The Lancet Reports on Country Workhouse Infirmaries, Walsall.

WALSALL WORKHOUSE, STAFFORDSHIRE.

THE town of Walsall presents every indication of great prosperity. Building operations are going on in all directions, and the inhabitants are well employed. The union comprises a population of over 60,000, and there is not usually a single able-bodied male inmate in the workhouse. This establishment is situate on the outskirts of the town. It has been erected thirty years, and is certified to contain 450 inmates. But in April last it was found to be so inconveniently overcrowded by 297 inmates, nearly half of whom were sick, that the inspector of the district reported the necessity for an extension, and a letter was received from the Poor-law Board urging the guardians to take the question into their serious consideration. This, however, has been a matter of considerable difficulty, and illustrates the unwise economy which is too often the characteristic of Poor-law administration. When the guardians built the workhouse, they might have purchased any quantity of land at £30 an acre, but, with the consent of the Poor-law Board, they only bought sufficient for the bare erection of the building. Some years afterwards the want of garden ground was felt, and the opportunity was desired of employing the inmates in out-door work. Negotiations were therefore entered into for the purchase of the adjoining field, but, as £200 an acre was then demanded, the opportunity was lost. The workhouse in the meantime has been surrounded by streets, and the guardians have just completed the purchase of a small piece of land, forty yards wide by sixty yards in depth, all they will ever get for the proposed extension, at the rate of £1000 an acre.

With this exception the Walsall workhouse has been favourably reported to the Poor-law Board for more than twenty years, and we have a curious and instructive example of the efficacy of such reports in the fact, that the tramp wards were reported bad and insufficient in the year 1847, and that they remain exactly in the same state now, no further complaints having at any time been made. The original complaint was indeed well founded. The male ward is a narrow barn-like building, only eight feet wide. Within it is something like a hound-kennel, though neither half so clean nor comfortable. It is paved with rough brick, and there is a small window for ventilation at the side. There are two wooden shelves across the end, one above the other; the lower is three feet, the other six feet from the ground, and on them the unfortunate vagrants are supposed to sleep, under cover of a dirty rug. The only accommodation is a filthy-looking iron bucket, sprinkled with carbolic acid, and enclosed by the present master in a wooden box. This ward, in the opinion of the medical officer, is fitted to contain seven inmates, but the average is much more, and on several occasions twenty-seven tramps have been locked in, without food or light, or any means of communication with the officers outside. Imagination cannot picture the fearful Pandemonium on such occasions, and we cannot trust ourselves to comment on the continuance of such a gross enormity for twenty years.

In the interval between these two reports we find no hint recorded of imperfection or complaint. When the yards were unpaved and the privies had stinking cesspits; when the sick were compelled to go to the receiving wards to get a bath, and were scattered about the house, far removed from their nurses; when the supply of linen barely sufficed to afford a pair of sheets for every bedstead, or a change for every inmate; when there was not a cupboard in the wards, and the general storeroom was not larger than a closet,-the state of the workhouse was still "reported satisfactory; inquiries made into the several wards elicited no complaint, and the wards, offices, and yards were always in proper order. Nevertheless, care seems to have been taken that the workhouse rules and dietary were rigidly enforced. No attention appears to have been directed to the fact that sickness and infirmity had completely occupied the place,-, of idleness, and that the workhouse, from having been the refuge of destitution and the lodging of vagabonds, had become an infirmary for sick almost from top to bottom. Notwithstanding the change of inmates, "the workhouse test" must be maintained, and no deviation from the rules or dietary was or is willingly permitted. Even the poor old women may not smuggle in a teapot to make themselves a quiet cap of tea; they must be contented with the workhouse slops, which if anyone desire to try, let him pour fourteen imperial pints of boiling . water on an ounce of tea at Is. 5d. per lb., add 5 oz. of moist sugar, and a little skim milk, and taste it if he can. But the local authorities have kindly hearts; they wink at the women's smuggled teapot, and give tobacco to the men; they have made the wards look cheerful; they have polished the floors and painted the walls; they have put matting between the beds and curtains to the windows, and, at the instigation chiefly of the master and the surgeon, they have attended to a variety of minor matters, which show that more still would have been done if only they had known how to do it. Well might the master be anxious to show us over the establishment, for there were abundant proofs that he had done his best, according to his knowledge and opportunity, to make the patients comfortable, and we believe no one was more surprised than he at the defects which were revealed. What avails it to put curtains to the windows if they are closed at top, and open only at the bottom, close to the patients' heads, subjecting them to continual drafts ? The comfort of a roomy bedstead and of a well filled bed is soon destroyed when bread and salt, spoons and spectacles, and a host of other things are put beneath the bolster, because there is no convenient place provided on which to put them. The cleanest sheets will soon become dirty if the patient cannot protect them when he takes his meals, or washes in a bucket. Throughout the entire establishment there is but a single washhand basin, and it was a mystery to the master how it came there. The bedridden, the fever-stricken, the venereal, the infected with itch, and the convalescent -nay, even the infants in the nursery, are washed in dirty-looking wooden buckets. Two towels a week are given to a ward of ten patients; and there are neither combs nor brushes given out to any throughout the house. So little are the essentials of cleanliness attended to that the male nurse has but a singe iron basin, which is used to wash all wounds alike, to. make poultices, and for every office for which a basin is required. The tidy appearance of the wards is equally superficial and deceptive. The male infirmary consists of seven wards, which are for the most part 17 ft. wide, and 9 ft. or 10 ft. high, with opposite windows. They look light and clean. But the beds are so close together that another could not anywhere be placed, and there is scarcely space to walk between them. There is, therefore, no room for lockers. The ventilation is throughout defective, and the waterclosets (where there are any) open directly upon the wards. They are universally small and badly ventilated, and stink abominably. The fever ward contains 3978 cubic feet, and has nine beds. It is, therefore, more than twice too crowded. The classification. is most extraordinary, and shows the unfitness and inadequacy of the building in the strongest light. In this fever ward there are several patients with venereal disease, and two box-beds filled with straw for the treatment of the itch. Moreover, all these patients use a water-closet in common with those of an adjoining general sick ward, with which there is direct and immediate communication.

