 Preface to Reminiscences of a Workhouse Medical Officer. This is a LibriVox recording. All LibriVox recordings are in the public domain. For more information or to volunteer, please visit LibriVox.org, recording by David Wales. Reminiscences of a Workhouse Medical Officer by Joseph Rogers. Preface. The author of the brief narrative, which I have edited and have seen through the press, passed away before the printing of his work was completed. What he wrote was composed under the presence of a mortal disease, the issue of which he clearly foresaw. But he was unwilling to quit life without leaving behind him some record of the evils with which he grappled, of the obstacles which he had to encounter, and of the changes which he strove to effect. He might indeed, and with the acquiescence of the profession which he honoured, have claimed the credit of those great reforms in the treatment of the sick poor, and in the status of his professional brethren to which the labours of his life were directed, but he has preferred to give a narrative of his experiences and to leave his reputation to the members of the great and beneficent calling which he followed, and to those among the public who were cognizant of his zeal and perseverance. My late brother was the descendant of three generations of medical practitioners, who from the first quarter of the eighteenth century plied the art of tending and healing the sick down to the last quarter of the nineteenth, for his elder brother relinquished his practice only about ten or a dozen years ago, and this was in the same locality. But soon after my brother Joseph was qualified he went to London, and very speedily after he came to London he began the labour of his life, the reform namely of the medical relief accorded to the indigent poor. To this he surrendered the prospects of professional success and fortune, prospects which his professional abilities might have made certainties, for this he sacrificed popularity, health, and all that a vigorous constitution might have assured to him. He literally wore himself out by his labours. It is infinitely more difficult for a medical practitioner to urge unnecessary but unpopular reforms than it is for any other professional person to do so. The physician believes that he can succeed only by raising no prejudice against himself. He is always tempted to be neutral when partisanship may seem likely to imperil his interests. There are no safe prizes to be won in the one profession which everyone allows to be beneficent, whatever may be thought of other professions. By a code of honour which is rigidly adhered to, the process of a physician's treatment cannot be kept to himself. By an equally rigid rule the competences proposed in him are as sacred as the secrets of the confessional. It is no easy matter to win position and fortune in a calling which is regulated by the strictest rules of professional honour. It seems easy to imperil the most carefully acquired reputation by running counter to obstinacy and prejudice. A medical man has every motive to avoid hostile criticism. If he determines on doing that which is unpopular, the risks which he runs are far greater than those of any other person. Now all this was encountered by my brother's action and he never was allowed to forget that he had to encounter it. He had to reckon with sordid London vestrymen, perhaps the worst class of men with whom honest people have to deal, and with the officials of the poor law board who were determined as far as possible with rare exceptions to shirk all responsibility. In the pages of this volume he shows plainly what were the obstacles to his endeavours. As might be expected from an honest man who never counted the odds against him when he was convinced that he was in the right, his original manuscript commented with no little indignation on the persons who thwarted his efforts and would have baffled his ends. But it is entirely superfluous to stigmatize such people and I have excised these just but unnecessary judgments. It is sufficient that the reappearance of such persons has been made improbable, if not impossible. The new poor law of 1834 was probably a necessary measure, but it was suddenly and frightfully harsh. The Whigs carried it, in deference to a particular school of economists, now happily I trust extinct. It was exceedingly and reasonably unpopular. The working classes had been impoverished in the country by the enclosure of the common lands and in both town and country by restraints on the right of combination with the object of raising wages. But they had always been assured that the maintenance of the poor was a first charge on the land and that it must be satisfied and should be before the profit of the enclosure should accrue to the landlord. When the plunder was completed the other side of the bargain was repudiated and the easygoing system of the old method of parochial relief was abandoned for the new and severe provisions of the new departure. I am old enough to remember the indignation which the change aroused. I am sure that indignation and resentment against the new poor law had a good deal to do with the political reverses of 1841 and the entire destruction of the popularity which the Whigs had achieved by the Reform Act of 1832. It is true that the act established a central authority which should control the action of the new boards of guardians. But these persons were by no means willing to check the machinery which they had erected. If the legislation of 1834 was distasteful to the country they were resolved to limit their responsibility to the change which they had themselves made in the law and to avoid further odium. The case of the permanent officials who were really the departments of state was much simpler. They wished to earn their salaries with as little trouble as possible just as they wish now and always will wish. To importunately call attention to the cruelties practiced under the new system was to diminish their ease, to give them trouble, and such action must be resented and discouraged. In my personal experience of the permanent staff of the poor law board I have met with officials who were persistently resolved not to give themselves, if they could help it the trouble to rectify evils which were brought before their notice by the board of guardians to which I belonged if they could in any way find a delatory plea. Of course a reformer is always odious to a large number of persons. There are people who profit by the abuse or malpractice which he tries to remove and such persons are naturally indignant at his meddlesomeness. There are others who acquiesce in the existing state of things from sheer indolence and are impatient only at being disturbed. There are others who hold that all reforms cost money and are alarmed at the expense which they may incur. While the fact is that all reforms which are wise and true save money in the end and diminish cost. To build a proper hospital for the sick poor to supply it with properly qualified nurses and sufficiently paid medical officers one must incur initial expense which is in the end constantly overpaid by eventual economies. My late brother constantly predicted that the changes which he counseled would relieve the rates in the end and his prediction was constantly verified. The reader will find these facts illustrated in the pages which follow. A genuine reform is a sensible saving. But even if this result did not follow the system which he found and attacked was a scandal to humanity and a dishonor to civilization. The London vestrymen did not see this but Londoners have found out at last that the average vestryman is unteachable and incurable. The courage which will