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The Lancet Reports on Country Workhouse Infirmaries, West Ham.

In 1867, The Lancet — as part of a campaign to improve the conditions in workhouse infirmaries — conducted published a series of reports detailing the results of its visits to a number of provincial workhouses. Below are extracts from the report on the West Ham workhouse, published on 5th October, 1867.

WEST HAM WORKHOUSE.

THE West Ham Workhouse occupies a healthy site of eleven acres on the Leytonstone-road, about a mile from Stratford. It is an irregular building, the body of which was built in the year 1840 to accommodate 500 inmates. Since that period successive additions have been made, until at the present moment its power of accommodation is nearly doubled. As in many other cases, the character of the inmates has entirely changed; and whereas formerly the workhouse was employed as a test of idleness and destitution, it has become an asylum for imbecility, old age, infirmity, and acute disease. To prove this, we may mention the fact that, at the period of our visit, there were only three inmates in the men's able-bodied ward; and, with curious inconsistency, all of them were cripples.

We were conducted over the entire establishment by the master and matron, who afforded us every facility for the inspection we desired to make, and who evidently perform their onerous duties with zealous kindness and consideration for the welfare of those around them. We have but one remark to make on the body of the house, and that relates to the pitiable condition of the pauper boys. They are twenty-one in number, and of an age fitted to go to school and work; yet here they remain shut up in the ward originally built for imbeciles, tended only by an old pauper eighty years of age, who "reads them" twice a day. Dressed in the usual workhouse suits of corderoy, with dirty untied boots, and unkempt hair, they looked the very pictures of workhouse wretchedness. They are said to be kept here because the district schools are full; but surely some effort should be made to break the chain of poverty and idleness which will undoubtedly gather round them in their present state. It is fair to add that their health seemed excellent.

From the main building we proceeded to the wards devoted to the female imbeciles and epileptics, which consist of a series of rooms and chambers, opening upon the women's airing-ground. There were nineteen occupants, one of whom was bedridden upstairs, and the rest were sitting about the yards and day-rooms. The patients appeared tolerably healthy, and were clean and tidy. The day-room is rather dreary-looking; but the bedroom windows were neatly fitted with curtains, and the beds were well filled with wool, and very clean. The meals of the patients are sent from the general kitchen. There is a pauper wards woman and a helper for each room; the former was engaged in washing towels in a small apartment, which seems to have been intended for a padded room. The male imbecile wards are also situated at a distance from the main building. The airing-ground is quite separate, and some part of it is cheerfully laid out in flower-beds. The dayrooms were dark, untidy, and comfortless-looking places; and one of them is fitted up with seats against the wall, in which the patients may be tied if necessary. Their appearance was greatly inferior to that of the women; and there seemed to be no occupation or amusement to relieve their monotonous confinement. These wards, which are, by the way, in separate buildings, are also in charge of a pauper wardsman. He was described by the matron as specially intelligent and kind, and has been in the same position several years. At best, however, he seems to be a confirmed invalid, suffering from ulcerated legs; and his pallid and puffy-looking face gave indications of former dissipation or Bright's disease. He has eighteen patients under him, and is assisted by other disabled paupers, who get meat and beer daily for what they do. Although we are assured that these poor creatures are kindly treated, we cannot but distrust the character of such attendants; and if so many imbeciles and epileptics are allowed to remain in workhouses, it is but fitting that they should be placed in charge of a responsible attendant. To multiply these officers, however, is expensive, and difficult to carry out; for it is all but impossible to provide them for every class of inmates.

It is greatly to be desired that the Poor-law Board should promote a Bill in Parliament to enable the guardians to form district asylums for the class we are describing. It is evident they need special treatment, and intelligent and kindly supervision. The workhouse is not adapted to their wants, and the greater number require to be placed on the doctor's books, not on account of any special disease, but simply because the diet of the house is unfitted for their use. Many also would be the better for a little work, but it is unfair to associate them with other paupers, who are apt to ridicule their peculiarities; whilst, in an asylum, their labour, such as it is, might be turned to profitable account.

