I H;£r I T. i < ¦ I i i . REPORT ON THE CAPABILITIES OF THE METROPOLITAN WORKHOUSES FOR THE RECEPTION AND TREATMENT OF CHOLERA CASES. Ad r 3&vttmWa to fcotij feowtes of $arltamcnt b)j Commantf of %cv jfWajeatg. LONDON: PRINTED BY W. CLOWES AND SONS, STAMFORD STREET, FOR HER MAJESTY'S STATIONERY OFFICE. 1848. We 3 REPORT ON THE CAPABILITIES OF THE METROPOLITAN WORKHOUSES FOR THE RECEPTION AND TREATMENT OF CHOLERA CASES. George Nicholls, Esq., to tbe" ftight Hon. Sir G. Grey, Bart. Sir, ( Poor Law Board, January 26, 1848. I am directed by the Poor LawJ3oard to forward, for your information, the accompanying report of Dr. Arthur Fahse. Mr. Martin, and Mr. Toynbee, on the sanitary condition of the several workhouses iß^h^ioetiapcdk^fcf^^ made by them in conformity with instructions conveyed in Sir Denis Le Marchant's letter of the 26th November, 1847, a copy of which is prefixed to the Report, together with the letter addressed to the above-named three gentlemen by the late Poor Law Commissioners. I have, &c., The Rt. Hon. Sir George Grey, Bart. (Signed) George Nicholls. <$fc. fyc. . places. i each No. Height. Width. iSingle. Double Person. Ft. In. Ft. In. Ft. In. Ft. In. Ft. In. First Floor— (Children 586 14 690 2 12020 1 1 2 221 with Fever). 2 6 7 3 0 Ditto ditto 6 16 6 14 6 9 0 2 1 2 0 2 0 1 2 2 351 2 6 7 3 0 Ditto ditto 7 17 0 14 6 9 0 1 12 0 2 0 1 5 1 312 2 6 7 3 0 Second Floor— Men's Sick 11 16 6 14 6 8 0 2 2 4 0 4 0 1 5 .. 374 Ward. Ditto ditto 12 17 0 14 6 8 0 1 3 7 9 3 9 1 5 .. 393 4 0 4 0 4 0 16 Second Floor— Children's 13 17 0 13 0 8 0 1 3 53 28 1 5 1 196 Sick Ward. 8 and nurse. First Floor— Children's 45 24 0 11 0 6 6 1 4 2 9 2 7 1 7 ..132 Sick Ward. 4 0 2 9 11 boys 3 0 2 0 and 2 4 0 3 9 nurses. ¦Ground Floor— Chil- 58 48 6 18 0 7 9 1 8 3 8 3 0 1 15 3 327 dren's Sick Ward. Convalescent ward. There is also a convalescent ward for each sex. The great number of sick lately occupying Insufficient room this house rendered it necessary to place some of the children in a portion of the building so old for sick. an( j dilapidated as to have been condemned by the Guardians. The medical officer, however. stated that he was obliged to place them there, notwithstanding the order of the Board to the contrary. Water. Water is supplied by the East London Company. There are three water-tanks. There is also a well in the yard, which has lately been deepened in consequence of the increased sewerage in the neighbourhood. There is no fixed bath, but one portable for adults, and two for the children. No provision for No provision for cholera cases could be made or recommended in this house. Should cases cholera. occur among the inmates, which we think more likely to happen than in any house that we have visited, they would require to be removed to the other house in the Whitechapel-road. Suggestions. Suggestions. — This house appears to call for most extensive improvements — as far, at least, Sick wards very un- as regards the sick wards. These occupy a portion of two low buildings flanking one of the fit for the purpose yards ; the level of which is 3^ feet below that of the street ; while the fever ward, which is on to which applied. g rO und-floor, and paved with brick, is again 2 feet below this. These rooms are very old, Deficient ventila- badly constructed, low, and dark. They are mostly destitute of means for ventilation, and at 10n ' the same time give an average of only 288 cubic feet per person. In one ward the space Small cubic space. b e j n g re duced to 132 for each, without any means for insuring change of air to the inha- bitants. These rooms, however, are still superior to those which we have stated were recently Nuisances. obliged to be occupied, notwithstanding the orders to the contrary. Besides the faulty condi- tion of these rooms, the inhabitants are further subject to the injurious influences of two of the worst nuisances in the neighbourhood : — the one a factory for the desiccation of night-soil and bullocks' blood; the other a depository for soil and the sweepings of Smithfield and Bevis Marks. These have been often complained of as intolerable nuisances. We find, from the report of the medical officer, that gangrene and cancrum oris were very prevalent among Convalescent chil- the children, who were attacked by these diseases generally during convalescence from various dren die ofgaii- illnesses, notwithstanding every attention was paid to curative treatment; while the old are grene. reported to suffer from diarrhoea and dyspepsia. These effects are less observed when the wind blows from the north, the nuisances being situated on the south side of the house. We think these circumstances call for most serious consideration, both in regard to the construction of the wards now used for the sjck, and also in regard to the nuisances mentioned as adjacent to the house.* We would also advise attention to the drain in the yard, which passes directly to the sewer without a trap; and furl her, it may be well to inquire as to the source of the water, which, as we have stated, was found to fail, so that the well required deepening, in consequence of the increased sewerage. No. 6. ST. GILES'S WORKHOUSE Neighbourhood. I s situated in Broad-street, Bloomsbury ; the neighbourhood is very crowded, dirty, and badly sewered, and the house is wanting in external ventilation. Lascelles-court, upon which the * One of these nuisances, we are informed, has been since removed. for the RECEPTION and TREATMENT of CHOLERA CASES. 15 old infirmary abuts, is very dirty, and has no drains or sewers ; it is a source of disease to the inmates of the workhouse. The number of people the house is permitted to receive is 900 ; it contained 756 at the Number of inmates, time of the visit ; there are 90 sick in the wards. The sizes of the wards are as follows : — Sick war^s. The New Infirmary, 7 Wards. fur- j Cubic Windows. pa, v . , Wards. Length. Breadth. Eleight. Doors. ,^" 8 Beds. *ach No. Height. Width. Person. Ft. In. Ft. In. Ft. In. Ft. In. Ft. In. No. 41 . 43 2 20 8 13 8 2 6 7 2 4 0 2 18 682 No. 42 . 31 6 20 8 13 8 2 4 7 2 4 0 1 14 730 No. 43 . 42 10 20 4 14 9 2 6 7 2 4 0 2 18 730 No. 44 . 30 6 20 4 14 9 2 4 7 2 4 0 1 14 615 No. 45 . 42 6 20 0 14 8 2 6 6 0 4 0 2 15 838 No. 46 . 21 4 20 0 14 8 2 2 6 0 4 0 1 6 528 12 Children. No. 47 . 42 7 20 0 9 0 2 6 6 0 4 0 2 18 428 The Old Infirmary, 8 Wards. No. 48 . 25 3 18 0 12 4 1 5 4 0 3 3 1 18 313 No. 49 . 29 6 16 7 12 4 1 4 4 0 3 3 1 12 496 No. 50 . 17 10 19 3 12 0 1 4 5 0 3 0 1 8 270 14 Children. No. 51 . 29 0 17 6 12 0 1 6 5 0 3 0 1 11 553 No. 52 . 24 10 19 5 9 9 1 7 5 0 3 0 1 9 632 No. 53 . 28 9 17 5 9 9 1 7 5 0 3 0 1 11 430 No. 54 . 18 0 18 0 9 10 1 5 6 0 3 0 1 6 526 No. 55 . 