attack abuses such as were found in those workhouses nearly 40 years ago is rare indeed. The person who undertakes the unpopular task has to come to close quarters with such guardians of the poor as are described below and such government officials as are resolved to wink at abuses. Not but that even in the worst days the poor law board and the local government board were of great public service. They could be squeezed in parliament. A judicious and temperate question has often discomfited the most corrupt official and stirred the most lethargic. I am pretty sure that nearly all the reforms which have been achieved in the administration of the law for the relief of the poor have been derived from persistent questioning in the House of Commons. Much indeed remains to be done but much has been done and my brother was exceedingly fortunate during his lifetime efforts in the advocates which he obtained among members of the House. It must not be forgotten that a medical reformer is apt at first to be unpopular with his brethren or at least to be discouraged by them. The more fortunate members of the profession are apt to feel a serene indifference to the purposes which he avows. I do not think that the reform of those evils with which my brother concerned himself has had much assistance from the more wealthy and influential among the physicians. As Arnold said contemptuously and justly of Isaac Walton that he fished through the civil wars so these good people held as a rule severely aloof from the struggle. To the poor members of the profession who had to make every effort for a livelihood and were constrained to give their services for nominal sums in order to get a status in their calling it seems more practical to get them better pay and not to give offence. In the end this was part of the result of my brother's labors. He was able to assert towards the close of his active career that he had added 18,000 pounds a year to the incomes of the poor law medical officers in the metropolis and to allege that the change with others had saved ten times that amount in the metropolitan rates. I am convinced, having once been a guardian of the poor in the city where I live that the adoption of the policy which he recommended has affected a still greater saving. The first reform which my brother undertook, persevered in and speedily saw achieved was the prohibition of intramural interment. He had good reason to make efforts in this direction for he had abundant evidence of what came from the old practice in the experience of his profession. Most of the metropolitan clergy were very hostile to this reform and for obvious reasons but it came gradually, finally and thoroughly. The present generation in London has a very inadequate conception of the abominations in the midst of which their fathers and mothers lived and not a few of them were born. The abandonment of intramural interment and the drainage of London, imperfect as the latter is, have turned one of the unhealthiest cities in the civilized world into one of the healthiest. One of the first churchards closed was that of St. Anne's Soho, the parish in which my brother lived for many years. His next efforts were directed towards obtaining a mortuary in the parish. Everyone admits how serious are the evils of overcrowding and how difficult a problem it is to supply the London poor with decent homes at moderate rents. A century ago, as I know very well, house rent even in London took a small part of the workman's scanty earnings. Now his earnings are sometimes very little better than they were a century ago and his rent absorbs from a fourth to a half of what he earns in poorly paid labor. At best his home is crowded and unhealthy enough but when death occurs in the family the condition of things is intolerable. It cost my brother three or four years of incessant effort and pleading to obtain this concession from the vestry of St. Anne and for a long time this was the only London parish which made this necessary provision. The next mischief which he attacked was the window tax. His experience as a physician proved to him that lack of light and air intensified disease and rendered recovery difficult. There was a plea for the window tax. It seemed to bring a fair charge on large houses which an assessed tax notoriously does not. In assailing the tax his principal helper was Lord Duncan. At that time one of the Metropolitan members. The tax went at last in 1851. The repeal of this tax took nearly twenty years agitation. The first physician who attacked it on sanitary grounds having been Dr. Southwood Smith. My brother commenced his practice in London in 1844. In 1855 there was a serious visitation of cholera in St. Anne's Soho and he became a supernumerary medical officer in the district. Cholera had a very serious effect on his private practice as he states himself and nearly twelve years after he had taken up his abode in London he concluded to become a candidate for the function of medical officer to the Strand Workhouse. He was to receive a stipend of fifty pounds a year and find all medicines for the sick. It may be doubted whether he knew what he was undertaking. Certainly they who appointed him and the officials who confirmed his appointment at the poor law board had no conception of what they were doing. The character of his duties and a description of the place he had to perform these duties is to be found at the commencement of his narrative. For its condition it is hard to decide whether the guardians of the time or the central authority were most to blame. The Strand appointment was the beginning of those systematic labours on behalf of the sick poor and the medical profession which thence forward became the principal business of his life to which he sacrificed such leisure as he had health and money which he could ill spare. He gave also what was more important undaunted courage and accurate information. Thus in 1861 he gave evidence before a select committee of the House of Commons on the subject of the supply of drugs in workhouse infirmaries such a supply being as essentially part of the guardian's duty as the purchase of food and clothing are. His views were adopted by the committee and pressed on the department. What he advocated was the germ of the workhouse infirmary. During the last few months of his life he lived at Hampstead in the hope that the air might help him. At the back of his new home there was built one of those great hospitals for the sick poor which it was the principal aim of his labours to render general and to see constructed in such a way as would give the fairest prospect of recovery for the patients who were treated in them. The practice of the poor law board at this time was to assert on paper the supremacy of the medical officer in his own department to give him no personal support when he did his duty to visit on his head all the consequences of their own negligence or delatoriness and right or wrong to support the guardians when they took offence at conscientiousness and zeal. Now in 1865 a scandalous case of neglect led to an inquest to an exposure of the fact and to very severe comments by the press. Shortly afterwards the proprietors of the Lancet newspaper a medical journal which has during a very long career then distinguished a like for its zeal in maintaining the honour of the medical profession and for its advocacy of humanity in dealing with the sick and destitute poor. Resolved on investigating the condition of the London workhouses and their hospitals. Among other places Dr. Anne Stee visited the Strand workhouse in Cleveland Street and made his own report on what he saw in the columns of the paper which he represented. The report