For five or six years after the departure of Mr. Catch my life was a fairly pleasant one. There was no obstruction from the master or the matron, and as there was nothing to ask of the Board things went on quietly, and therefore the daily duty ceased to be onerous added to which I had several pupils whose instruction in the wards was to me a very agreeable pastime. Here let me remark how melancholy it is that the vast field for clinical observation and study which the sick, nursery, and lying-in wards of large urban workhouses afford, should be utterly thrown away. There are certain diseases which can hardly be seen anywhere else, such as of those of young children and of aged persons, and yet they are completely ignored.
I have said that for a time everything went on peacefully, but a rude awakening was in store, for about the years 1862-1865, in consequence of widespread distress in the metropolis, persons were admitted beyond the capacity of the House to hold them. This necessitated a representation to the Board, and, as a consequence, a revival of the antagonism from the so-called economical members of the Board, who charged me with being too squeamish, and with having brought the influx on myself by being too indulgent to the sick. The hostility went so far with one Guardian who considered me so very troublesome that he put a notice on the agenda to reduce my salary. This was renewed by him from time to time, indeed, whenever I made a representation to the Board on this subject.
That there was abundant cause for such representations will be understood when it is stated that, in consequence of the overcrowding and the heated and vitiated atmosphere caused thereby, cases of fever induced therefrom were constantly cropping up, and it was one of my perplexities how to deal with them. In those days there were no such facilities as now exist for sending fever cases away to separate asylums, and we had to do the best we could.
Having, in 1863, had a succession of boys affected with fever sent in from St. Anne's, Soho, I inquired of the relieving officer from where they came, whereupon he informed me that a Mr. Williams, a clergyman in Porter Street, Soho, had opened a home for friendless boys. On interviewing this clergyman, I told him that I had called to protest against his sending these fever cases to the Workhouse, there being no room for them. He replied by asking me what he was to do with them, as at that time he had some four or five boys down with fever; and then he took me into an old, disused slaughter-house, where, on some straw, I saw these lads lying ill. Before leaving him I arranged that he should go over the House and see for himself that there were no vacant beds. On the morning appointed he came, bringing with him a person whom he represented to be his secretary, and who he asked to be allowed to take with him. No objection being made, he accompanied us. I was somewhat surprised at the bearing of this so-called secretary, and still more so at his conduct in the House, when we went through the wards. I thought he was a very intelligent gentleman, and wondered at him occupying the position of secretary to Mr. Williams, at say, £1 a week. I satisfied Mr. Williams that I could not continue to take in his numerous waifs and strays, and on leaving, his companion parted from me with many expressions of thanks for my courtesy in allowing him to accompany me. I had not the least idea who he was, or his name, but I felt pretty sure that he must be a gentleman. It transpired subsequently that he was no other than Mr. J. Alexander Shaw Stewart, and my chance acquaintance became in after years one of my kindest and truest friends. As a result of this interview with Mr. Williams a school was opened, called afterwards the Newport Market Refuge Industrial School, and for several years it was under my medical charge. During the years I was connected with that establishment I never had a case of fever of any kind, although the school was located in a densely crowded and repulsively degraded neighbourhood. It was a striking instance of what could be done in keeping schools free from epidemic disease, if only the persons having control of them adopt, and strictly carry out, judicious sanitary arrangements. During my period of office I made the acquaintance of the Duke of Westminster, Mr. and Mrs. Gladstone, the latter of whom was a frequent visitor there, as well as many ladies of rank, &c.