27 9 17 0 9 - 10 1 6 6 0 3 0 1 14 313 In the wards of the new infirmary the average space to each person is 650 cubic feet ; the largest space is 838, the smallest 425. In the wards of the old infirmary the average space to each person is 441 cubic feet ; the Ventilation, largest space is 632, the smallest 270. The wards of the new infirmary are lofty and light. Circular plates are introduced in the floors for the admission of fresh air, but complaints of the cold they occasion induce the nurses to close them. There are openings in the ceiling for the egress of the foul air, but when the doors and windows are closed the cold air passes down through them. Arnott's valves were fixed in the chimneys at the time the building was erected. They are small, being the size intended for ordinary rooms. It appears that they were left closely screwed down by the builder, and they continued so until the present visit, although they were supposed to be in action. Upon being unscrewed they acted exceedingly well. In the old infirmary there are no means of ventilation except through the doors and windows ; the wards are dark, close, and offensive. In the new infirmary there is an ample supply of Water. water and water-closets. The cesspools were abolished six months since; in the yard are Cesspools, privies, through which water is constantly flowing. There are open dust-bins in the yard. There are no distinct wards for fever cases. There are two baths for the sick. There are two Medical officer, medical officers, and the medicines are supplied from the house dispensary. There is one Nurses. paid nurse, the others are paupers with a gratuity of 3s. or 4s. weekly. There is ample room here for cholera patients ; they should be placed in the new infirmary. Accommodation for Cases of cholera reported in 1832, 628; deaths, 280; recoveries, 348. cholera patients. Suggestions — The new wards should be supplied with warm air from the passages. Arnott's Suggestions. valves of a larger size should be introduced into the chimneys. The old infirmary should not be used so long as Lascelles-court remains in a filthy state. The wards require warming and ventilation. As the workhouse is much surrounded by houses at present, it is highly desirable that the west side, looking towards Endell-street, should not be built upon, as this is the only opening for the external ventilation of the infirmary. No. 7. LAMBETH WORKHOUSE Is situated in Princes-road, Lambeth. The neighbourhood is very crowded ; the houses of Neighbourhood, the poor are in a bad state, and the drainage and sewerage are reported to be in a very faulty condition; uncovered ditches abound. Within 200 yards of the house there is a dust-yard, Nuisances, where the entrails of pigs, &c., are left to decompose ; and about 150 yards distant are the premises of two bone-crushers, which give out noxious smells, and there is an open sewer about 200 yards from the house. The house consists of the main building fronting the street, having three floors, of a wing running back from the east end of the building, also consisting of three floors, and of some premises containing the lying-in and other wards situated behind the west end of the building. 16 REPORT on the CAPABILITIES of the METROPOLITAN WORKHOUSES These together enclose the yards, in which are the washhouse, men's foul ward, general workroom of women, fever wards, insane wards, &c. Number of inmates. The stated maximum number cf inmates allowed is 1100, the present number is 1014. The number of sick persons at the time of the visit was 157 ; the dimensions of the sick- wards are Sick wards. as follows : — „,. , Cubic Windows. f; F t Wards. Length. Width. Height. Doors. Beds. *™ No. Height. Width. Person Ft. In. Ft. In. Ft. In. Ft. In. Ft. In. 3rd Floor— Ward A. for Men 47 1 27 10 10 8 1 7 4 5 3 6 2 26 531 Men's Infectious Ward and 29 7 15 6 12 6 1 3 4 6 3 0 1 12 276 Outbuilding. 20 persons. 3rd Floor— Ward B. for 53 9 28 6 11 0 1 5 5 6 4 0 2 30 568 Women. Women's Infectious Ward— 29 1117698 2 27036 1 12 356 No l 14 patients. Ditto— No. 2 29 11 17 6 9 8 2 15 8 3 7 1 12 356 14 patients. Fever Ward— No. 1 ... 23 8 14 2 8 11 1 25437 1 7 407 Ditto— No. 2 9 1 7 11 7 0 1* 1 5 3 3 8 2 252 Ditto-No. 3 23 8 17 9 9 9 If 3 5 6 3 6 1 10 406 * Out of a Fever Ward. f From Fever Ward, No. 1. Ventilation. The large ward A. for the sick men is ventilated by means of large circular brass ventilators placed in the floor ; these are for the admission of fresh air ; but on account of the cold draughts which they produce, they are generally closed, and the medical officer states that they can only be used in warm weather, at which time they are objected to by the patients. At the time ofthe visit they were closed, and had been so for a long time. Upon careful examination it appeared that some of the foul air from the ward below would escape into this ward through these ventilators when open. For the escape of impure air there are four openings into the false roof, each 2 feet square ; from the false roof, however, there are no distinct apertures communicating with the outer air. These four openings were also closed, on account of the cold air pouring down through them upon the heads of the patients. When the door of the ward was open, the air passed freely upwards through these openings into the false ceilings, but directly it was closed the air descended. The air also entered the ward through a grated opening in the wall, which communicated with the open air by a shaft several feet in length ; into this shaft the gas-lights were ventilated, so that the products of combustion from them would be returned to the ward. This ward was very close, and as the water-closet which opens into it is unventilated, the effluvia is continually being drawn from it into the ward. The men's infectious ward is dark, dirty, and very close; it is a building having only a ground floor placed in the yard not far from the privies. There are three circular brass ventilators in the floor which are generally closed, and there are large openings into the false roof above ; these are also closed. There is no direct communication between the false roof and the outer air. The infectious wards for women are also dark, close, and unhealthy ; the only ventilators being small doors communicating directly with the open air, and which are closed. The large sick ward for women, B, is clean and light ; the ventilators below for the admission of air are closed, and there is no outlet for the bad air above. There are 30 women sleeping here at night without any means of changing the air. Thelever wards are placed at the top of a building apart from the house, the lower portion Fever wards. of which is occupied by the women's day-room and the insane wards ; the former of these rooms is very crowded and close, and the bad air which escapes from it whenever the door is opened, passes up stairs and renders the air in the staircase very offensive, and increases the unhealthiness of the fever wards. These fever wards are small and very badly ventilated ; Ventilation. there are openings in the walls communicating directly with the open air ; these are closed, and the openings into the false roof are not used. At the upper part of the wall of the fever ward next to the staircase is an opening through which the foul air escapes; this opening is directly opposite to one in the nursery, so that there is every reason to believe that the air from the fever ward frequently passes into the nursery. These fever wards have only lately been esta- Ventilating shaft. blished, and are used until the patients can be removed into the hospital. In a new part of the building for infirm men, a ventilating shaft commences at the upper part of the oakumpicking room, which is crowded and full of offensive air ; the shaft passes to the top of the building, and has openings into two wards which are not, guarded by valves. There is only one medical officer. There is one paid nurse to each ward, and two pauper Nurses. assistants. The medicines are supplied by the surgeon. The yards for exercise are much too small. Water is supplied every day to the top of the house by the Lambeth Water-works. Water. Water-closets. There is a water-closet to each of the large sick wards, but not any to the fever wards. There Cesspool. are two large privies which empty themselves into a trapped cesspool, the cost of removing the soil is 16/. yearly. The privies are in a neglected and offensive state. There are two moveable baths, two which are fixed, a vapour bath and a shower bath. Privies. Baths. Accommodation for The Board has not yet considered what it would be advisable to do on the visitation of the cholera patients. cholera. On the former occasion the house was not full, but in its present over-crowded state it is not advisable that cholera patients should be admitted. A separate establishment ought to be taken, but a suitable one has not been pointed out. for the RECEPTION and TREATMENT o/CHOLERA CASES. 