was candid, graphic and by no means flattering to the guardians, to their management and to their officials. But it was entirely accurate for the Strand Union and its guardians at that time were probably the worst examples of a thoroughly bad and vicious system. Of course the guardians were as angry as they could have been if they had been known for the best of characters and motives and had been grossly defamed. The time was plainly come for concerted action and one of the Strand guardians, a Mr. Store, a gentleman of very different character from most of his colleagues convened a meeting at his own offices in order to discuss the situation. It was at first suggested to call a public meeting but my brother pointed out that even if the meeting were a success its effect would be ephemeral. It was determined therefore to create an association under the title of the Workhouse Infirmaries Association, Mr. Store offering to find a hundred pounds towards its preliminary expenses. But his generous offer was not needed. As soon as it was known that the association was in process of formation, names and money poured in upon the scheme. New evidence from the Strand Union came out and was forwarded to Mr. Charles Villiers then president of the board. An inquiry was held and as usual the permanent officials strove to throw the blame on the medical officers to exonerate the guardians. Now to counteract this my brother called a meeting of all the Workhouse Medical Officers in London. The object of this meeting was the formation of an association for the protection of the character and interest of these officials and for supplying information to the public as to the manner in which their best efforts were hampered and thwarted. This was the nucleus of the Poor Law Medical Officers Association an organization which has extended itself to the three kingdoms. Of this my brother was as long as his health allowed the president and principal administrator. In 1867 Mr. Gothorn Hardy, now Lord Cranbook was president of the Poor Law Board and in this capacity introduced the Metropolitan Poor Bill. Some of the provisions of which were the establishment of Workhouse hospitals and dispensaries and the supply of all medicines and medical appliances at the charge of the guardians. The president frankly acknowledged that he owed much of the information which he had acquired from my brother. It was unfortunate that the provisions of the act were not made to general throughout England at least but London at last got an installment of Poor Law Reform and on rational lines. The administration of the Poor Law is far from perfect but the best part of it is that of the sick poor. Even here officials for a long time obstructed the will of the legislature and the objects of the law but on paper at least the ancient abomination described in the earlier part of my brother's reminiscences were swept away. In the eyes of the strand guardians or rather of a majority among them his offenses on behalf of justice and humanity were unpardonable. He had to be got rid of in this the officials of the Poor Law Board then under Lord Devon agreed with the guardians. The guardians picked a quarrel with him. The Poor Law Board instituted an inquiry and apparently instructed their inspector as to what he should report and the president gave solemnity to the farce by removing him from his office. The ground on which he was dismissed was that he could not get on with the Board of Guardians. Of course he could not. No man of sense, honor, humanity, decency and conscientiousness could get on with them or in those evil days with the Poor Law Board either. For the president and his officials perhaps unconsciously lead with the guardians in the maltreatment and oppression of the poor. It is a common trait in mean and malignant natures to think if they can injure in fortune or character an advocate of justice and right dealing that they can arrest his efforts and discourage those of others. Many experiences will occur to those who have any knowledge of public affairs which will illustrate this policy and its failure. It always fails with such men as have any character at all. They disregard the loss or the insult and redouble their efforts after the object which they have put before them. I do not remember that my brother ever dwelt with any peculiar acerpity on the circumstances of his dismissal but he gave himself more than ever to the self-imposed task which became the business and eventually the success of his life. He spoke indeed with bitterness and wrote with bitterness of the crew who had sought to injure him but for the reason that they were prolonging the miseries of the poor and for that reason only. Of course my brother had the sympathy of his profession and the support of the medical papers but he resolved to perfect and extend the organization which he had founded. The result was the formation of the Poor Law Medical Officers Association. In order to give strength and stability to this agency he visited most of the principal towns in England. He made several journeys to Ireland the infirmary system of which he highly commended and went once at least to Scotland where indeed reform was greatly needed and in these places he inculcated the important truth that where medical relief was abundantly and generously accorded by the guardians pauperism decreased and rates were lessened. In my frequent communications with him I urged him to assist on this as a matter of principle and a matter of fact. Generous relief to the poor if it be discriminating and founded on a few intelligible rules is the truest economy in the end. Owing to his efforts many towns voluntarily adopted the principle of the Metropolitan Act and with the best results. In the earlier years of his campaign he obtained great assistance in Parliament from the late Dr. Brady member for Lightrum and from Dr. Lush member for Salisbury. Four years after his expulsion from the office in the Strand Union he was elected to a similar office in the Westminster Union. His career here was not one of incessant and unavailing remonstrance. The poor law board subsequently the local government board began to awake to a sense of its duties and to see, though reluctantly and haltingly that boards of guardians sometimes need supervision. But soon his troubles recommenced. The inferior officials were harsh, violent and dishonest and they were abetted by a majority of the guardians. The inevitable consequences followed. My brother undertook the cause of the poor and the guardians and their tools or accomplices turned on them. They tried their old trick of suspending him in hopes that the poor law or local government board would endorse their ruling. My brother employed his enforced leisure in extending the organization which he had founded. In due course he was reinstated by the department and his enemies were baffled. The mismanagement of the workhouse by these guardians and the outrageous misconduct of the master at length roused the wrath of the rake-payers. An influential committee was formed which recommended a new list of guardians to the electors and the whole of the old gang were ejected from office by overwhelming majorities. I have reason to know that the atrocities perpetrated by the master roused the anger and secured the unobtrusive but effective cooperation of a very exalted personage. The resentment which affected this total change was not the act of one section of society or of one party only. And it is just to say that my brother had the assistance of eminent persons in both political parties. I mentioned this the rather because my brother made no secret of his political opinions and never omitted any opportunity