I was not wholly unprepared for this laxity of discipline, as some few days before entering on my duties I met the ex-chaplain of the Strand Workhouse, who, whilst congratulating me on my return to the Poor Law service, said, "You will have a great deal to meet with at St. James's. I have taken the duty there for the chaplain occasionally, and the scenes of drunkenness and quarrelling among the inmates on their return home on liberty days, which I have witnessed, exceeds anything you can imagine." One of the most terrible exhibitions of this kind I ever witnessed was on the first Christmas Day after my appointment. The subject having previously been brought under the attention of the Board, an order was issued that for the future this indiscriminate permission to the inmates to leave the house on Christmas Day should be stopped. It will hardly be believed that on the next Christmas Day the Chairman took upon himself, most presumptuously, to go to the House and give permission for them to again go out. The scene that occurred that night was the most disgraceful that ever happened in the history of a workhouse. Several of the drunken inmates on their return home fought like demons. I and my assistant were engaged for some time in dealing with the injuries that were caused. I must state that I never saw the master so justly indignant as he was at the impertinent interference of this Chairman, in setting his authority and that of the Board at defiance in the way he had done.
Finding that no dietary for the sick and infirm had been adopted at the House, I at once drew up a form which continued in force until ill-health caused my resignation. It was similar to that which I had introduced at the Strand several years before. There was one diet for which I claim especial credit. It was framed with the view of dealing with capricious appetites or severe sickness. It was called Number Five, or ad. lib., and consisted of either eggs, fish, a chop, beef-tea, or arrowroot, or anything else of the same value. It was enjoined that the nurse should at 8 a.m. ask what these special sick would take for dinner. When she had ascertained the wishes of the patient, a statement on a diet-sheet showing how many of each description of diet would be required was sent down to the kitchen. At the end of the week the cook handed to the master's clerk the number of each diets she had supplied, who then proceeded to distribute these among all those who were on ad. lib. diet. It might appear on the master's side of the Medical Relief Book that A or B had had a chop daily, whilst in reality the dinner might, by this arrangement, have been changed every day. This plan of dealing with capricious appetites has since been adopted in several workhouses.
Although five years had passed away since the Metropolitan Poor Law Act had become law, no attempt had been made to carry out the dispensary clauses until after my election, and one of the first things I had to do was to put the dispensary in order. I had been taught a lesson in economic prescribing whilst at the Strand, and therefore was enabled to speedily arrange for a pharmacopœia. I also drew up a formula for the supply of large bottles of simple medicines, which were placed in charge of the nurses, for administration in trivial ailments so common among the aged poor. I also introduced bed pulleys, to enable the sick to assist themselves in rising, or in getting in or out of bed. I also ordered small shawls for the aged women and woollen jackets for the men—a great comfort to those who were suffering from consumption or bronchitis, the principal affections I had to encounter.
I have stated that although it was midsummer the House was full of sick people, which arose partly on account of the sickness that prevailed in the worst part of St. Anne's and similarly in that of St. James's, and also to the fact that the Chairman had opposed the transfer of any of the sick to the Sick Asylum Hospital, at Highgate, to which the Westminster Union, in conjunction with the Strand, St. Giles's, and St. Pancras, was affiliated. He had opposed the junction of the two parishes on personal grounds, and being beaten, had, in conjunction with his party, obstructed the removal of the acutely sick.
As medical officer I did not object to this, for as the sick wards were extremely good and were all that I had desired to carry out when I initiated the Workhouse infirmary movement, I simply complied with the wishes of the majority of the Guardians not to send any one away. I had held office some weeks when, in the autumn of the year, I encountered Dr. Drydges in Regent Street. This gentleman, who had acted temporarily whilst Dr. Markham was ill, had about this time been permanently appointed to be Metropolitan Inspector, Dr. Markham having resigned. He came up to me and said, "I was coming to the Westminster Union to learn why it was you did not comply with the law, and send your acute sick away." "Oh," I replied, "that is soon explained; it is because the majority of the Board will not let me." "Indeed," he said; "you must do your duty, even if the Board object to it." To which I replied, "I did that at the Strand, and your Secretary called on me to resign because I was not sufficiently respectful to the Guardians. I shall comply with the wishes of the Guardians now, and not with that of the Local Government Board, as they would throw me over." To which he rather angrily replied, "You speak to me like that, when I am an Inspector, and you only a Workhouse medical officer?" To which I answered, "And who, pray, made you a Poor Law Inspector. Why, if it had not been for me and my initiation, neither you nor Dr. Markham would ever have been Inspectors." "Oh," he replied, "I did not know you had had anything to do with it." "I think," I said, "if you will trouble yourself to inquire you will find what I state to be correct." When I broke down in 1886, and he had to call and see me, he was then most kind and sympathetic, and I take this opportunity of stating as much.