17 During the former epidemic there were 565 cases of cholera in Lambeth parish ; there being 337 deaths and 228 recoveries. Suggestions. — In the large wards A. and B. the plans for ventilation and warming require Suggestions, to be changed ; the openings into rhe two wards from the oakum-room shaft should be trapped or closed. The cesspools and privies should be abolished and water-closets substituted. The foul wards should be made more cleanly, airy, and light. No. 8. ST. JAMES'S WORKHOUSE Is situated in Poland-street, Oxford-street ; it stands upon an acre and a half of ground, and Neighbourhood, is almost entirely surrounded by houses. There is a slaughter-house very near, which is Nuisances. - complained of on account of the unpleasant odours which frequently arise from it. The house forms a square, no part of which is open to the street ; a small portion of the men's infirmary 1 looks upon a court ; there is a want of external ventilation. The maximum number of inmates received is 700, the present number is 688. Number of inmates. The number of sick is 100 ; there are 66 in the sick wards, the dimensions of which are as Sick wards, follows : — Windows. p . Jgujrfe Wards. Length. Breadth. Height. Doors. V re " Beds. * eetto " ° places. each No. Height. Width. Person. Ft. In. Ft. In. Ft. In. Ft. In. Ft. In. No. 1 . 59 6 16 0 9 6 1 6 6 0 3 3 1 13 692 No. 2 . 59 6 16 0 9 6 1 6 6 0 3 0 1 14 642 No. 3 . 59 6 16 0 9 6 1 6 6 0 3 0 2 14 642 No. 4 . 55 6 24 6 10 6 1 3 8 0 6 0 1 13 1110 No. 5 . 57 4 18 6 10 6 1 2 8 0 6 0 1 12 916 I 1 The average space to each sick person is 802 cubic feet; the largest space being 1110 cubic feet, the smallest 642. The plans for ventilation consist of gratings which are fixed in the upper part of the rooms, Ventilation. and directly communicate with the open air. In cold weather these are always closed, also at night. The rooms are close. Fever patients are sent to the fever hospital. There is one medical officer for the house, who also attends the out-door poor. There are two nurses to each ward, both are paupers. Nurses. There are seven water-tanks, which are filled four times a-week. Water. The water-closets for the women are in good condition, but there are not any on the same Closets. floor with the men's sick wards. All the drains empty themselves into the sewer, with the exception of those from part of one Sewers, wing which pass into a cesspool, having an overflow pipe into the sewer. There is one large Cesspools, uncovered dust-bin, the contents of which are removed twice a-week. There does not appear to be room for the reception of cholera patients ; on the former Accommodation for visitation they were taken into the house and the wards were comparatively empty ; but unless cholera patients. the number of inmates is much diminished, no patients can be admitted. There does not appear to be any probability of separate wards being empty. Suggestions. — The wards require efficiently warming and ventilating. Water-closets should Suggestions, be fixed on the same floor with the men's sick wards. The cesspool should be abolished, and the dust-bin covered. No. 9. ST. MARGARET'S WORKHOUSE, DEAN-STREET, WESTMINSTER, Is situated in a very crowded district, the inhabitants of which are very poor and filthy ; in the Neighbourhood. course of two weeks 25 cases of fever were brought into the house from one room only. There are two slaughter-houses in the immediate neighbourhood, which are great nuisances when the wind blows from their direction. The house forms a square, three sides of which are not surrounded by buildings. The limit to the number of inmates is 600; the number at the time N um ber of inmates of the visit was 584. There are four wards for the sick in the house, and five of a temporary nature out of the house. There are 75 patients in the sick wards, the dimensions of which are g^ war( j s# as follows : — In the House. iKT- j Cubic Windows. v . F f . "Wards. Length. Breadth. Height. Doors. , Beds. * eel t0 No. Height. Width. Person. Ft. In. Ft. In. Ft. In. I Ft. In. Ft. In. No. 46 .. 30 0 18 0 10 6 1 3 6 0 3 4 1 12 472 No. 46a .. 30 0 18 0 10 6 1 3 6 0 3 4 1 13 436 No. 35 .. 39 0 18 0 9 3 1 3 6 0 3 4 1 15 433 No. 34 .. 39 0 18 0 9 3 1 3 6 0 3 4 1 15 433 D 18 REPORT on the CAPABILITIES of the METROPOLITAN WORKHOUSES In the Temporary Building in York Street. Windows. v . Jp u . bi . e i Wards. Length. Breadth. Height. Doors. . f^* Beds. *®* h No. Height. Width. Person. Ft. In. Ft. In. Ft. In. Ft. In. Ft. In. Ft. In. No. 1 ... 22 6 11 0 7 9 1 1 3420 1 5 383' No. 2. ..22 611079 I 1 342 0 1 5 383 A No. 3 ... 22 ft 11 0 7 9 1 1 3420 1 5 383' No. 4 ... 22 6 11 0 7 9 1 1 3420 1 5 383J A Room in the New Wai/, at present used as a Fever Ward. 27 610 18 0 10 6 2 .. 4 0 4 0 1 8 649 The average space for each sick person in the house is 443 cubic feet ; the largest space is 472 ; the smallest 433. Ventilation. The means for ventilation in the sick wards of the house consist of apertures communicating directly with the outer air, and situated at the upper part of the wall ; these are always closed ; there is also a fan-light over each door, which is often closed during the day, and always during the night. The wards are very close and unhealthy. They are warmed by open fire-places. Fever hospital. The building in York-street was formerly used as a cholera hospital, and has since received fever patients. It is an isolated building, and open ; the basement consists of a large coal- Ventilation, cellar, over which are two stories, accessible by an external flight of stairs. The rooms are very low, and have no means for ventilation ; they are warmed by a small fire-place in each. The room in the New Way was provided for the nightly lodging of male vagrants; but during the prevalence of fever it has been used as a fever ward for men. It has only one fire-place, is Medical officer. dark, and is not ventilated, excepting by means of the doors and windows. There is one medical Nurses. officer for the house, who also supplies medicines. There are two unpaid nurses to each ward. Privies. There are no cesspools, but the privies, ten in number, consist of seats placed over a receptacle from which there is an overflow pipe into the sewer ; some of them receive the water which passes from the washing room, but a deposit takes place, and they are dirty and unpleasant. There is an open dust-bin, which is emptied as soon as it is full. Water-closets. There are no water-closets to the sick wards. Accommodation On the former visitation of the cholera, the house in York-street was used as an hospital, for cholera patients, and it is proposed to retain it; so that, should the necessity arise, it can be again used for the same purpose. It requires efficiently warming and ventilating. The room in the New Way can also be used. Suggestions. Suggestions. — The sick wards ought to be warmed and ventilated thoroughly The privies should be abolished, and water-closets used in their place. Water-closets should be fixed near to the sick wards. The dust-bin should be covered. No. 10. ST. MARTIN'S WORKHOUSE Neighbourhood. Is situated in Castle-street, Leicester-square, at the back of the National Gallery. The neighbourhood is not very crowded. The house forms a square, three sides of which consist of four stories. In the centre are sick wards, recently erected outbuildings, and the airing courts. The means for the circulation of air among the buildings are very defective, although three sides of the house are open to the street. Number of inmates. The prescribed maximum number of inmates is 650 ; the number at the time of the visit Sidewards. was 646. The rooms for the sick are principally situated in the south wing; they are 10 in number, and contained, at the time of the visit, 72 inmates. Their dimensions are as follows : — Windows. F're- Beds. p " .' - Wards. Length. Breadth. Height. Doors. place's. . each° No. Height. Width. Single. Double. Bed. Ft. In. Ft. In. Ft. In. Ft. In. Ft. In. A. ... 