of inculcating them. He belonged, as all his brothers did, to the advanced liberal party. During the remainder of his active life he was in perfect accord with the Board of Guardians. He had the good fortune to see that what he had labored for and had been persecuted for was now acknowledged to be humane, politic, and economical. He even had the opportunity of checking reckless and unwise expenditure. He had done great services to the poor though his clients were unable to express more than their personal gratitude to him. He had recognized and secured the cooperation of some among those excellent women who have worked so energetically and unobtrusively on behalf of the poor destitute. He had done great services to his own profession and has secured them a little of their due. For I repeat, there is no class of persons who do so much from whom so much is expected to be financially remunerated than medical practitioners among the poor. Some of these practitioners in 1884 determined to offer him some recognition of his lifelong services. There was nothing in his whole career which he dwelt on with more satisfaction than on the route of the Westminster Guardians in 1883 and on the testimonial of 1884. Two years afterwards he was attacked by heart disease and became conscious of the organic mischief against which his naturally strong constitution struggled for nearly three years. His incessant laborers had literally worn him out. His disease rapidly increased on him and with great pain and effort he rode out in the interval of his trying disorder the reminiscences which follow. Had he been in better physical health they would have no doubt been fuller for his memory was exact and tenacious. That which is printed will show what manner of man he was. But it will be seen that he dwells but little on his own unwearyed laborers. During his sickness he was attended by many physicians who knew him and valued him. Chief and most untiring among them was Dr. Bristo. I can say without consciousness of reality that my brother's life was one of incessant devotion to a noble object. They for whom he labored were the poor and helpless who could make him no recompense could perhaps hardly understand his purposes. He was met by obstacles which would have daunted a less resolute man but he was sustained by the rectitude of his aims and by a firm belief in their wisdom. Such men changed the face of the world as far as their own sphere goes. Their reward is generally the approval of their own consciences and sometimes evidence accorded in their lifetime as to what has been the fruit of their labors. Thousands of our fellow countrymen have been saved from suffering and misery by the life work of Joseph Rogers. James E. Thurold Rogers Oxford, April 10. End of Preface Chapter 1. Part 1 of Reminiscences of a Workhouse Medical Officer by Joseph Rogers This LibriVox recording is in the public domain. Chapter 1. The Strand Part 1 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 dant 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 and sanitary measures, I was requested by the parochial authorities of Saint Anne's Soho to take charge of one of the district into which the parish was at once divided. During the busiest of those very busy days a medical friend and neighbor called on me and an 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. You in the neighborhood 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 follow the medical officership of the Strand Workhouse Cleveland Street and of the parish of Saint Anne's Soho fell vacant. The person who held the appointment proposed to resign in favor 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 30 years. My first impressions were not very exhilarating and could I have foreseen all that was in store for me I questioned 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 for 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-story 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-storyed building with an underground apartment guided 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 500 inmates, was carried on in the cellar beneath the entrance hall in the general dining room whence it came to pass that the said hall and so forth days in each week filled with steam and the odours from watching 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 shop with a forge and un sealed roof. This ladder 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 shop. There were no paid nurses such nursing as we had and continue 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 crossbar. On this bar were suspended the carpets taken in to beat by the so called able bodied inmates from whose labor the guardians gave a clear income of four hundred pounds 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 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 expedience 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 difficult experience from his case alone. I was constantly stitching up his wounds. The female and sane 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 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 anyone else. To be allowed to remain in the house and get weighted 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 Alamoad beef shop in that locality. Through this chairman's influence he became the porter of the work house and the master falling sick he had performed his duty for him. The illness ended fatally through the same influence catch was promoted to the vacant office though at the time I first knew him he was so ignorant 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 must hear after 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 50 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 20 shillings only. The decision as to the necessity for such attendance was vested in the midwife or matron and until medical officer was interdicted from entering the line 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 the regulations were disregarded. I have stated that the chairman of the board was the proprietor of an Alamoad beef shop. During my first year of work, the secretary would often come to the house on Sunday morning dressed in the dirty greasy jacket in which he had been serving Alamoad beef the night before and unshaven and unshorn he would go into the chapel with the pauper inmates and afterwards go to the boardroom and have breakfast with the master and matron. Of course between the three there was an excellent understanding and the other 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 word used for foul cases which was in immediate proximity to the tinker 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 signet forms of blood poisoning that I ever saw. These two successive deaths took place whilst the tinker was flying 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. I have referred also to the nursery ward. This place was situated on the other side of the partition. It was a wretchedly damp and miserable room nearly always overcrowded with young mothers and their infant children. That death relieved these young women of their illegitimate offspring was only what was to be expected and that frequently the mothers followed in the same direction was only too true. I used too dread to go into this ward. It was so depressing. Scores of children took place during my continuance in office through there being located in this horrible den. It frequently happened that some casual was admitted with her child or children to the room below the female receiving ward. On my visiting the house next day I would find that her child had got an attack of measles and could not go out and in spite of my sending the mother