This refusal on the part of the majority of the Board, led on by this Chairman, to allow me to send suitable cases of sickness to the Asylum Hospital, was in the highest degree absurd, seeing that the ratepayers of the Union had to pay their proportion of all expenses at the Asylum Hospital, and for the beds to which the Union were entitled; and although this Workhouse infirmary was a perfect paradise in comparison with the den at the Strand, still the House had not been arranged on the principle that all the sick should be retained in it. My nursing staff was insufficient to enable me effectually to deal with the great number of sick persons there at the time of my entrance on my duties. One illustration will suffice. There was a man in an infirm ward who had been under Mr. French some five or six years. He did not belong to Westminster, he was kept there because he alleged he was so ill that he could not bear the fatigue of journeying some sixty miles in the country. He was a healthy-looking man about forty years of age. He always lay in bed with his knees drawn up, and constantly asserted that he could not stand nor walk, nor put his legs down. He complained piteously of his sufferings. I exhausted every conceivable treatment, but all without the least apparent benefit, as he never owned to being any better for my attention to him. This went on for two years, until I began to get suspicious of him. One day an inmate of the ward, who had recovered and left the House, called on me at my private residence. On seeing me he said, "I have called to thank you for your kindness to me, and also to tell you that you have been deceived by that man Webster, who you have done so much for. He is an impostor. He can walk as well as I can, and, what is more, does walk about." "Nonsense," I replied; "he says he cannot get out of bed, and the nurses confirm it." "Well," he continued, "he takes very good care never to allow them to see him get out of bed, he takes his constitutional walk about the wards between 2 and 4 a.m., when the lights are down, and most of the inmates asleep." "But, surely," I said, "the night nurse must have seen him, and if so she would report it to me!" "Oh," he replied, "she hardly ever comes into the ward during the night, she is generally in her own room fast asleep—she gets herself called when she is wanted." I made some further inquiries, and finding that there was evidence of deception, I sent him to the Asylum Hospital with a letter to the superintendent medical officer, giving his history, and telling him of my suspicions, and asking that he might be carefully watched by reliable persons. He came back in a fortnight, having been found out. He was immediately transferred to his settlement, where doubtless he recommenced the game of deception, having found it answer so well.
It may be here said, If you had not confidence in your nurses, why did you not get rid of them? For the simple reason that I had no power to do so. They were not selected by me, but by the Guardians, and therefore were not my officers, but the Board's. I once reported the night nurse on the male side (the woman who had allowed the malingerer to deceive me) for drunkenness, but I had so much trouble to get rid of her that I was not induced to repeat the experiment, added to which I was most grossly insulted by the master for bringing this woman's conduct before the Guardians.
In my opinion the medical officer should select and discharge all the nurses—of course, reason for this latter action being shown. I should have discharged several at the Westminster Union for neglect of duty and for general incompetence if I had had the power. Simple complaint would be attended by no beneficial result, as it would be a hundred to one that the nurse would be supported in her misconduct by some member of the Board, whose protege she might be. On mentioning this to an ex-workhouse medical officer, he told me that on having occasion to represent the conduct of the resident midwife, who claimed and exercised the right to go out on every Sunday for several hours, leaving the wards wholly unattended on every such occasion except by pauper helps, the only action taken by the Board as a return for it, at the instance of the midwife's friend, was the adoption of a resolution that a return should be prepared and laid on the Board-room table, showing the occasions when the medical officer went out and the length of time he was out, &c., &c. Of course he found out that he had achieved worse than nothing by his effort to check this abuse. This circumstance occurred in one of the largest of our metropolitan workhouse infirmaries.
When first I entered on my duties at the Westminster Union the chaplain there was a very energetic little man named Duval. I do not remember his Christian name, for the reason that he was known and spoken of as Claude Duval, and for a long while I supposed him to possess no other. At last I discovered that the name had been given him in joke, and that he was in no way connected with the celebrated highwayman. He most assuredly did not convey the idea that he had any brigand blood in his veins. He was extremely attentive to his duties, and deserved and had gained the respect of all the inmates and officers.