23 0 12 1 8 7 1 25039 1 5 .. 469 B. ... 23 0 12 1 8 7 2 15039 1 4 .. 586 C. ... 40 2 23 0 8 7 2 85039 1 16 .. 657 D. ... 29 9 23 0 8 7 2 65039 1 12 .. 478 E. ... 23 0 12 1 8 7 2 25039 1 4 .. 586 F. ... 23 0 12 1 8 7 1 25039 1 5 i 33j G. ... 23 0 11 6 8 7 2 15039.. 4 .. 561 H. ... 30 2 23 0 8 7 2 65039 1 13 .. 490 K. ... 23 0 11 6 8 7 i 25039 1 5 .. 469 L. ... 32 6 12 8 12 0 1 36639 1 10 .. 691 The average space for each sick person is 532 cubic feet; the largest is 691, the smallest 335. for the RECEPTION and TREATMENT o/CHOLERA CASES. 10 In each of the upper wards there is an opening two feet square, which communicates with Ventilation, the outer air through the false roof; but as there are no provisions for the ingress of air, there is a down current through the apertures, unless the doors and windows are open. In the ground-floor of the main building there are no plans for ventilation. In the new wards, which have lately been erected in the yard, there are openings communicating with the false roof, in the top of which a cowl is placed ; but the inmates find that the cold air comes down in large quantities. There are no wards for the convalescent ; they generally go to the infirm wards, of which there are 18. There are no provisions for fever patients; they are sent to the fever hospital. There is one medical officer, who supplies the medicines himself. There are three nurses to Medical officer, each ward ; not any of them are paid. The yards for exercise are too small. The water is Nurses. supplied to 10 cisterns from the main, which are filled four times a-week. There are two Water fixed baths, and one which is moveable. There are 1 1 water-closets to the sick wards. There \y a t e r-closets and are 14 privies on the ground-floor; there is also a cesspool, from which there is no overflow privies. pipe into the sewer ; this cesspool has not been emptied for 10 years, and is close to the house Cesspool. wards. There is a large open dust-bin in the airing yard, which is emptied once a-week. Additional wards, capable of holding between 30 and 40 patients, have lately been erected Accommodation in the square of the building; if these are ventilated, and properly warmed, they can be made for cholera patients use of for cholera patients requiring admission. Suggestions. — The sick wards require ventilating and warming ; the cesspool and privies Suggestions, should be abolished, and the dust-bin covered. It is desirable that no further buildings be erected in the square, as the yards are now much too small, and the air is too much excluded by the high buildings all around. No. 11. BERMONDSEY WORKHOUSE Is situated in Russell-street, Bermondsey ; the ground on which it stands was formerly a tan- Neighbourhood, yard ; there is a bed of peat about 10 feet in depth, below which is the clay. The neighbourhood is very crowded and badly drained, and a great number of sick people are brought into the house from it. The house consists of buildings, which form a square ; the front of it faces Russell-street ; it Nuisances. is surrounded by tanners' yards. Abutting on the back of the premises is a yard, containing the refuse-matter of fellmongers and tanners; the liquid refuse is very offensive. An open sewer, 12 feet wide, runs along the western side of the building, and washes the walls of that part of the house which is occupied by the infirmary. This open sewer receives the contents of several privies, and some of the water-closets of the house empty themselves into it. There are two manufactories near; one for hats, a second for vinegar; the smoke from both is very offensive. The prescribed maximum number of inmates is 845; the present number is 668. Number ofinmates There are six wards for the sick, situated in the fourth floor of the western wing ; they have Sick wards, the following dimensions :—: — W a Cubic Wards. Length. Breadth. Height. Doors. !!!!!___ J^ Beds. F^° No. Height. Width. Person. Ft. In. Ft. In. Ft. In. Ft. In. Ft. In. No. 23 .. 45 9 20 6 7 11 4 7 3 5 3 5 1 14 536 No. 24 .. 15 9 20 6 7 11 2 5 3 5 3 5 1 6 430 No. 25 . . 19 6 9 6 7 11 1 2 3 5 3 5 1 4 185 8 children. No. 21 .. 30 6 20 6 7 11 2 7 3 5 3 5 1 lv 451 1 1 people. No. 20 . . 27 6 20 6 7 11 1 5 3 5 3 5 1 11 376 12 people. No. 29 .. 25 0 22 6 10 0 2 3 3 5 3 5 1 8 562 10 people. The average space for each sick person is 423 cubic feet, the largest space being 562 ; the smallest space for adults is 376, and for children 185. Some fever patients are received into these wards ; others are sent to the fever hospital. These sick wards have gratings near the Ventilation, floor, a foot square, through which air is directly admitted from without. In ward No. 23 there are eight of these gratings ; but in this and other wards they are always closed at night, and generally during the day. The gas burns at night without the use of a ventilating tube. The wards are very close. The yards for exercise are much too small ; one measures Exercise yards. only 60 feet long and 45 broad. There are not any convalescent wards. One medical officer Medical officr. attends the whole of the house; he supplies the medicines. There are two paid nurses to each Nurses. ward. The supply of water is from the Southwark Water Works; it is supplied from the main Water. into two large tanks in the yard every day ; it is pumped by the inmates from these tanks into 20 cisterns, situated in different parts of the house. There are two baths in the infirmary, but Baths. neither of them has a supply of hot water ; the patients are carried down stairs to those which are used for the general inmates. There are two slipper baths. There are four privies, all of Privies. which are in a bad state ; they are situated near the house. They are constructed so as to allow of a deposit of a foot and a half in depth ; there is an overflow pipe into the sewer ; but frequent stoppages occur, and accumulations of soil take place. The gas which escapes from these D 2 20 REPORT on the CAPABILITIES of the METROPOLITAN WORKHOUSES privies is very noxious, and blackens the paint upon the doors. There are two covered dust- bins, the contents of which are removed twice a-week. Burials take place twice a-week. Accommodation for During the last visitation of the cholera patients were admitted into the house ; this could cholera patients. not be accomplished now, as the only part of the house in which there is vacant room is in the wing appropriated to the children. The Board proposes to take a house for cholera patients, and to increase the number of out-door medical attendants. Cases of cholera reported in 1832, 516 ; deaths, 210; recoveries, 306. Suggestions. Suggestions. — The wards require efficiently warming and ventilating. The privies should be abolished, and water-closets introduced in their place. The open ditch ought to be covered over. Warm water should be supplied to the baths for the sick rooms. It appears desirable that the children should be sent into the country, and the wing of the house which is now devoted to them should be used for the accommodation of the general inmates. No. 12. ST. MARYLEBONE WORKHOUSE Is situated in the New-road, at the corner of Northumberland-street. There is a large burial.Neighbourhood. ground at the back of the house, and York-court, which is in the immediate neighbourhood, is very crowded, and often infected with fever. The house consists of a compact mass of buildings, enclosing quadrangular spaces. The stated maximum number of inmates is 2200; the average number is 1900. Number of inmates. There are 16 wards for the sick the dimensions of which are as follows :— Sick wards. Windows. r . JF" bic Wards. Length. Breadth. Height. Doors. f ire " Beds. Feet lto l t0 to j places. each No. Height. Width. Person. For Men:— Ft. In. Ft. In. Ft. In. Ft. In. Ft. In. No. 1 ... 