Joseph Rogers, M.D.: Reminiscences of a Workhouse Medical Officer

THE STRAND.

In the latter part of the summer of 1854 I was living in Soho, where I had been engaged in general practice for some ten years, and where, by dint of laborious attention to my profession, I had secured a sufficiency on which to live, when I became aware that an outbreak of Asiatic cholera might be looked for. Some suspicious cases had appeared, when, towards the end of the month of August, there was suddenly developed an epidemic outbreak of such virulence and extent that it became necessary for immediate action to be taken, if this fell disease was to be effectually dealt with. Having taken an active part for some years previously in sundry sanitary measures, I was requested by the parochial authorities of St. Anne's, Soho, to take charge of one of the districts into which the parish was at once divided. During the busiest of those very busy days, a medical friend and neighbour called on me, and in answer to my remark that I was too busy to talk to him, replied, "You are busy now, but you will live to regret this outbreak in Soho. It will ruin the neighbourhood and your practice for many years to come, for the public will believe that it is too unhealthy to live in, and ere long you will have nothing to do."

This casual prediction was amply verified in the following year by the death of many inhabitants, and by the removal of others. As was the case with others in other callings, I had to commence the world afresh. When casting about for the best course to follow, the medical officership of the Strand Workhouse, Cleveland Street, and of the parish of St. Anne's, Soho, fell vacant. The person who held the appointment proposed to resign in favour of his son, and I was strongly urged to compete for it. I elected to try my chance, and, after a severe contest, was selected. Here I began my experiences of the sick poor, which lasted, with a very brief interval, for thirty years. My first impressions were not very exhilarating, and could I have foreseen all that was in store for me, I question whether I should have applied for the appointment at all, but, having been appointed, I resolved to try it for a time at least. The Strand Workhouse in the year 1856 was a square four-storied building fronting the street, with two wings of similar elevation projecting eastwards from each corner. Across the irregularly-paved yard in the rear was a two-storied lean-to building, with windows in the front only, used as a day and night ward for infirm women. There were sheds on each side for the reception of so-called male and female able-bodied people, whilst in the yard, on each side of the entrance gate, was a two-storied building, with an underground apartment lighted by a single window, and with a door for the reception of male and female casual paupers; the wards above being for those of both sexes admitted to the house.

The necessary laundry work of the establishment, which never in my time fell below five hundred inmates, was carried on in the cellar beneath the entrance hall and the general dining-room, whence it came to pass that the said hall, &c., was for four days in each week filled with steam and the odours from washing the paupers' linen. A chapel was contrived out of one of the male infirm wards on the ground floor on the Sunday, and utilized on that occasion for both sexes. On the left of the entrance hall was the Board-room; the corresponding apartment on the right, and the room above on the first floor, being the apartments of the master and matron. On the right side of the main building was a badly paved yard, which led down to the back entrance from Charlotte Street; on each side of this back entrance there was--first, a carpenter's shop and a dead-house, and secondly, opposite to it, a tinker's shop with a forge and unceiled roof. This latter communicated with a ward with two beds in it, used for fever and foul cases, only a lath and plaster partition about eight feet high separating it from the tinker's shop.

There were no paid nurses. Such nursing as we had, and continued to have for the first nine years I was there, was performed by more or less infirm paupers, with the occasional aid of some strong young woman who had been admitted temporarily and was on pass. Unfortunately it frequently happened that just as she was becoming useful she left, and there was nothing for it but to fall back upon the ordinary broken-down inmates, the selection of whom did not rest with me, but with the master or the matron, or both.

Just outside the male wards of the House, at the upper end of the yard, there were two upright posts and a cross-bar. On this bar were suspended the carpets taken in to beat by the so-called able-bodied inmates, from whose labour the Guardians derived a clear income of L400 a year. In despite of the continued noise and dust caused by this beating, the Guardians persisted in carrying it on for ten of the twelve years that I was there. The noise was so great that it effectually deprived the sick of all chance of sleep, whilst the dust was so thick that to open the windows was entirely out of the question until the day's work was over. I attempted repeatedly to get this nuisance done away with, but so fierce was the antagonism of the majority of the Board that I had to abandon it.