About this time there came an urgent request to go to the House. On my arrival I found a young German woman near her confinement who was in a state of great mental distress. On asking for an explanation, I was informed that the day before a gentlemanly-looking person had called at the house and asked to see the matron. To her he stated that he was a medical man, and had been commissioned by the friends of one of his patients to look out for some healthy young woman near her confinement who might be engaged as a wet nurse by a lady under his care. The master brought down to him this girl, when he instructed her to send her next day to his consulting-room, where the lady's friends might see her. She accordingly went. Shortly after her arrival there she rushed out of the house, stating that she had been insulted by the doctor. Police aid coming to her assistance, the doctor's residence was visited, with the result that he was taken into custody, and brought before the magistrate, who remanded him without bail for inquiries to be made. The publicity of the case led to the bringing of other charges of a similar character, and he was ultimately committed for trial. Having been called upon to attend the German girl, I was naturally called as a witness, and was subsequently subpœnaed to attend at the Old Bailey. I found four other young women there in a similar predicament, all in charge of a police constable, and for three days I spent my whole time in their company, for whenever I got up to walk anywhere the women and the constable got up also and followed me. The situation was suggestive, but by no means pleasant. On the Thursday morning I was informed by the prosecution that I might go away, as the prisoner, who turned out to be a man of good family and an officer in the army, had pleaded guilty to a common assault, &c., &c. As the girl's history was somewhat interesting I sent an account of it to The Times newspaper. It was as follows: She had been living at Chicago with her two brothers, when they received a letter stating that their mother in Germany was very ill, and begged that her daughter would come home. She started immediately, but on arriving at her native town found that her mother was dead. She thereupon sold all the effects, and with upwards of £100 started back again for Chicago. She passed through London to Liverpool to take passage for New York, but the machinery of the steamer breaking down when two days out, the captain returned for repairs. She had made the acquaintance of a young Frenchman on board, who finding she had money, made love to her, and induced her to go back to London and become his wife. After living with her until all the money was gone, he deserted her, and being without friends, she had to come into the House. My letter appearing in The Times, some £45 was sent me, which sufficed to enable me to send her and her child to her brother in Chicago. I provided her with an outfit, and arranged with the captain of the steamer to take charge of her, and send one of his trustworthy officers to see her to the station in New York for Chicago, and parting with her to put into her hands the balance remaining. Some months afterwards I had a letter from the captain, stating that he had carried out my request, and had finally given her the £25 or thereabouts. There was every reason to believe that one of the subscribers was Her Majesty the Queen, though it was not so distinctly stated in a letter I received from a gentleman connected with the Court.
In the early part of 1865 the Guardians appointed a superintendent nurse. She was a young, and very respectable-looking woman. The Guardians had been moved to do this by the evidence of Miss Twining before the Select Committee, and by the general feeling excited by the revelations made in Gibson's case in St. Giles's, and that of Timothy Daley in the Holborn, Union. In the winter of 1863 and 1864, and again in 1864 and 1865, as also in 1865 and 1866 the admissions had been so many, and the crowding so great, as to tax the resources of the establishment to the utmost, notwithstanding that I had moved the sick ward to the top of the building, and gained additional cubic space by removing the ceiling and re-ceiling the rafters; but I could not by any contrivance increase the area. The beds therefore were placed so close together that the patients had to get out at the end of their beds, there being no possibility of getting out at the side. It was a task beyond this young woman's strength to effectually supervise the numerous patients, but she could check some of the graver abuses connected with pauper nursing. This she did to the best of her ability. In the same spring that she was appointed—that of 1865—the late Dr. Francis Anstie called on me. He said he was deputed by the late Dr. Wakley to call and state that he had decided to appoint a commission for the purpose of investigating the state of London workhouses, and he thought I could suggest the best course to follow to obtain admission to them. I told him I would introduce him to the Chairman of the Board, who alone had the power to grant permission to a stranger to enter the Workhouse, unless special application had been made to Board, and leave given. He called on the Chairman, who gave him a letter to the master, authorizing his admission. Before he left, I told Dr. Anstie that when he went over the House I would accompany him. Some short time after, he wrote, making an appointment. I showed him through the whole House, pointing out the defects and shortcomings, and told him of my continued efforts to get the place improved, and of the determined hostility of the majority of the Board to any efforts I had made. I also showed him a list of the fever cases I had attended, and how constantly fever was developed when the numbers increased and the overcrowding was greatest. Dr. Anstie took careful notes of what I showed him, as the sequel proved. Some month or so after, I had a note from him, asking me to look in that week's Lancet for the report of his visit. I did so; when I found that he had exposed the rotten condition of things with marvellous clearness and fidelity, but as he had referred to me and my efforts to clear out this Augean stable, I was perfectly convinced that the least intelligent element of the Board would be incited by their clerk to charge me with having written the article in question. As I anticipated, this came to pass, for I heard that so it had been said at the Board meeting, and in consequence, a most insulting resolution was adopted, in which I was directly charged with trying to bring the Guardians—'who were my masters'—into contempt. So angry was their language and so bitter their hostility, that Dr. Anstie wrote to the Board, stating that he had been permitted by their Chairman to go over the House, and that the observations he had made were his own, and that I had not seen a line of his manuscript, or knew of his report, until it appeared in print; he further challenged the Board to show where, in his description, he had departed from the truth. The storm he had raised was, after a while, allayed. Dr. Anstie continued to visit other workhouses, the condition of which he similarly described. These reports, which appeared in The Lancet, were copied into, and commented upon, in sundry daily and weekly journals, and gradually produced a feeling of intense public indignation. Dr. Anstie had acted so generously towards me in screening me from the hostility of the worst elements of the Board, that I arranged a dinner-party, to meet and discuss workhouse abuses. Among the guests was Mr. John Storr, of King Street, Covent Garden, who was one of the wealthiest, as he was one of the most respectable, members of the Strand Board, and who, since his election two years before this, had proved to be my most able advocate and friend. When Dr. Anstie arrived, he brought with him Mr. Ernest Hart, whom he introduced as one of the staff of The Lancet, and as one interested in the question of workhouse administration. After dinner a discussion took place as regards the general condition of these establishments.