27 0 18 0 12 6 1 38050 1 11 552 No. 2 ... 27 0 18 0 12 6 1 2 8060 1 11 552 No. 3 ... 27 6 18 0 14 0 1 38050 1 10 693 No. 4 ... 27 6 18 0 14 0 1 38050 1 10 693 No. 5 ... 20 0 18 0 14 0 1 28050 1 8 C3O No. 6 ... 42 0 18 0 14 0 2 58050 2 18 588 No. 7 ... 27 0 18 0 14 0 .. 3 8050 1 10 693 No. 8 ... 36 0 18 0 14 0 .. 4 8050 1 14 648 For W r omen : — No. 1 ... 44 0 18 9 13 9 .. 3 8050 1 13 876 No. 2 ... 38 9 26 6 13 9 .. 4 8050 1 15 870 No. 3 ... 52 0 26 6 13 9 .. 5 8050 2 22 861 No. 4 ... 25 0 21 0 15 0 .. 2 8050 1 ]0 787 No. 5 ... 48 0 26 6 13 9 .. 5 8050 1 17 991 For Children :— No. 1 ... 36 0 18 0 8 3 .. 4 6090 1 14 382 No. 2 ... 16 0 14 0 8 3 .. 2 5090 1 4 462 No. 3 ... 19 6 18 0 8 3 .. 2 .. .. 1 11 271 The average space for each adult is 725 cubic feet; the largest space is 991 > the smallest is 552. The average space to each child is 370 cubic feet ; the largest space is 462, the sitiallest is 271. The plans for ventilation consist of gratings at the upper part of the rooms, about, 2 feet in length, and 10 inches deep; they are for the ingress as well as the egress of air. When the Ventilation. doors and windows are closed, air enters into the wards through these gratings, and in the low wards the cold air is much objected to. In the wards, which are lofty, the air is diffused somewhat in its descent, and is therefore not so much complained of. Arnott's valves are introduced into five of the sick wards ; in two of them, which are situated at the top of the house, they answer exceedingly well ; in three of the wards, from want of a due supply of fresh air, and from the large size of the chimney, smoke enters by them sometimes whpn the fire is first lit ; they have therefore been closed. Fever patients are taken into the general infirmary wards. There are two honorary physicians to the infirmary, and an honorary surgeon, one resident Medical officers. physician for the infirmary, and one resident surgeon of the house. There are paid nurses ; also night nurses and assistants. The medicines are supplied by the parish, and there are Nurses. three dispensers. The water is supplied by the Grand Junction Company to numerous tanks upon the roofs of Water. the building ; there are also springs, from which water is pumped. There are six baths. There are 40 water-closets and privies, all of which are well supplied with water. There are six cesspools, which receive the surface water only. In the present state of the house no cholera cases could be admitted, but there are wards Accommodation for suitable for the reception of patients, which might be emptied by removing some of the sick cholera patients. from the infirmary to the house, and by sending out some of the general inmates upon out- door relief; either this plan must be adopted, or out-door provision made. The number of cases of cholera reported in this district in 1832 was 516; deaths, 224; recoveries, 292. for the RECEPTION and TREATMENT of CHOLERA CASES. 21 Suggestions. — A better system of ventilation and warming is required. Arnott's valves Suggestions. might be made to act by trilling alterations in the fire-places. In those wards where gas is burnt, the products of combustion should be carried directly away by ventilating tubes. The cesspools should be abolished. No. 13. RATCLIFFE WORKHOUSE, OF THE STEPNEY UNION, Situated in York-street, West Ratcliff, is for infirm men and women above 60 years of age. Situation. It stands upon a gravel soil, and consists of a main building, having three stories, which fronts the street, and of lower buildings, which form together three parts of a square. The house is not in a confined situation, and the neighbourhood is not crowded. A chemical factory at a Neighbourhood very short distance gives out large quantities of gas, having an unpleasant odour, which is Nuisances. sometimes a great nuisance. The prescribed maximum number of inmates is 272, the present Number of inmates number is 270. There are 8 wards for the sick, 6of them are placed in the main building, Sick wards. and 2in a low building apart from the house. The number of sick at the time of the visit was 114 ; the dimensions of the wards are as follows: — Windows. „ p Cu^ c v Cu^ c Wards. Length. Breadth. Height. Doors. Fire " Beds. Feet , to Feet , to 6 ° — places. each each No. Height. Width. Bed. Person. Women's Ward. Ft. In. Ft. In. Ft. In. Ft. In. Ft. In. No. 2 ... 28 0 18 8 10 3 1 35736 1 10 549 366 1 5 persons. No. 3 ... 40 2 17 8 10 3 1 85736 1 15 485 368 20 persons. No. 5 ... 29 6 19 8 8 11 1 38036 1 9 555 331 15 persons. No. 6 ... 40 6 18 0 8 11 1 10 5 7 3 6 1 16 406 295 22 persons. No. 7 ... 32 6 16 8 8 11 1 44836 1 13 373 285 17 persons. No. 8 ... 41 3 10 0 8 11 1 10 4 8 3 6 1 13 509 473 14 persons. Men's Wabd. No. 1 ... 38 10 22 0 8 6 1 27228 1 16 454 454 No. 2 ... 31 0 12 7 8 5 1 2 7 4 3 4£ 1 8 410 410 The average space to each sick bed is 462 cubic feet ; the largest space is 509, the lowest 373. But as there are 127 persons occupying 100 beds, the average space to each person will be only 365 cubic feet. The 6 wards for the women are situated in the main building, and do not possess any means for ventilation ; although there are plenty of windows the rooms Ventilation. are close, and having only one fire-place in each room, the patients complain of cold. The men's sick ward, No. 1, is situated under the men's general dormitory ; it is low and exceedingly close, the door does not open into a passage or the outer air, but directly into the men's workroom. The men's sick ward, No. 2, is situated directly over the men's workroom, from which it is entered by a staircase through which the foul air from the workroom is continually entering the sick ward. There are four openings through the false roof of this ward, but they are kept constantly closed on account of the descent of cold air which takes place when they are open. Whenever a window was opened the warm air was, however, found to pass up quickly through the apertures. There are no convalescent wards, there are two pauper nurses to each ward, the medical officer complains of want of due attention on their part to the sick. Water Water supply. is supplied by the East London Water Company to a tank over the washhouse ; none is laid on up-stairs, where it has to be carried; there is one fixed bath and two slipper baths. Baths. There are two double privies, but no water-closets ; there are two portable closets to each ward. Privies. There are two cesspools which have no opening into the sewer, there is a large sewer passing Cesspools. the gate, but it is not made use of; the surface water of the yard and the slops drain into a sewer. There is an open dust-bin for solid refuse. There is not room here for cholera patients, but as there is accommodation at the Mile End Accommodation for Old Town workhouse for 54 fever patients, it is probable that in point of space that establish- cholera patients, ment would be sufficient for the whole Union. It appears desirable, however, that a house more centrally situated should also be provided. Suggestions. — The cesspools should be filled up, the privies abolished, and water-closets Suggestions. established. The two men's sick wards are not well adapted for the reception of invalids ; the men's workroom into which they both open should not be occupied, a stove might be placed in it to warm the air which should be abundantly supplied to the sick wards; the sick wards for women in the main building require warming and ventilating thoroughly. 