We were next conducted to the "Old Infirmary," the greater part of which will be converted into sleeping rooms for married women and hale old men. The upper room on the female side is used as a lying-in ward. It is a cheerless room, with windows so high that no one can look out. It felt close and oppressive, and is greatly overcrowded. It is thirty feet long, fifteen feet wide, and nine feet six inches high. Its cubic space is therefore 4275 feet. There are no less than ten beds: five were occupied by lying-in women, one of whom had twins, and two other beds by the pauper wardswoman and her helpmate. The room, moreover, is fitted up with curtains which draw completely across it between the beds, and when in use must greatly impede any movement of the air. There are three windows which open at the top, and a fourth which looks upon a corridor. There are also ventilators at the top of the walls, but they are too small, and can be of little use. As the Commissioners on cubic space recommend that each bed should have at least 1200 cubic feet, it follows that this room should be allowed three beds instead of ten. There is no second or convalescent room, and we would strongly advise the guardians to appropriate one of the other vacant wards for this purpose, and so relieve the present overcrowded state of the principal ward. All the midwifery is attended by the medical officer, but the present nurse is competent to act on an emergency : it is, however, possible that she may leave, as she is only a pauper; a nurse should therefore be appointed to take her place. There is a scullery and nurse's room vacant, which might be appropriated to her use.

The most prominent and praiseworthy feature of the Ham Workhouse is the "New Infirmary." It is built for 200 patients, and was certified by the Poor-law inspector, Sir John Walsingham, on the 3rd of November, 1866, as "having excellent arrangements in itself, and affording the means of relieving the over-occupied rooms in the main body of the original building." The "New Infirmary" is placed at a considerable distance from the other buildings; it contains four sick wards on each side, apartments for two superintendent nurses, bath-rooms, waterclosets, kitchen and scullery, and its general appearance shows that if the guardians had possessed the necessary knowledge of hospital construction, they had the real desire to provide liberally for the accommodation and general management of the sick poor.

On entering, there is a tolerably spacious passage, on the right of which is a ward, 30 ft. long, 15 ft. wide, and upwards of 12 ft. high. It contains ten beds, in two of which a wardswoman and attendant sleep. In the corresponding ward on the male side, there are but eight beds, and that number more nearly conforms to the recommendations of the Cubic Space Commission. These wards have large windows on one side, and ventilators opening into the passage on the other. There is an open fireplace at one end; but we should fear that, in winter, the patients near the door would suffer from the cold. Turning to the left, there is a ward 100 feet in length, and of the same height and width as the one just noticed. There are three open fireplaces, one at each end, and one in the middle. Throughout the greater length of the room there I are windows on both sides, placed so high up that no one can look out of them, as if the green of the garden were likely to make the patients ill. In this ward were thirty-four beds, more or less completely occupied by chronic cases confined to bed. Upstairs are two wards, of the same dimensions and method of construction. The smaller one was vacant on the women's side, and the larger one contained a mixture of acute and chronic cases. On the male side the wards were all in use, though not entirely full. All the wards are fitted in the same way. There are two water-beds, one of which was in use; the rest are of flock, and tolerably well stuffed, though in several cases the patients had increased the thickness by making them but half the length. The bedsteads are of iron, with sacking bottoms, and all the furniture was clean and comfortable. At the head of the bed was a ticket stating, in general terms, the diet and extras allowed to the occupant; but no specific quantities are given except in the office of the master, the common diet of the house being alone placed upon the walls, as directed by the orders of the Poor-law Board. There was an. ample supply of wash-basins, arm-chairs, night-stools, tables, table-knives, foot-warmers and other appliances. The general aspect of the wards is particularly good, the walls being coloured and decorated with pictures, the floor covered with cocoa-matting down the centre, and the windows hung with green curtains.

There is also an abundant supply of linen, which is changed at the uncontrolled discretion of the superintendent nurse, who was trained at the London Hospital. A sufficient number of scrubbers is sent down every day to clean the floors and passages, and help to wash the towels and other small articles, so that it were neglect indeed if the general appearance of the wards or patients were otherwise than clean.

Fair, however, as all this seems, there is nevertheless an amount of untidiness which needs but a little care to remedy. There ought to be cupboards in which to put away the necessary household utensils. We saw blacking-brushes, black-lead, sweeping-brushes, and buckets under the beds of the wards; whilst wash-basins and jugs were stowed away in corners on the floor, fully accounting for the large extent of breakage of which complaint is made. There is the same absence of a place for the necessaries of the sick; no drawers and no lockers. We asked an old man where he kept his knife and fork, and on turning up his bolster discovered the following list of articles, which would be amusing did they not lead to filth and vermin — namely, his knife and fork, a piece of soap, his hair-comb, a quarter of a pound of sugar, a piece of bread, some butter, a cabbage-leaf with fruit, a towel, and several articles of clothing. Furthermore, the untidiness of the wards is increased by the method of serving the meals. Each bed is provided with a separate round table, not more than eighteen inches in diameter; upon this the food is served to all who can sit up, the crumbs and pieces falling over the beds and on the floor. There are neither dining-tables in the wards nor a convalescent-room where those who are able to leave their beds can sit; and, consequently, all who are permitted to take exercise continually go in and out of the wards, carrying in dirt, and disturbing the comfort of those who are permanently confined to bed.