Ultimately it was arranged that a conference should be held at Mr. Storr's offices, King Street, Covent Garden, at a time hereafter to be named. Our dinner-party was held in December, 1865. In the early part of January, Dr. Anstie, Mr. Hart, and I, met by appointment at Mr. Storr's, when our discussion was resumed. At first it was proposed that we should call a public meeting and denounce the system, when I pointed out that if we only did that the agitation would soon come to an end, and therefore it would be better to form an Association for the purpose of more thoroughly enlightening the public. My suggestion was adopted. Mr. John Storr generously offered to put down £100 to float the Association. He also offered to become its treasurer, and to give us the free use of one of his offices, in which the meetings of the Association could be held. This meeting took place on a Thursday evening, and as The Lancet came out next day, Mr. Hart left us and went down to The Lancet office, to announce in the paper the formation of the society. At our meeting it was also arranged that we should respectively write to those we knew and ask them to join our Association. I wrote, among others, to Mr. Shaw Stewart, who at once joined us, and to Miss Twining, and to many other ladies and gentlemen who had been engaged in works of benevolence. The Association prospered beyond our wildest anticipations, and we were speedily joined by Earl Carnarvon, Earl Grosvenor, the Archbishop of York, &c.; whilst money came in freely. Shortly after the formation of the Association, of which, in conjunction with Dr. Anstie and Mr. Hart, I was one of the honorary secretaries; Mr. Farnall, the Metropolitan Poor Law Inspector, wrote to me, stating that he had been deputed by Mr. Charles P. Villiers, the President of the Poor Law Board, to offer his services in giving information to the youthful Association, and that he had written to me, as I was the only honorary secretary he knew. Mr. Farnall subsequently attended the meetings of the committee, and afforded us much valuable information. No use was ever made of Mr. John Storr's office, as all subsequent meetings of the Association were held in Mr. Hart's house, in Wimpole Street.
In the month of May, 1866, Miss Beaton, the superintendent nurse, informed me that she intended to resign her situation, and apply for another as a nurse at a general hospital; at the same time asking me whether I would give her a reference. Whilst expressing my regret that she was going, I readily promised to do all I could for her, and with that object gave her a letter of introduction to Dr. Anstie, assistant physician to the Westminster Hospital, and to Mr. Hart, who was then connected with St. Mary's Hospital. Dr. Anstie took her name and address, and promised to do what he could for her; Mr. Hart asked her to sit down, and proceeded to question her on the various matters connected with the Strand Workhouse I had mentioned at the committee meetings, &c. Ultimately he dismissed her, but not until he had a promise from her that she would write down all her experience of the wrong-doing she had witnessed at the Strand. She did this. On getting her manuscript statement he sent it to Earl Carnarvon, one of the committee, and asked him to apply to Mr. Villiers for an official inquiry. I had not the remotest knowledge that anything of the kind had been done, nor had my other colleague, Dr. Anstie. In the early part of June Mr. Hart told me that there was to be an official inquiry into the management and the condition of the Strand Workhouse, and that I should be called as a witness, but he did not tell me how it had been brought about. A few days after I received an official intimation that such inquiry would be held, and that my attendance would be required. I had hoped that the inquiry would be conducted by the Metropolitan Inspector, Mr. Farnall; but it was not so. Mr. Fleming sent another member of the staff. The inquiry was held, the first witness called being Miss Beaton. She astonished me by the extent and character of her revelations, of some part of which I was an eye-witness, and therefore knew to be true. Her examination lasted all day. Next morning, the evidence she had given appeared in all the papers, which commented thereon. On the second day I was called. On taking my seat Mr. Caine said, "Oh! we have met before;" I did not know where. I had not long been under examination before Dr. Anstie, who was in the room, came behind my chair, and said, "Take care how you answer questions; this inspector does not mean fairly by you; he is trying to put you in a false position." Forewarned by this, I simply answered his questions, and parried those which were irrelevant and misleading. The next day my evidence, in full appeared in every paper, and all the leading journals denounced the Board of Guardians for their management of the House. It was unfortunate that my Board should have been selected, inasmuch as nearly all the workhouses in the metropolis were in very much the same condition. After the close of the inquiry Mr. R. B. Caine returned to Whitehall, and made the remarkable statement in his official report that the condition of the House was due to my not having made proper representations to the Guardians. I subsequently heard that on his report being submitted to the President of the Board, it was altogether set aside by him, and that he wrote the report himself. It had, however, come to my knowledge that Mr. Caine had delivered himself of this view; when I wrote to the Poor Law Board complaining of his injustice, and pointed out that for some three years he had, as Metropolitan Inspector during the time Mr. Farnall was away in Manchester, visited the Strand, and that he had always entered in the