22 REPORT on the CAPABILITIES of the METROPOLITAN WORKHOUSES No. 14. MILE END OLD TOWN WORKHOUSE, OF THE STEPNEY UNION, Situation. Situated in Globe Fields, Mile End, is for the reception of able-bodied men, and of the fever patients in the Stepney Union. It stands on a gravel soil; the house consists of a building, Neighbourhood. having two floors, running from east to west, and facing a large open space called Globe Fields; on the opposite side of the house is a yard, at the bottom of which are the oakum-picking sheds, and at the back of these again is a burial-ground belonging to the Jews, which has been closed Number of inmates. 25 years. The stated maximum number of inmates is 251, the present number is 224. To the west of the house, and separated from it by the laundry and other offices, is the building Hospital. containing fever and infirmary wards ; it is open to the east and west, and consists of a ground ai-d first floor, the ground floor is devoted to the infirm and to the convalescent, and on the first floor are the fever wards, which communicate with those below by means of a wellstaircase, through which they receive the foul air. The sick wards contained 86 patients; their dimensions are as follows :—: — Cubic Wards. Length. Height. Width. Doors. Windows J"*~ a Beds. F^ch° Person. Ft. In. Ft. In. Ft. In. Women's Fever Ward . 30 10 6 2 13 3 .. .. .. 12 281 Men's Sick Ward— No. 1 38 0 7 11 16 5 .. .. .. 13 373 Men's Sick Ward— No. 2 . . . . . . . . . . . . 7 283 Foul Ward— No. 1 .. 25 6 7 0 14 8 . . . . ? 7 375 Foul Ward— No. 2 .. 17 10 5 10 14 10 .. .. .. 7 213 Sick Ward— No. 3 . . . . . . . . . . . . . . 7 283 General Infirmary .. 18 6 7 9 16 11 .. .. .. 15 162 Men's Fever Ward . . 38 0 16 5 7 11 .. .. .. 15 345 Ventilation. The means for ventilation in the sick wards are apertures measuring 3 and 4 inches by 4, placed in the chimney close to the ceiling : these are much too small; there is also a tube over the gas-lights in two rooms ; they were placed there at the recommendation of the medical officer; these tubes are too large, and in one of them there is a back current from the chimney into the room ; there are also circular brass ventilators for the admission of air, but these are generally closed. The fever wards are low and close ; although at the time of the visit there were only 12 inmates in the women's fever ward ; a short time previously there had been 20, each person having only a space of 169 cubic feet. Cesspools. The places for exercise are too small. There are four cesspools receiving the contents of eight privies, each of these cesspools has an overflow pipe into the sewer, in one of them is a Privies. deposit of soil 14 feet in depth. One of these cesspools, with its privies, is close to the fever wards, and the odours arising from it are very noxious ; the medical officer complains of them as being a great nuisance. There are no water-closets, and the sick have to make use of the Water supply. night-stool. The water is supplied by the East London Water Company. There are three Nurses paid nurses for the fever wards; sometimes there are four: the paid nurses are taken from the Nurses. paupers, and receive only Si. yearly ; there is a pauper assistant to each ward. Accommodation for This establishment would only be available for the surrounding district, and as the other cholera patients. three houses in this Union are so full as not to be able to take in cholera patients, it appears desirable that a house should be taken between Wapping and Ratcliffe, but a suitable place has not been pointed out. Suggestions. Suggestions. — The rooms require properly ventilating. The dust-bin should be covered, the cesspools and privies abolished, and water-closets substituted for them. Water should be laid on in the house, and baths established having an abundant supply of warm and cold water. Arrangements must be made to prevent the foul air escaping from the wards below into those above. Note on the Four Houses of the Stepney Union. — It is quite apparent that the four work- Note. houses in this Union do not provide the amount of accommodation required ; some of the sick wards in RatclifFe, Wapping, and Mile End are wholly unfit for the purpose to which they are devoted. The children should be removed from Limehouse into the country, and part of the house now occupied by them might be used as an infirmary. Cases of cholera reported in 1832 in the Stepney Union, 487 ; deaths, 225; recoveries, 262. No. 15. LIMEHOUSE WORKHOUSE, OF THE STEPNEY UNION, Neighbourhood. For children only, is situated in Church-lane, Limehouse. It is on a gravel soil, and the Number of inmates, buildings around are very crowded. The prescribed number of inmates is 400, but there are 411 in the house at present. There are 5 wards for the sick, the number of whom at the time of the visit was 53. Sick wards. Cubic Feet Wards. Length. Width. Height. Doors. Windows. Fire-places. Beds. to each Person. Ft. In. Ft. In. Ft. In No.l .. •• .. •• •• 8 296 No. 2 ... . • • • • • • • • • • • 20 334 No. 3 •• •• .. •• •• 10 330 No. 4 ... . . . • • • • . • • • • 4 557 Foul Ward . . . . . • • • • . • . • • 16 people. 392 for the RECEPTION and TREATMENT of CHOLERA CASES. 23 The wards 1, 2, 3, and 4 are in the main building which looks towards the street, they are clean and light, but ventilated only by an aperture measuring 8 inches by 4 over each door, with seven 1-inch orifices at the lower part for the admission of air, and there are openings of the same size as those over the door into each of the chimneys. The cold air passes into the Ventilation, rooms through the openings over the doors, which are therefore often filled up with clothes, when the rooms become very close ; the foul ward, in a separate building in the yard, is crowded and close ; there are four brass ventilators at the upper part of the room, but they are closed. Water is supplied from the main by the East London Water Works, which fills a Water supply, tank from which water is carried into the house ; each child takes a bath every week. There are no water-closets, the only accommodation being four privies, which are cleared out twice Privies, a-vear ; the privies are wet and very dirty and offensive. There is no room for cholera patients here, they should be sent to Mile End workhouse, or Accommodation for . , , ii , i r i.v cholera patients, a separate house should be engaged for the purpose. r The number of cases of cholera reported in 1832, was 188; deaths, 83 ; recoveries, 105. Suggestions— -The privies should all be abolished. Water ought to be laid on to the house, Suggestions, and closets established. The rooms all require ventilating. No. 16. WAPPING WORKHOUSE, OF THE STEPNEY UNION, Is devoted to the able-bodied and infirm women. It is situated near Wapping Church. The Neighbourhood, neighbourhood is very crowded, abutting upon the court-yard. About a dozen yards from the house is the dead-house in Stepney Churchyard, in which are deposited the bodies of persons found dead in the river, and which are awaiting the coroner's inquest. Here bodies sometimes give off" so bad an odour, that the mistress of the house is obliged to throw a solution of chloride of lime over the yard; this nuisance is especially felt in warm weather. Few burials take place now in the graveyard of the church, but about 30 yards distant, there is another burialground, in which great numbers are buried. The house is open on two sides, and consists of a main building having three stories, and of some premises separated from the house by a yard. These consist of the oakum-picking room, nursery, and the foul and insane wards. The stated maximum number of inmates is 386, the present number is 418. There are 7 sick rooms, Number of inmates, having the following dimensions :—: — Sick wards. F - Cubic Feet Wards. Length. Width. Height. Doors. Windows. , Beds. to each 1 Person. Ft. In. Ft. In. Ft, In. Sick Ward— No. 1 . . 