and child to the children's love, measles always broke out in the nursery some 11 days after and I have had as many as 20 down with it at a time. I will not horrify my readers by stating the proportion of deaths to recoveries but content myself was stating that the latter were very few. What made these continuous outbreaks so vexatious was this that I had laid down the most stringent regulations as regards isolation and disinfection but unfortunately my orders could only be given to pauper women. I had no other persons to act with and with that habitual carelessness which had led to their becoming paupers they only in exceptional instances paid any attention to what I said. Now and then a decent widow with an infant came in and became an inmate of the nursery ward there being no other place for her to go to. What her feelings must have been when forced into day and night companionship with some of the most abandoned of her own sex in this miserable gayena I will not attempt to portray and yet the majority of the board looked upon this den as a perfect paradise and looked on me as an irreconcilable fellow for troubling them with my complaints respecting it. I had not been the medical officer for many months before I found that my pauper nurses were frequently under the influence of drink and that too in the forenoon. On inquiring I heard to my surprise that the master was in the habit of giving out the stimulants at 7am and as many of the inmates sold their allowance the nurses had become partly or wholly intoxicated when I reached the house in the morning. My first request to the master was that some other time be selected for the issue of stimulants. Such request was angrily refused and it was not until I had appealed to the board that I succeeded in effecting an alteration but my success made the master hence forward my determined foe. As I have stated the medical officer's salary was intended to cover the provision of medicine. The guardians however had supplied my predecessor with Lindsay de Meal and Mustard but finding that I had a great many consumptive and bronchidic patients I was induced to apply to the guardians for some linseed to enable me to give the patients some linseed tea. Now there was one nurse and the female sick ward by name Charlotte Massingham who had been in supreme authority there some years. She was nearly always muddled to work with her was impossible. Charlotte invariably treated me with supreme indifference not unmingled with undisguised contempt. I had introduced newfangled notions would have my medicines correctly given and the patients well attended to. On hearing that my application for the linseed had met with success I went up to the workhouse. On going into the female sick ward I told Charlotte of my having gained the assent of the board when suddenly springing up at least one foot she came down slapping both sides with her arms on the ground with a startling observation my god linseed tea in the workhouse. Charlotte's reign however was not of long continuance after this she died worn out by the effects of habitual intemperance. I heard after she was dead and the inmates were free to speak that she systematically stole the wine and brandy from the sick. It's obvious that one of the first points to secure was the removal of the laundry before referred to situated in the cellar beneath the dining hall. The guardians having assented to my suggestions a contract was entered into with the builder to put up a laundry in the backyard. The structure was to cost some four hundred pounds. On proceeding to dig out the foundation the workman came on a number of skeletons the yard having been originally the poor burial ground of St. Paul's Covent Garden for which parish the workhouse and so forth had been built and had been rented by the guardians from that parish when the strand union was formed. So full was this yard of human remains that the contractor was compelled to go down twenty feet all round before a foundation for the laundry could be obtained. In making this huge trench they disinterred the remains of the poor Italian boy murdered by Bishop and Williams whose murder was discovered by the late Mr. Partridge of King's College Hospital to whom Bishop and Williams had sold their victim for anatomical purposes. Similar murders of the same kind in Edinburgh led to the passing of the Anatomy Act and to the suppression of the practice of body snatching by the abandoned wretches who formerly supplied schools of anatomy with subjects. My next endeavour was an enlargement of the cellar at each wing so as to secure better accommodation for the reception of casual poor and increased space for sick children and others. This was accomplished by nearly rebuilding the wings. Unfortunately, these suggestions rendered me extremely unpopular with many of the guardians and delayed for some two years any increase of my wretched stipend would otherwise have been granted if I could have remained a passive observer of that which I saw around me. But worse was in store. My first serious quarrel with the board happened thus. Many of the young women who came in to be confined came under treatment afterwards suffering from extreme exhaustion and some were hopelessly consumptive. On making inquiry I found that the practice of giving in ward was to keep the single women on a dietary of gruel for nine days and then at the end of a fortnet to dismiss them to the nursery ward on house diet with their children. Assuming as I had a perfect right to do that this dietary had emanated from an order of the poor law board I wrote to the department telling what I had observed and asking that board's permission to introduce a more generous system. My communication was sent to the guardians and I was informed in a letter from the board at Whitehall that it rested with me exclusively to order whatever form of dietary I chose, a power which I did not hesitate to use. The board of guardians condemned my conduct in writing to the poor law board in the strongest possible terms and the use I had made of the power vested in me. The course taken by me was held to be in the highest degree reprehensible as it traversed the deliberate action of the guardians who had established the starvation dietary for single parturient women as a deterrent against the use of the workhouse as a place in which to be confined. As the number of fresh admissions went on increasing and I had not sufficient accommodation I recommended that the side wing should be enlarged by carrying up a story higher. This was done and the pressure put on the accommodation was met for a time but all these suggestions increased my unpopularity with certain of the board who condemned me for the expense I was putting them to. About this time the annoyance and obstruction I met with from the master and matron compelled me to apply to the inspector for support. He came to the house to make inquiry but so large a number of guardians attended to support the master that after a few questions had been put he closed the inquiry. Some years after he expressed to me his regret that at that time he could not see his way to aid me. At the end of the first year some business took me to Scotland the board sanctioned my absence and gave their approval of the gentleman who was to act as my substitute. On my return journey by the night train on getting Peterborough at 6 a.m. to get some coffee I was surprised to see the master of the work house and the clerk of the board standing on the platform. On reaching King's Cross I remained in the carriage till all the passengers had alighted and had passed me. I wasn't out whether I had been deceived but I had not been for presently the pair passed