There are no baths in connexion with these or any other sick wards; the patients who require a bath, and we suppose those with itch and venereal also, are compelled to descend to the one common to the men and children in the body of the house. No. 2 male ward is dark, ill-ventilated, and without a watercloset. A patent bedchair is provided, and chloride of lime is used. A new ward has just been made in the upper story by pulling down partitions and opening out the roof; it is the best in the establishment, but was the only one disfigured by dirty-looking rugs upon the beds.

The female infirmaries, though scrupulously clean and tidy-looking, are even worse than the male in all essential points. The wards are generally crammed to the full with beds, the ventilation is defective, and the waterclosets equally objectionable, and even more unclean. An acute case had just been admitted into No. 1 ward from the school. The presence of four epileptics would scarcely conduce to her quiet or recovery. As there are no special wards, the imbeciles are distributed amongst the sick and bedridden-a most improper arrangement, which cannot be too strongly condemned. Wards 4 and 5 are devoted to venereal disease. In all our experience we never saw patients in a more wretched state. There are two beds in each, and all occupied. There is neither fireplace nor ventilation-nor any furniture except the beds. The chamber utensils contained the lotion they were using, and the only commode was unclean. Nor were two fever patients in much better case. They had no fire, and nothing to look at but the four bare walls. One had some tea sent her from the matron's room, but it was placed upon the floor, there being nothing else within reach on which to put it. The patients are tended by a pauper nurse, who sleeps in the next room. There is no night nurse in the establishment, and the female paid nurse is at the present moment ill. The watercloset in the fever ward, as usual, opens directly to the ward, and was stopped up.

But the most objectionable feature of the female side is the conversion of sleeping rooms for the able-bodied into wards for the sick, without any attention to ventilation or the requirements of the sick. There are seventeen patients, many of whom are bedridden, who have no other accommodation than common night-commodes. It is but reasonable that wards should be fitted up as hospitals before they are used as such. The nursing is superintended by two paid nurses, male and female, who have apartments near the sick. They are assisted by paupers placed on extra diet. There are, on an average, 130 patients in the house; it is clear, therefore, that the staff is insufficient, and that much of the nursing must be left in pauper hands.

The medical officer's salary is £100 per annum. In addition to attendance, he finds all the medicines, a supply of which is kept in each nurse's room. All medicines are administered by the paid nurses; but although the names and diseases of the patients are placed on tickets at the bed-heads, there are no written prescriptions, and there was not a single male patient taking medicine specially provided for him. A series of mixtures and pills appear to be kept in store, and only verbal orders are given to the nurse for their administration. In so large an establishment this arrangement is obviously liable to miscarry, and fatal mistakes might easily occur. It is simply impossible for any nurse to remember, much less exactly carry out, the orders of the medical officer, unless they are given in writing; we therefore suggest that an immediate change be made. The guardians ought to find the medicines, and appoint a dispenser to make them up.

The food of the sick is cooked in the ordinary workhouse fashion, and is served up in dirty-looking tin basins such as bread is baked in. Surely, if the Poor-law Board would authorise its medical adviser to issue a system of diets for the sick, both medical officer and guardians would be glad to adopt it. A greater boon could not be conferred upon the patients than by giving them varied and comfortably served meals.

Before concluding, it is necessary to make a few observations on the condition of the children, a considerable number of whom are confined in a separate ward on account of skin disease. The schoolroom appeared to us close and overcrowded, and both playgrounds are reported by the surgeon damp and insufficient. The boys' bedroom is also overcrowded. As there is no garden, green vegetables are only exceptionally provided. These circumstances would seem to account for the obstinacy of skin complaints, and should be remedied at once. If this be impossible, let the guardians break up the school and distribute the children in the villages around on the Scotch plan. They would thus relieve their overcrowded house, and avoid the necessity of the proposed extension.

In conclusion, the Walsall Workhouse presents an example of cleanliness and order calculated to deceive a superficial observer. A closer inspection, however, reveals the absence of all essentials for the proper treatment of the sick. The wards are ill-furnished, overcrowded, and for the most part unfitted for their purpose. The ventilation is defective and ill-arranged. The stinking closets open upon the wards, many of which are not provided for at all. There are no baths, no day-rooms, and no airing-ground. There is a shameful deficiency of lavatories and washing apparatus. There is no classification of the patients, who are necessarily disturbed by imbeciles and epileptics. There are no night nurses, and not sufficient paid assistance to secure attention to so large a number, the master being overwhelmed with accounts and other duty. The surgeon is ill-paid, and the dispensing arrangements are unsatisfactory in the extreme. Indeed, we can only wonder that anyone could have visited the wards without discovering causes of complaint.

Walsall workhouse in construction is not so bad as Farnham, and its evils have been modified by a good master, a kindly medical officer, and a board of guardians who complain loudly that the Poor-law Board is but a drag about their necks. It is certain they have been allowed to slumber in utter ignorance of the defects we have exposed, and we have every hope that they will take immediate steps to remove them now that they are known.