30 0 21 0 10 6 1 8 2 12 673 Sick Ward— No. 2 .. 17 0 15 0 11 0 I 2 1 4 701 Sick Nursery .... 18 0 14 0 12 0 1 2 1 4 748 Foul Ward— No. 1 .. 40 0 12 0 8 0 1 4 1 13 294 Foul Ward— No. 2 .. 48 0 12 0 6 6 1 4 1 10 622 Foul Ward— No. 3 . . 30 0 12 0 8 0 1 2 1 7 297 Foul Ward— No. 4 30 0 12 0 6 6 1 2 1 8 260 11 persons. Ward, No, 1, is situated in the main building; it is large, clean, and light, but with the ex- Ventilation, ception of ventilating panes in the windows, which are usually closed, there are no means of ventilation. Ward, No. 2, also situated in the main building, is much more airy, on account of a constant communication which exists between it and the staircase, which latter is so laro-e, that the cold draughts are not complained of. The foul wards and those for the insane are in low buildings unfit either for ordinary dormitories or for the sick. The rooms are low, dark, and close ; there are no means of ventilation. The privies of the neighbouring houses frequently overflow, and make the walls of this building filthy and noxious. There are three cess- Cesspools, pools which receive the contents of the privies, from these cesspools are overflow pipes into the Privies, sewer ; other privies open directly into the sewer, having a few inches of deposit. The pans fixed over this deposit are very filthy, being washed only by water poured down now and Water, then. Though water is abundant here, being pumped by the inmates from wells into cisterns at the top of the house, no water-closets are in use, these having been discarded on account of Water-closets, their frequent derangement. Those formerly in use had the bell-trap. Night-stools are therefore now made use of. There are two slipper-baths for the women, and one for the children ; Baths, whenever a bath is taken, the warm water is carried up-stairs from the coppers. The exercise ground is used for drying clothes. Gas-lights are used in the wards without ventilating tubes. There is no room for cholera patients here. It is proposed to increase the out-door medical Accommodation for attendance, and to send those patients who cannot be attended at their own homes to the hos- cholera patients, pital at Mile End Old Town, which is now devoted to the sick of the Stepney Union. It appears necessary to have a second house more centrally placed. Suggestions. — The wards in the main building require to be warmed and ventilated; tubes Suggestions, should be placed over the gas-lights. The water-closets should be put in proper order, the pan of Doulton and Watt, or Austin's closet might be introduced, as they are found to answer in other houses. Baths ought to be placed on a level with the sick wards, and supplied with warm water. Another building ought to be provided for the inmates of the foul and insane wards. Cesspools and privies should be abolished, and closets fixed in their place. Some arrangement should be made to abolish the privies in the adjoining houses. 24 REPORT on the CAPABILITIES of the METROPOLITAN WORKHOUSES No. 17. THE WORKHOUSE OF ST. MARY, NEWINGTON, Neighbourhood. ' I s situated in the Walworth-road, it is open at the back, and stands on a sandy soil; it is in the immediate neighbourhood of an immense number of small houses, which are badly drained, and densely populated ; they are a continual source of fever. The ditch which receives the drainings from these houses is uncovered, and 1500 feet in length. On the premises of the workhouse there is an uncovered sewer, 180 feet long, and a continuation of it beyond these premises runs between 300 and 400 feet in the same state. Number of inmates. The prescribed Sick wards. The wards for 1 The prescribed maximum number of inmates is 320 ; at present there are 310. The wards for the sick are situated in a separate building of a recent date. These are four in number ; their dimensions are as follows :—: — Windows. ?. Jpubic Wards. Length. Breadth. Height. Doors. {^ Beds. JJgh* No. Height. Width. Person. Ft. In. Ft. In. Ft. In. Mary's Ward ... 38 0 15 0 9 6 1 75430 1 13 413 14 people. Dorcas's Ward .. 58 0 15 0 9 6 1 6 5 0 4 3 1 18 454 Men's Casual Ward . 47 0 15 6 'J 6 1 8 6 4 4 0 1 13 531 Men's Sick Ward . 45 0 15 6 9 6 1 8 4 6 4 4 1 11 604 The average space to each sick person is 500 cubic feet ; the largest space is 604, the smallest 413. The means of ventilation in Mary and Dorcas wards consist of openings into the false roof a foot square, for the escape of the foul air ; these were either partially or entirely closed. For the ingress of air, there are air bricks which were closed, and a hopper over the door 3 feet long, and Ventilation. half a foot deep, which is also closed at night, and frequently during the day. Gas burns in the sick rooms at night without ventilating tubes. In the men's sick ward there were no means for ventilation, and in these wards, as well as in the ward for convalescents, giving a space of only 225 cubic feet to each inmate, the fire-place was closed up. No plans for ventilation Medical officer. were adopted, and the air was most, offensive. There is one medical 1 officer for the house, the medicines are supplied from the workhouse dispensary, where the prescriptions of the out-door Water. medical officers are also dispensed. The water is supplied from the Lambeth Waterworks, to a large tank, which is filled daily. Water-closets. There are six water-closets with the bell-shaped trap ; the pipes from which pass into a cesspool. Cesspools. There are three cesspools — one very large ; one is in the wood-yard ; a second is near to the convalescent yard ; and the third is near to the sick ward : each of them has an overflow pipe into the sewer. Offensive smells are complained of. Nuisances. The dust-bin is not covered ; it is emptied once a- week ; in the yard, at the end of the infirm yard, is a large iron vessel full of hogs wash, also a deposit of bones. Baths. There is one large moveable bath and a slipper-bath. There are two unpaid nurses to each ward. Accommodation for Durino- the former visitation of the cholera, a separate house was taken, and should the house cholera patients. remain as full as it is at present, a similar course must be resorted to. Cases of cholera reported in 1842, 476; deaths, 200; recoveries, 276*. Suggestions. Suggestions. — The wards should be ventilated, the cesspools privies should be abolished, the ditch should be covered over, the liquid refuse removed daily, and the dust-bin covered over. No. 18. BETHNAL GREEN UNION-HOUSE Situation. Is situated in Bonner's Hall Fields, near to Victoria Park. The neighbourhood is not crowded. It stands in an open space upon a gravel soil, and is well drained. It has been recently erected. Number of inmates. The stated maximum number of inmates is 1014, but there are 1200 at present. The infirmary Sick wards. * s a detached building, having 8 rooms, and containing 92 beds. The dimensions of the wards are as follows : — Windows. m w Cl f. c Wards. Length. Breadth. Height. Doors. ,^" Beds. No. Height. Width. Person; Ft. In. Ft. In. Ft. In. Ft. In. Ft. In. No. 1 36 0 18 0 10 10 1 3 7 7 3 4 1 16 445 No. 2 36 0 18 0 13 9 1 3 6 2 3 4 1 16 556 No. 3 36 0 18 0 10 10 1 3 7 7 3 4 1 16 445 No. 4 36 0 18 0 13 9 1 3 6 2 3 4 1 16 556 Foul Ward— No. 5 . 19 3 18 0 10 3 1 2 7 0 3 4 1 7 506 Fever Ward— No. 6 . 19 3 18 0 11 3 1 2 4 11 3 4 1 7 556 Foul Ward— No. 7 . 20 0 18 0 10 3 2 1 7 0 3 4 1 7 527 Fever Ward— No. 8 . 20 0 18 0 11 3 1 2 4 11 3 4 1 7 578 for the RECEPTION and TREATMENT of CHOLERA CASES. 