the carriage each carrying a small bag. About ten days after a letter was sent from the board asking for an explanation of an alleged neglect of a sick person in the house I forthwith called on my substitute and showed him the letter. He denied in the most positive terms the allegation of neglect. On visiting the house no information could be gained from anyone but it occurred to me on leaving to ask the porter whether he could throw any light on the matter. After reading the clerk's letter he made the remark why it was not in the house at the time he alleges the neglect took place for he and the clerk went down to Peterborough from the Thursday to the Monday morning to be entertained by the contractor who put up the laundry boiler. In my defense I stated this to the board when great was the indignation expressed by some of the guardians. First at his false charge of neglect and secondly that he and the clerk should have gone away without leave and for the being by the contractor. The exposure of course intensified this master's hostility in which his friend the clerk cordially cooperated. The consequence to me was that I was continually sent for on most frivolous pretenses. The messenger would come to my house and say you are wanted at Cleveland street if I asked for what he was studiously ignorant. If I went or if I sent my assistant catch would keep us waiting in the hall until it suited his humor to come out to me when in a loud voice he would say you are wanted in such and such award. Hard as this was to bear with from this ignorant and incompetent official I put up with it for a time but at last I again called on the poor law inspector and asked him his advice when he informed me that the master was bound to send a written order stating the name of the sick person and so forth on my having intimated to him that I should not again notice his calls unless this requirement was complied with the annoyance was stopped nearly all of these second visits having been wholly unnecessary and arranged with the view of wearing me out. I have stated that unless called on either by the midwife, matron or master to visit a woman recently confined I was debarred from attendance on her and could not claim any fee. The master and Clark arranged that no order should be given until nine days had elapsed when it was held that I was bound to take charge of the woman as in an ordinary case of illness. This calling one in on the morning of the tenth day was so frequently done that I saw that the thing was arranged especially as I learned on inquiry that the woman had been ill for some days and had asked that I should be sent for. I thereupon took on myself to visit the ward daily and to judge for myself as to the necessity for my attendance. Some half dozen of these cases occurred within three months. On sending notice to the Clark that I had visited such and such a case I received the reply I have made inquiries and find that you attended without getting the necessary authority. This I afterwards learned was done without any authority from the board. I decided that I would give up going into this ward for the future. Some time after and in pursuance of this man's policy of annoyance a case occurred just as I expected which enabled me to get rid of him. On going to the house one morning the porter told me there was a woman ill in the lying in ward. On going into my room the pauper attendant came and asked me to go to this ward. To the inquiry who sent you no one she replied I then said go to the matron or if you cannot find her to the master state that the woman is very ill and bring me the authority to visit her. She went away. Some half hour after I went by the ward door and heard this poor wretches cries for assistance but I did not visit her. Again the attendant came to me and implored me to go up. I asked have you seen the master or matron? Yes she said. What did they say to you? Why they only laughed. I again declined to visit the ward. Shortly after I left the house. I had hardly passed the gate when the master rushed into the hall and inquired whether I had left. On hearing I had done so he said in a loud voice I have caught that damned doctor at last and directed the porter to go for the nearest medical man. Some gentleman came and attended to her and the bill and a garbled statement of the fact was sent by catch to the board. I was ordered to attend their next meeting and explain my conduct. I requested the attendance of the porter and of the pauper nurse at the board's meeting. Catch gave his version of the story when called on for my explanation I narrated the course adopted by the master the matron and the clerk and pointed out to the guardians the evident intention of all three to be paid any fee. That in the case in question I had asked for an authority to visit the woman that although both of these officers knew of the poor woman's condition they had maliciously allowed her to remain without proper attendance and would not give any order so that I should not be paid a fee. The defense was so complete and so completely turned the tables on all three that a severe censure was passed on the master and matron for their inhumanity and a hint was given that they had better look out for some other appointment. This they did and a vacancy for a master and matron having taken place at Newington Workhouse Mr. and Mrs. Catch applied for the post and to the delight of all the inmates and officers of the Strand Workhouse were selected so intensely tyrannical and cruel had been the rule of this man that the day he resigned to the keys and leaving the house the whole establishment at least all those who could leave their beds rose in open rebellion and with old kettles shovels penny trumpets celebrated their departure from the premises. The incoming master subsequently told me that he had never witnessed anything like it in his life and that the row was so general and spontaneous that he was powerless to check it. Mr. Catch's subsequent career did not disappoint the expectations of those who were cognizant of his utter unfitness for so responsible a post I shall refer to him again in a subsequent part of this narrative. Before I had been long in office I became aware that there was a benevolent agency at work conducted by some Christian ladies whose mission it was to visit the wars, read to the sick and infirm and generally to help them in the effort they might make in re-establishing themselves. At the head of this movement was Miss Luisa Twining who has devoted years of her busy life to the amelioration of the lot of the work house sick. Lady Alderson, the widow of the late judge, her daughter Miss Luisa and though last but by no means the least, Miss Augusta Clifford were associated in this good work. It was to Miss Twining's initiative that the abolition of the system of entrusting the care of the sick poor to the numerous seriocamps and the Betsy prigs was mainly due. But she did not succeed in her laudable efforts until after several years of incessant appeal to the guardians of the poor and the poor law board. Ultimately her demand was conceded in deference to outraged public opinion. The efforts of Miss Clifford demand a special reference here. Very early in my official wife called on me and volunteered to help any deserving case brought to her notice. Over and over again did she put her hand in her pocket and give money to inmates of her own sex whose cases I called attention to. At last her good doing attracted the notice of the board who passed a very eulogistic resolution in which they thanked her for her great kindness to their sick. Here let me remark that although the majority of the strand were wholly unfitted for any