visitors' book that he was completely satisfied with the state of the House. I am happy to say that Mr. R. B. Caine got very little credit out of the whole transaction, for his report was severely criticized by the press for its transparent bias. Just at this time a circular letter was sent by the Poor Law Board to all the workhouse medical officers—some forty in number—in the metropolis. It was issued evidently with the view of entrapping these gentlemen into contradictory answers to the questions which were submitted to them. It was clearly necessary to take immediate action. I therefore sent a letter to each of them, asking them to meet me at the Freemasons' Tavern, Great Queen's Street, Lincoln's Inn Fields. The majority of them came. Having been voted into the chair, I pointed out to them what was the object of the letter, and earnestly urged that we should agree as to the form of reply. This view was adopted, and the answers as agreed upon were sent by all present to the Poor Law Board. On the same occasion it was arranged that an Association should be established of metropolitan workhouse medical officers, so that we might be prepared to deal promptly with any similar departmental trickery. This was done, and I was elected as the first president, an office which through various changes I have occupied to this day. The Association was, during the two following years, enabled to play an important part in the settlement of many vexed questions in the administration of workhouse medical relief, which, without the practical knowledge of medical men, would have been wholly left in the hands of the officials at the Poor Law Board, who at this time exhibited a singular unwillingness to face the facts. My official life after this was a particularly unpleasant one, inasmuch as I was credited with having asked for the inquiry, and having resolved to state that which would bring "my masters" into contempt. I should have survived all this misrepresentation, but unfortunately just at this juncture the Liberal Government was overthrown, and the Derby-Disraeli premiership was established. Earl Derby speedily pointed out that he intended to deal effectually with the scandal that had been brought to light in connection with workhouse infirmary administration, and with that view he had selected Mr. Gathorne Hardy—now Lord Cranborne—as the President of the Poor Law Board, he being in Lord Derby's judgment one of the fittest men in Her Majesty's dominions to put things straight. Mr. Hardy up to that date had been principally known as a Chairman at Quarter Sessions, and an ex-officio Guardian of a Kentish Board of Guardians. One of the first official acts of this gentleman was to punish Mr. Henry Farnall for his conduct in aiding the Workhouse Infirmary Association. He was banished from London and sent to the northern counties. As Mr. Farnall's residence was at Blackheath, where his wife and children were living, this act of Mr. Hardy's was a serious inconvenience to him. The next thing done was to appoint Dr. Markham as a Poor Law Inspector and so-called medical adviser. Dr. Markham up to this date had been the editor of what was at that time an obscure journal. He was not known to have ever been associated with any sanitary work, nor to have seen the inside of a workhouse in his life, and yet out of all the able physicians at the time in the metropolis he was selected. The popular explanation given for this appointment was that he spent the larger portion of the day in looking out of the windows of the Carlton, Pall Mall, and that Mr. Hardy, making his acquaintance, gave him something to do. He fully justified the selection thus made, as will be shown hereafter, as he became in every sense one of the most difficult officials of the Board.
At this time the permanent officials, notably Dr. Edward Smith, promulgated the heresy that the area and cubic space suggested by our Association for the housing of the sick was excessive; indeed, that the area did not so much matter if the roof of the sick ward was carried up high enough. These and other statements having been promulgated by the staff, a meeting of the Workhouse Medical Officers Association was called, to take the subject into consideration. We had the aid of the late Dr. Parkes, the eminent Professor of Hygiene, at Netley Hospital, as well as of my two colleagues in the secretaryship of our Association. Conjointly, we drew up a paper stating what was in our view the minimum area and the minimum cubic space that should be sanctioned. This action forced the hand of Mr. Hardy, and caused him to issue a cubic space commission to determine this question.
Shortly after the formation of the Conservative Government a numerous and influential deputation, consisting of Earl Shaftesbury, the Archbishop of York, Earl Grosvenor, and many others, waited on Mr. Hardy, when representations were made to him urging extensive alterations on the then system. I was so hurt at the intrigues going on at the Poor Law Board and the attempt of Mr. R. B. Caine to make me solely responsible for the condition of the Strand Workhouse, that I availed myself of the opportunity to tell the President that in any scheme he might lay down for an alteration, I hoped that he would be guided by his own judgment, and not by that of the permanent officials, who would most assuredly lead him astray. This plain speaking was not particularly relished by those against whom it was mainly directed; it doubtless intensified ill feeling against me. I also handed to him a series of Resolutions drawn up by the Council of our Poor Law Medical Officers' Association protesting against the misstatements that had been propagated by Dr. E. Smith, Poor Law Inspector, against the Metropolitan Workhouse medical officers.