The male insane ward, used also for epileptics and imbeciles, was on the right wing above the male casual and reception ward. To reach it you had to go up some four steps; it was absurdly unsuitable for such cases, and when I had lunatic and imbecile there together I was always in dread lest some horrid catastrophe might happen. One case of an epileptic was to me the cause of much anxiety, for he was wholly unaware when his fits were coming on. When a seizure occurred he always sprang up and then dashed himself to the ground on his forehead and face. He contrived by these means to smash his nose, make dreadfully disfiguring wounds on his forehead and face, and from a good-looking, became a perfectly repulsive-looking person. Poor fellow! I tried all sorts of expedients to prevent his doing himself any further injury, but though he constantly wore a stuffed helmet, he sometimes managed to injure himself. I got him away at last, but I had two or three years of him, during which time I had a very extensive surgical experience from his case alone. I was constantly stitching up his wounds.

The female insane ward was a rather large room, and was situated over the Board-room. As we always had the place full the space was desirable or necessary. It was immediately beneath the lying-in ward. When we had a troublesome or noisy lunatic in the ward, it must have been anything but a comfort to the lying-in women above, but then neither their interests, nor the feelings of any of the other inmates, were at that time officially considered by the Guardians, by the Poor Law Inspectors, nor by any one else. To be allowed to remain in the House and get waited on somehow was all that was looked for by these truly wretched women.

The master of the House, a certain George Catch, since deceased, had been a common policeman in Clare Market, where he had made himself useful to the Chairman of the Board, who was the proprietor of an a-la-mode beef shop in that locality. Through this Chairman's influence he became the porter of the Workhouse, and the master falling sick, he had performed his duty for him. The illness ending fatally, through the same influence Catch was promoted to the vacant office, though, at the time I first knew him, he was so ignorant that he could only write his name with difficulty. He was single on his appointment, but an alliance with the late master's niece, who had acted as matron for some time, was talked about on my taking office. As this official, Mr. G. Catch, appointed with the sanction of Mr. H. Fleming, some time Permanent Secretary of the Poor Law Board, played an important part in bringing the Department into deserved contempt, I must hereafter again refer to him.

On the morning of my entering on my duties I went over the sick ward with the son of my predecessor. My curiosity was excited by sundry ill-shaped bottles, all of which contained the same description of so-called medicine. The salary did not admit of an extensive variety of medical necessaries, as it was only fifty pounds a year, out of which all drugs were to be found. It is true that this stipend was supplemented by an occasional fee from attendance on parturient women, in cases where difficulty or danger arose, or in any illness which took place prior to the ninth day after the confinement. That fee was limited to twenty shillings only. The decision as to the necessity for such attendance was vested in the midwife or matron, and until that was given the medical officer was interdicted from entering the lying-in wards. This regulation was in direct contravention of the Poor Law Regulations, but then the Department were very unwilling at that time to interfere with the so-called discretion of the Guardians, however much their regulations were disregarded.

I have stated that the Chairman of the Board was the proprietor of an a-la-mode beef shop. During my first year of office this dignitary would often come to the House on Sunday morning dressed in the dirty, greasy jacket in which he had been serving a-la-mode beef the night before, and unshaven and unshorn, he would go into the chapel with the pauper inmates, and afterwards go to the Board-room, and have breakfast with the master and matron. Of course, between the three, there was an excellent understanding, and during this Chairman's reign all alterations for the better were resisted.

I have before stated that all my nurses were pauper inmates. The responsible duties they had to perform were remunerated by an amended dietary and a pint of beer. Occasionally for laying out the dead, and for other specially repulsive duties, they had a glass of gin. This was given by the master or matron, but I was expected to sanction the supply.

I have referred to the ward used for foul cases, which was in immediate proximity to the tinker's shop. It was altogether unsuitable for the reception of any human being, however degraded he might be; but it had to be used. I remember a poor wretch being admitted with frost-bitten feet, which speedily mortified, rendering the atmosphere of the ward and shop frightfully offensive. At first I was at a loss to know whom to get to go through the offensive duty of waiting on him. At last a little fellow, called Wiseman, undertook the task, the bribe being two pints of beer and some gin daily, with steaks or chops for dinner. Presently the patient was seized with tetanus, and after the most fearful sufferings died. He was followed almost immediately afterwards by poor Wiseman, who had contracted from his patient one of the most malignant forms of blood poisoning that I ever saw.

These two successive deaths took place whilst the tinker was plying his business on the other side of the partition which separated this ward from his smithy. This place was an utter disgrace to the Board, but they never attempted to alter it whilst I was there.