administrative duties yet it should be ungrateful not to state that there were several kindly disposed persons among them. They were generally however outvoted though occasionally their suggestions for a milder and more generous regime prevailed. Cash had hardly left the house when it was proposed to increase my stipend at first to 75 pounds ultimately to 100 pounds a year and I was also entrusted by the board with the duty of certifying as to the lunacy of the inmates who were admittedly insane. This office had been filled for many years by a Dr. Beeman of Henrietta Street, Cova Garden, in deference to a view recently revived by the present Lord Chancellor in his hitherto abortive attempts to amend the lunacy laws and was to the effect that it would be hazardous to entrust such a duty to the Workhouse Medical Officer as he might be tempted to eke out his salary by certifying that healthy persons were mentally affected so as to secure a fee. The injustice implied in this gratuitous imputation having been brought before one of the presidents of the poor law board, he was induced to get the prohibition removed and one of the results was that my friends at the board carried a resolution that in future I should be the examining official as I had all the trouble of the case whilst a stranger pocketed the fee. Dr. Beeman was much annoyed at this and as the relieving officer who was a friend of Beeman's persisted in sending all cases to Dr. Beeman, a collision was inevitable. A short while after a lad was brought by the police found wandering at large. I diagnosed that he was a homicidal lunatic and that it was necessary that he should be sent away. The relieving officer having called in Dr. Beeman, he visited the house examined the lad and took him down to Bow Street and deposed before the magistrate that he was of sound mind. He would have been discharged but the police having testified to the very questionable condition in which he was on coming into their hands the presiding magistrate directed that he should go back to the house for further observation. This was done and I again saw and examined him and gave a fresh certificate of his insanity. Dr. Beeman was again requested to attend. He however sent his partner who also decided that the lad was not insane. He was again taken before a magistrate with the result that he was ordered to be discharged. Thereupon Dr. Beeman wrote to the poor law board complaining of the action and the evidence in appointing an inexperienced young man as the examining medical officer and stating that neither he nor his partner could discover any evidence of insanity in the case in question. A copy of this letter was sent to the guardians who directed the clerk to write to me for an explanation of my conduct. I was satisfied that I was right but I had a great deal of trouble in tracing what had become of the boy. My father, who informed me that the day he was discharged he came home and sat down to his dinner. After the meal was over the father resumed his work, that of Shumending, when his son without saying a word struck him a severe blow on the head with a hammer. The aid of the neighbors and of the police was in vogue and after a desperate struggle he was overpowered and cuffed, taken before a magistrate who sent him to Marlebone house from which establishment he had been sent to Hanwell where he had been some days. I sent a copy of my reply to the guardians to the poor law board. My judgment was never again called in question in cases of lunacy. I found this part of my duty an agreeable episode in my daily routine of all but thankless work. I also made the acquaintance of Sir Thomas Henry, Mr. Flowers and Mr. Vaughn, and all these magistrates received the greatest courtesy. Before I had long held my office my attention was drawn to the marvelous zeal displayed by the Catholic priests who although unpaid were untiring in their attendance on the sick poor of their persuasion, a large number of whom were always in the house. A somewhat ludicrous incident occurred about this time. There was a very old woman in the infirm ward across the yard. She was stated to be ninety-five. She had been blind from childhood and the balls of both eyes were gone, leaving nearly empty sockets. Although life under such circumstances was not very attractive, I never met with anyone who so strongly objected to dying. She was constantly sending for me to prescribe for her imaginary ailments. One very cold night when the snow was on the ground and it was blowing strongly from the northeast to the east, my night bell was rung violently. I had not gone to bed and therefore answered the door when I found a young Irish woman cowering in the recess of the doorway. On asking what she wanted she replied, oh, if you please, sir, the father has sent me over to ask whether Bridget Gaines is dying as a messenger has just come from the house saying Bridget is going and requesting the father to go there at once. Now the father has a bad cold and he has a poultice on his chest and he is afraid to go out as the night is so cold. I laughingly told her to go back and tell the father that I thought Bridget was not near her end yet. On the following morning the priest called on me. He was very anxious about Bridget and earnestly asked whether I had heard from the house. I told him there was no need for anxiety when in a deprecatory tone of voice he said, I should have gone after all, but Bridget has been very embarrassing. Do you know, he said, Bridget has had extreme unction administered 19 times. I saw Bridget that morning, she was much in her usual condition, she lived a long time afterwards and probably was anointed on a great many subsequent occasions. I was constantly encountering odd stories and odd people, many of them profligates who had seen better days. One person in particular attracted my attention as he had evidently been a gentleman. Indeed, he assured me that he had once a large estate in Yorkshire and was master of the hounds. I had no reason to doubt him. He did not live very long after his admission to the sick ward. After his death I received from five different solicitors written requests for a copy of my death certificate. It was accompanied in each case by a fee of a guinea. This poor fellow had ensured his life in five different offices and had sold the policies. It will be seen that I shared in the pecuniary advantages that sprang from his death. The immediate successor of Mr. and Mrs. Katch did not stay very long. The matron's health broke down as she had to resign. They were followed by Mr. and Mrs. Thorn who remained master and matron until the death of the former some years afterwards. Mr. Thorn was a kind-hearted person who had filled a position of responsibility in the parish of Marlebon. While Mrs. Thorn was a well-educated lady-like woman they managed the house well and treated the inmates with kindness and consideration. But do as they would they could not alter the structural deficiencies of the building make it larger nor prevent the fearful overcrowding with its disastrous results nor improve upon the wretched system of pauper nursing which was the curse of that and all similar institutions and which the powers that were in those days at Whitehall made no genuine effort to change. Shortly after the collapse of his friend Katch the proprietor of the Alamode beef shop ceased to be a guardian and a wholesale fruit dealer in Covent Garden reigned in his stead. He was a far less satisfactory chairman than his predecessor as all thoughts words and deeds were actuated by the consideration of his personal and private interests as will be shown by the following among other instances that could be related. One