is so remarkable that we have been at the pains of analysing its composition with the view of discovering whether there were any considerable infusion of those "gentlemen guardians" who have been lately mentioned as the real salvation of the Poor Law system wherever they can get elected. Well, we find that here are ten "esquires" and five clergymen among the fifty-seven guardians of Westminster. But we also find that many of these individuals take very little active part in the working of the board, and that in fact the real power of management becomes vested in individuals whom the "Post-office Directory" classes as "Butcher," "Pawnbroker," "Cheesemonger," "News-agent," "Grocer," "Baker," "Potato-salesman, "Publican," and so on. The vice-chairman is a pawnbroker.

The origin of the two workhouses which belong to the parishes is as follows. Some twelve years ago the only house was a miserably gloomy and dilapidated pile of buildings which stood on the site of the present Victoria-street. The Government of the day — anxious at once to benefit the poor and to get rid of a hideous eyesore in an important thoroughfare — gave the parishes a noble site for a workhouse at Kensington, and enabled them to erect, at a very large expense (not one farthing of which was defrayed from the rates), the building which stands in that situation. At the same time it became obvious that the needs of the parish required that a more centrally-situated house should be established for the use of the sick and of temporary inmates, and accordingly the house in York-street, Petty France, was built, which, after standing only these few years, is condemned as thoroughly unfit for its purposes, and is to be pulled down. At this place the general board holds its weekly meetings.

The days of the present St. Margaret and St. John's workhouses have been few, but eventful. Early in 1861 a scandal was brought to light at the Kensington house (chiefly through the disinterested and self-sacrificing labours of Mr. Robert Baxter and some other influential ratepayers), which necessitated a Poor-law inquiry, when a state of disorganization was disclosed which seems barely credible when one reads the records of it in the files of newspapers of that date. The solicitor, the matron, and the surgeon were all near relations of each other. Acts of dishonesty and immorality on the part of more than one of the chief officials were distinctly proved, and it was pretty certain that the crime of poisoning had been attempted by some one of the officers. The surgeon and the matron were peremptorily dismissed by the Poor-law Board, under circumstances of great ignominy. The then chairman of the committee for the Kensington house resigned his office, some damaging evidence having been produced against him. It was plainly shown, as anyone may see who cares to read over the documents, that no efficient supervision of the Kensington house existed.

It might be supposed that occurrences so shocking would have led to an immediate reform, not merely as regards the dismissal of the culpable officers, but in the whole system of management. Nothing of the kind has taken place; the machinery of supervision is as defective as ever. The Kensington house is still governed by a committee, which meets at that house only once a month (and then scarcely ever stirs outside the walls of the board-room), and inspected by a rota of visiting governors, one of whom is supposed to visit the whole house in each week; but, in fact, this duty is performed most irregularly. We understand that several weeks sometimes elapse in succession without a single visit from any of the persons appointed to this duty. And in particular, the very important duty of quarterly inspections of the lunatics (strictly prescribed by the rules) seems to be greatly neglected. But there is a much graver fact to be noted, as indicating the tone of public morality which characterizes the management — viz., that the very medical officer who was displaced in 1861, under the disgraceful circumstances above indicated, is still employed by the board to sign certificates for the removal of lunatic patients.

We proceed now to describe the condition of the Kensington infirmary of the Westminster parishes. The workhouse was built as an hospital for the infirm and aged, and but slender provision was made for the class of acutely sick, the infirmary being designed for forty-six beds (ten of these for lying-in cases, of which there are very few, the lying-in ward being at the other house). The infirmary stands well apart from the body of the house, in the spacious grounds, and has airing-yards attached to it for men and women respectively. It is two-storied, except in the centre, where there is an additional story; it is built of brick, in substantial style, and is fireproof. It was designed to accommodate forty-six persons, and each ward, on that computation, was to possess an adjoining day-room; but the overcrowding, which has now become habitual, has turned the day-rooms into sick wards, and at present, in consequence of this, the patients enjoy but from five to six hundred cubic feet of space each. The construction of the wards is good, except that they want loftiness; they have a double row of windows; but there is one extraordinary omission — namely, there appears to be no provision for subsidiary ventilation, save in a, few instances. It would appear that the builder, having had no orders to construct any ventilating apparatus whatever, has nevertheless, for his conscience' sake, put in a concealed system of shafts, which from time to time are discovered and utilised. In order, as it would almost seem, to render the windows as useless as possible, not one of them opens at the bottom, and even the upper sash will only with difficulty descend a little way; and, besides this, the board, in its wisdom, has decreed that as much light as possible shall be blocked out by frosting the panes. One ward on the ground-floor has this additional feature of attractiveness: the window is blocked up on the outside by a huge stone-heap, upon which the "able-bodied" and "casuals" exercise their industrial talents for a good many hours every day. The noise must be highly agreeable to the patients, most of whom are suffering from acute diseases! This is really almost an improvement on the carpet-beating at the Strand Union.