Another great defect is the distance at which the waterclosets are placed from the wards. Upstairs, particularly, the patients have not only to traverse the cold corridor, but to descend some steps. This must, of necessity involve the very frequent use of night-stools, which, under such, circumstances, ought to be provided with earth or disinfecting fluid. Lastly, there is no scullery near at hand, and such work has to be done in a dark bath-room, where also many of the patients wash. At the rear of the wards are the kitchen and scullery, in which is a range large enough to cook for all the inmates. The breakfasts and teas are here prepared, and mutton-chops are cooked; but the main supply of food is still sent from the body of the house, after being cut up and weighed. It is then sent down in trays, covered only with a towel, and arrives in anything but an inviting state.

The diets for the sick, infirm, and imbecile are, as usual, under the control of the medical officer. Some idea may be formed of the nature of his duties and responsibilities by the fact that 213 out of 586 inmates are placed upon his books for special diet. This list includes all the nurses and helpers; for it is a curious anomaly in workhouse management-(?) that all the important work of the establishment is done by paupers placed upon the sick list. This arrangement utterly destroys any value which the medical reports might otherwise possess, and thrusts upon the medical officer a responsibility which he is not in a position to undertake, and which ought to rest exclusively in the master's hands. The whole difficulty would be removed by a properly arranged dietary, which the guardians would no doubt be glad enough to adopt if prepared by the Poor-law Board.

Next to a proper dietary an efficient record of hospital duty is indispensably required. At Ham, as in every workhouse, we have seen, there is not even a sick admission and discharge book properly so called. The sick, aged, imbecile, infirm, and able bodied are all mixed up together. The visits of the medical officer, the nature of the disease, and the diets ordered are entered in a book in which the master keeps his provision account, and the quantity of extras dispensed, not only to the sick but to every inmate who is on extra diet. At Ham, as elsewhere, this book is kept in the master's office and made up under the master's care. There is not a single entry in the handwriting of the medical officer, who may not examine it for weeks together. As a record of medical duty it is therefore a complete delusion; it gives no conception as to the manner in which the medical officer's duties are performed. Careless habits are thus encouraged, no record of disease is kept, no pathological investigations are made, and the vast experience of these important hospitals is utterly and entirely lost.

For the purposes of audit also the arrangement is a farce. As the book is kept by the master, and simply initialed by the medical officer, months, it may be, after the articles are consumed, there is nothing but the master's honesty to guarantee that the entries correspond with what is really given or consumed. The voucher of the surgeon, to be of any value, should be given at the bedside of the patient, and is so given in the military hospitals; whilst the imbecile and infirm, should have special diets, which need not require the weekly endorsement of the surgeon.

In concluding our remarks on the radical defects in the construction and management of the West Ham Infirmary, we must attribute them chiefly to the absence of medical inspectors at the Poor-law Board. The guardians have acted with more liberality than judgment; indeed, it were unreasonable to expect from them a knowledge of the principles upon which hospitals should be constructed. In the "new infirmary," which cannot have cost less than £5000, the simplest requirements of an hospital are utterly ignored; and had the same sum been expended with judgment, the accommodation of the sick ought to have been complete. The plans of such buildings are submitted to the Central Board for approval before a brick is laid, and there should be some guarantee that narrow wards, 100 feet long, without convenient scullery, bath-room, and watercloset, are not sanctioned, or described as "excellent arrangements. " No real improvement will be made in the general treatment of the sick in workhouses until the whole subject is placed under the charge of competent medical inspectors, in the same way as is found necessary, and already practised, in the army and navy, in prisons and lunatic asylums. Practicable regulations for the dietary and accounts ought to be issued, and uniformity enforced. Records of disease and medical treatment ought to be kept, that the inspectors may form some conception of the manner in which the duties are performed; and periodical reports should be made as to the sanitary condition of the workhouses and their inmates, that defects may be pointed out, and speedily removed.

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