of the earliest things very properly done by the new master was to find out the previous occupation of those who had come in sick and to utilize them when recovered in the trade they had followed for the improvement of the house. One day a middle-aged man came in very ill. He had evidently seen these days. In fact he turned out to have been a highly skilled decorator especially in the representation of marble and in graining. As soon as he was well enough the master set him to work to decorate the entrance hall. This he did most admirably and his work was much admired by the guardians and by visitors to the house. This employment coming to an end he was allowed as a reward for his industry to go in and out responsibly to look for work. I used frequently to meet this man on my daily visits. As he continued to go out in this manner I one day stopped him and asked whether he had been successful in finding a job. His reply in the negative was accompanied by a look so significant that I was induced to push my inquiries when he told me that he was occupied in decorating the chairman's house and he had been engaged at it for some three weeks to the further inquiry what have you got there pointing to a bag he was carrying he replied that is my dinner which I always take with me from the house. Oh then I said the chairman does not find you your dinner even does he give you any beer or any money he replied I have been working there all day long for the last three weeks and he has never given me anything. As he shortly after disappeared I made an inquiry as to what had become of him when I learned that he had suddenly left the work he was doing for the chairman and gone off and drowned himself. This chairman did not long continue to act as such as some months after this he died suddenly of heart disease the only evidence he had ever afforded that he possessed one. Having occasion just at that time to go to the poor law board I was waiting in an office for the chairman went to see when one of the junior official said to me you have lost your chairman. Yes I replied but I do not feel his loss very acutely on which he said it is customary for the clerk of the board to write and apprise us of the death of the chairman and we always send a sympathetic letter and reply on the clerk's letter being read the question was asked should the usual reply be sent the official reply was grim enough to wait and say that we are delighted to hear it. The successor in the chair was very friendly disposed toward me and remained so until after the official inquiry in 1866 when having attended to hear the evidence that was given and having made himself conspicuous by some irrelevant interruptions he brought down on himself the criticism of the press which he most absurdly attributed to me and resented becoming a most determined opponent ever afterwards. About this time a select committee of the House Commons was appointed to take into consideration the administration of the poor laws and to decide as to the desirability or otherwise of the maintenance of the central department. In conjunction with my friend the late R. Griffin of Weymouth who distinguished himself so much by an advocacy of an amended system of medical relief and the late Dr. R. Fowler of Bishopsgate Street I volunteered to give evidence before the committee sometime afterward being asked by the late Metropolitan Inspector H. B. Farnell S. Squire C. B. to call upon him at the poor law board I did so. I here said he that you have asked to give evidence before the select committee pray what are you going to state. Nothing I replied that bears on my personal position as a poor law medical officer except so far as I may support my views by reference to my personal knowledge. I shall give evidence for the purpose of urging on the committee the desirability of abolishing the system whereby boards of guardians for a stipulated sum often wholly inadequate bargain with medical men to find all medicines and appliances because the inevitable outcome of the system is this that the poor do not get the medicines they require. I feel that the sick of the Strand Union got very little in the way of medicine before I was appointed and the provision of such medicines was to me in every sense a pecuniary loss until the guardians quite recently increased my stipend so as to make the strain less felt. He had once assured me that he would do his best to put my views before the chairman C.P. Villiers M.B. Hampton. I did not at that time know Mr. Villiers personally except by repute but I came to know him some years later. Mr. Fernal then proposed to put some questions to me and take down the answers. This he did and as each question was put I replied briefly giving my reasons for my suggestion. I had to be guarded in my answers as I was not desirous of bringing the charge against my medical brethren that they systematically failed to supply medicines for the sick though very many have with more or less questionable candor said to me why do you bother about the supply of medicines go in and get for us an increase of our pay. After Mr. Fernal had put me to the question he shook me very warmly by the hand promising that as far as I was concerned the views I held should be brought prominently forward. Some time after I received a notice to again when I found Mr. Richard Griffin and Dr. Fowler in the room Griffin had to come there with evidence that would have taken a month to take down. Fowler was not so diffuse a couple of days would have got through what he had to say. Appalled by the vast body of evidence offered by these two the committee ordered the room to be cleared. On our readmission we learned that the committee had decided that Mr. Griffin and Dr. Fowler should take down their evidence which should be taken as if delivered. I was then called on. I had neither note nor paper as I relied on Mr. Fernal's promise. The questions were mainly put by Mr. Villiers. I amplified briefly the views I had expressed to Mr. Fernal. This led to my being asked for some additional explanations which I supplied. Ultimately I was dismissed but not thrown away. Poor Richard Griffin had worked for many years with wonderful industry to call attention to the grievances of poor law medical officers and thought he should succeed but he was destined to fail for although the committee had allowed him to put in his evidence yet the facts he had collected with so much pains were successfully traversed by Mr. R. B. Gaines, poor law inspector who by certain statistics made out to see satisfaction that the medical men had no great cause for complaint. Poor Fowler's evidence was similarly snuffed out. As regards mine the committee reported in its favor but not as to the whole of it. They probably dreaded the cost to the various union boards of the provision of all medicines but they suggested a compromise to wit that boards of guardians should be required to supply expensive medicines such as cod liver oil quinine opium and so forth. Small as the concession was Mr. H. Fleming delayed the issue of the committee's recommendation for 15 months after it had been made and then sent out a letter couched in such official language that a great many boards contented themselves with ordering the letter to lie on the table. Some years after I asked Dr. Lush MP for Salisbury to move for a copy of the letter and a return of what had been done, I found from that return that about half of those bodies had not noticed the letter at all. Subsequently 20 years after the issue of the letter my brother, Thorold Rogers, moved for a similar return only to show that there were still several boards where nothing whatever was supplied. End of chapter 1, part 1