Besides the infirmary proper, which in its present overcrowded condition contains about seventy patients, there are nine large infirm wards in the body of the house, containing more than one hundred additional persons, a large number of whom are severely sick: in fact, the most laborious portion of the medical officer's duty is often comprised in the attendance on these wards. The cubic space in these wards does not average more than 500 feet per bed, but they enjoy the advantage of day-rooms adjoining, each of which contains about 3000 cubic feet, and in which those who are not bedridden take their meals, &c. The furniture of both sick and infirm wards is fairly good, and great efforts have been made by the officers of the house to give a cheerful look to these apartments: thus whitewash has been discarded for colour in several wards; and a large number of pictures have lately been hung up. Not that these improvements originated with the board; the pictures, we understand, were purchased by private subscription.

The waterclosets in the infirmary are well situated and unobjectionable. Some of those in the infirm department are very much the reverse, and we may refer to that of No. 51 ward as a typical instance of badness. It is placed inside the ward in such a way that its effluvium must often invade the apartment; besides this, we discovered that it was left in a very foul condition, from want of proper supervision and care: in fact, it forms just such a nuisance as one might expect would originate typhoid fever in hot autumn weather. While upon this topic we must mention that the nursery — a very important establishment, containing a large number of children — is not furnished with any watercloset at all. On inquiry, we find that some sort of order for the construction of one was given as long as twelve months since, but it does not seem as if any active steps whatever had been taken to carry it out.

The nursing department is superintended by one paid nurse, a very excellent officer, who receives a salary of not more than £20 a year. Till lately there was also an assistant-nurse; but we find that this officer was transferred in January to the Petty France house, and that no attempt has been made to fill up the vacancy. Yet the guardians have had startling proofs of the importance of paid nursing; for the twelve months which have elapsed since they first appointed a paid nurse have witnessed a most remarkable diminution in the mortality as reckoned against the previous twelve years during which the house has been in existence. The number of inmates has been steadily increasing, and especially the number of the sick; and not less than a dozen paid and trained nurses ought to be appointed. The entire absence of any regular provision for night-nursing produces its usual ill-effects; and were it not for the spontaneous exertions of the paid nurse, who will often sit up at night with a case in the infirmary, the misery of the patients would be greater. The atrocious practice of locking up the patients at night prevails in the whole of the infirm wards; there are no fires and no hot water; and the poor creatures lie there without any nurse to help them in their bitterest need, unless they can succeed in rousing a pauper nurse who sleeps in the next room. (N.B. There are no bells.) There is no doubt that shocking events have taken place; but no inquest was held, even in the case of a man who died some time ago, after a fall in the night in No. 51 ward.

The surgeon, Dr. Dudfield, is an excellent and conscientious officer, and it is really to his exertions, together with those of the master, and especially of the chaplain, that the house owes everything which gives it an approach to efficiency of management. Dr. Dudfield spends many hours every day in the wards; he visits every part of them, and minutely supervisee the arrangements in every particular. It must be a thankless office: the remuneration for attendance on the 170 sick persons already mentioned, the dispensing of all their medicines, and the attendance on the out-door parish district of Knightsbridge, amounts to £160 a year, out of which all drugs, except cod-liver oil, sarsaparilla, and quinine, are to be found by the doctor. But the hardest and most disagreeable feature of the medical officer's position must consist in the fact that he is the servant of a perfectly anarchical government. The visiting committee, and the visiting governors, may be briefly said to know scarcely anything about the condition of the infirmary, which it is their undoubted duty to keep under constant supervision; nevertheless, they do appear to have occasionally shown some disposition to listen to the voice of reason, and to adopt such measures as would be really most beneficial to the sick. But the general board, at Westminster, seems to take a special delight in reversing any decisions in which the Kensington committee may have exhibited leanings to the side of reform. It would be an injustice to charge the general board with such sentimental weaknesses as the purchase of pictures for the wards; and, in fact, we find that this never would have been done but for the perverse activity of the chaplain, who raised a subscription for the purpose, in which he was aided and abetted by the other resident officers, and by some other troublesome charitable people. And the far more necessary (indeed indispensable) diet and prescription cards, which we were glad to see at the head of each bed, prove to have been supplied by the medical officer at his own expense, after he had wearied himself in fruitless applications to the authorities.

Nowhere in the course of our peregrinations among the workhouse infirmaries have we realised more fully what is the labour entailed on a medical officer who conscientiously performs his duty, and who has to dispense medicines for a number of patients in addition to visiting the wards. No hospital could be better served as regards the quality of the medicine given to the patients, and the regularity with which it is administered to them — at any rate in the day-time while the doctor is about. But this is obviously done at the cost of most exhausting labours, and could only be done by one who has the leisure and the physical vigour of young manhood. It is quite plain that the whole weight of the responsibility of the management of the house and all its inmates rests upon three individuals: the master, the chaplain, and especially the surgeon. It is the circumstance that these officials are unusually earnest and energetic, which makes the establishment, in spite of some gross faults, decently presentable. To show the lack of administrative vigour which the committee display, it may be mentioned that we accidentally discovered that the gate porter has been invalided for the last four months, and that his duty gets done how it can — by his wife, or by the help of an occasional pauper. The schoolmistress also is, and has long been, in such weak health as to be quite unfit for her duties, yet no one seems to interfere.

But if the evils of an imperium in imperio are plainly shown in the absence of any efficient direct management of the Kensington house by the board, they are quite as strikingly displayed in the manner in which the transfer of inmates from one house to the other takes place. As we have already said, the Kensington house was never intended originally for sick inmates. But the Petty France house has been found so entirely unfit for the management of severe cases of disease that, in fact, it frequently happens that patients who are seriously ill are transferred from it to the Kensington house. Careful inquiry from more than one authentic source convinces us that great cruelty has frequently been shown to these poor sick creatures in the manner of their removal. We understand that not long since an aged sick woman of ninety-three years was put into a common van along with nearly twenty other persons, and jolted across to Kensington, where she arrived nearly dead from exhaustion. We do not know how far the surgeon of the Petty France house is responsible for the condition of patients who leave it, but we can hardly understand how he can have permitted this or several other occurrences to take place. He is a gentleman who has grown grey in the honourable performance of his professional duties, and has won the respect and, we believe, the affection of a very large circle of patients and professional friends; and we have every desire to speak of him with respect. Other cases have come to our ears, from independent sources, which force us to believe that many of the patients at the Petty France house receive very little treatment, and that, on becoming too troublesome, they are shifted without much ceremony.

The treatment which the casual poor receive at the hands of the Westminster Board of Guardians and their Kensington Committee is too flagrant an abuse to be entirely passed over here, although it is not strictly a part of our inquiry. We understand that till quite lately there was no casual ward at Westminster at all; and even at the present time the great majority of these people, however weary and foot-sore they may be, are compelled to tramp three long miles to the Kensington house after they get their order for relief. It will hardly be believed, but it is a fact, that until quite lately the board allowed these poor exhausted wanderers no no supper at all, and merely four ounces of bread for breakfast. The arrangements for housing the casuals at Kensington are disgraceful. They are placed in wards of the body of the house, and ordinary inmates are often obliged to sleep in the oakum shed. The casuals are not supplied with any closet commode, but merely a tub, for the purposes of decency; the sewage is carried out and emptied in a closet outside ward No. 51, while the inmates of the latter ward use the highly improper and dangerous inside closet of which we have already spoken. There can be no manner of excuse for the guardians that they do not build on their extensive grounds, a thoroughly proper set of casual wards, with every convenience for decency which their case requires. The oakum-shed to which reference has been made allows only seventy-five cubic feet to each worker when it is at all crowded.

But it is impossible for us to deal with the whole subject of the management of these houses in one paper, and accordingly, in another report, we shall return to the subject of St. Margaret's and St. John's Workhouses.

In fact, following the ordering of an official inspection by the Poor Law Board, the above was to be the last of the workhouse reports to be published by The Lancet.

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