25 The average space for each sick person is 521 cubic feet; the largest is 578, and the lowest 445. Although the infirmary forms a detached building, has been only recently erected, and Ventilation, has lofty wards, the latter are so badly ventilated as to be extremely close. The means for ventilation consist of a circular brass gratinc" in the floor for the admission of fresh o © air, and an orifice in the ceiling one foot square, faced with perforated zinc, for the egress of the foul air. Immediately above this orifice in the ceiling is the circular grating in the floor of the room above, so that the foul air which rises from the lower ward, ascends directly into the one above, mixed with the fresh air, which passes between the rafters from without. In some wards the orifices in the perforated zinc have become so filled with dust that no air can pass through them ; in one foul ward, the perforated zinc had been removed from the ceiling, so that there was a direct and free communication between it and the fever ward above, so that the fever ward was constantly receiving the air from the foul ward. In the upper wards the vitiated air passes into the false roof, but there is no aperture for its escape into the outer air. There are not any convalescent wards. There is one paid nurse for the infirmary ; all the other nurses are paupers. The water is supplied from an artesian well, from which it is pumped to Water supply. all parts of the building. There are 1 1 privies, which are washed down at certain periods ; Privies. they consist of seats placed over a reservoir, which has an overflow pipe into the sewer; there is always a deposit of soil a foot or two in depth; these privies frequently require to be opened, in order to remove accumulations from the overflow pipe. On the occasion of the former visitation of cholera, a detached house was engaged for Accommodation for patients, but the Board are now of opinion that, should the cholera appear before the present cnolera patients. number of inmates is diminishsd, they would send out some of the able-bodied paupers upon out-door relief, in order to make room for cholera patients in the house. The Board also propose to increase the number of out-door medical attendants. Cases of cholera reported in 1832, 304; deaths, 170; recoveries, 134. Suggestions. — The infirmary requires efficiently ventilating. Suggestions. The privies should be altered. No. 19. ST. LUKE, MIDDLESEX, UNION WORKHOUSE, In the City-road. The situation of this house is excellent. It has the advantage of being Situation, placed upon an elevation in the centre of the ground on which it stands; having a large gravel yard in front, and at. the back large exercising-yards and airing-grounds. Open ground. The infirmary, which also contains two of the sick wards, is detached from the house to the Infirmary, west, as is also the building containing the fever wards on the east. The limit of this house Number of inmates is 654, but on the day of our visit it contained 684. The following are the particulars of the sick wards :—: — Sick wards. In the Infirmary. Windows. Fire Cubic Feet Name of Ward. Length. Breadth. Height. Doors.— . places . Beds. Bed# No. Height. Width. l r Ft. In. Ft. In. Ft. In. Ft. In. Ft. In. Two-pair Story— Men's Sick 74 6 24 0 11 0 1 11 6 6 3 6 2 32 614 Ward, No. 15. Two-pair Story — Women's 74 0 25 6 11 0 1 11 6 6 3 6 2 32 648 Sick Ward, No. 16. In the Fever House. Fever wards. Name of Ward. Length. Breadth. Height. Doors.- .^ Beds. "'^ J et No. Height. Width. v * Ft. In. Ft. In. Ft. In. Ft. In. Ft. In. Two-pair Floor — Women's 28 9 18 0 10 0 1 4 5 3 3 4 1 10 517 Ward. One-pair Floor— Men's Ward 28 9 18 0 10 0 1 4 5 3 3 4 1 10 517 There is one medical officer for the house, and four for the out-door district. The house Medical officer. contains a dispensary, which is supplied with medicines, provided at the cost of the parish, and Dispensary supdispensed by the medical officer's assistant. There is one paid nurse ; also three helpers for P^ed by parish, each sick and infirm ward, as well as night nurses. These are all inmates having gratuities in Nurses. extra diet. The water supply, which is abundant, is derived from a well upon the premises, 22 feet deep, Water supplied by in which the water Vises about 6 feet. A lift-pump carries the water to a tank holding 4000 well, gallons, which is placed sufficiently high to supply all but the upper stories ; there is also Tanks, another tank holding 300 gallons in the yard. There are two baths in the receiving wards, two in the itch wards, and one in the boys' Baths, bath room, also two portable baths. There are neither water-closets nor privies in the house, nor are there any in the fever No closets in fever wards. There are, however, five closets in the infirmary. There are about 12 privies in the wards, yards. E 26 REPORT on the CAPABILITIES of the METROPOLITAN WORKHOUSES Cesspools. There are two main cesspools and one smaller one. These are emptied once in 18 months. Flushing drains, The two principal ones are trapped. The privies in the yard are flushed daily by the drainage of the refuse water of the house, and once a fortnight the contents of the large water-tank are emptied through the drains. Provision for clio- The detached building used for fever cases would answer exceedingly well for cholera wards, lera. It would give a room for each sex, each containing 5170 cubic feet, together with two smaller rooms below, which might be used for convalescents ; as well as two other small rooms, one for a nurse, and the other for a medical attendant to sleep in. There is also a separate entrance by which patients might, be brought at once to these wards. The number of cholera cases in this district in 1832 was 258 ; the deaths, 118 ; recoveries, 140. Suggestions. Suggestions. — It is in contemplation to form an additional drain at the back of the house. Removal of cess- If this were done, the cesspools might be at once removed, as the fall is excellent, and the pools, means for flushing the drains abundant. 6 Additional closets. Water-closets should be furnished to the fever wards. No. 20. GREENWICH UNION WORKHOUSE, Situation. Situation. In the Woolwich-road. The house is built facing the north, at a distance of about half a mile Open neighbour- from the river. It covers a large surface of ground, and is perfectly open on all sides. The work- shops, lodges, and offices form detached buildings. The infirmary is also detached and is Infirmary detached, situated on the highest point, at the back of the main building, with an intervening yard of about 48 feet in length. Behind the infirmary, again, is a large market-garden. Number of inmates. The number of inmates at present is 1023, the limit 1044. Of these there are 214 in the infirmary, including 27 idiots. Sick wards. The infirmary contains 17 sick wards, besides two day and two sleeping wards for idiots ; to the latter rooms we shall presently refer, as suitable for the reception of cholera cases. The following are the dimensions of the several rooms in the infirmary :—: — Windows. m N °% ea , d reS( : nt Present Cubic Wards. No. Length. Breadth. Height, i Doors. , c " VVar(l iXO> * n No. of Feet ° ; " places. may each „ , B , No. Breadth. Height. contain. Ward. Dea *- PerlseaP erI5ea - Ft. In. I Ft. In. Ft. In. Ft. In. Ft. In. Men ... 1 34 0i 17 0 10 0 1 64255 1 10 12 12 481 Ditto ... 2 18 6I Hi 9 10 0 1 34360 1 6 6 7 442 Ditto ... 3 34 0 17 0 10 0 2 64160 1 10 12 12 481 Ditto ... L 3 17 2 17 0 10 0 1 24160 1 5 6 6 486 Ditto ... 4 30 2 17 1 10 0 1 3 4 4 6 0 1 10 11 12 427 Ditto ... 5 29 2 17 1 9 3 1 3 4 3 3 8 1 10 15 14 327 Ditto ... L 6 17 0 17 9 9 6 1 2 4 0 3 9 1 5 4 4 712 Ditto ... 6 33 8 17 0 9 6 I 2 34039 1 10 12 12 459 Idiots ... 8 23 3 17 0 10 2 1 2 4 0 5 9 1 10 12 12 334 D.iy-room .... 17 9 17 0 10 0 1 2 4 0 4 0 1 .. 2 Women . . 9 34 0 17 0 10 0 I 1 6j 5 5 4 2 1 10 12 12 461 Ditto ... 10 18 6 16 9 10 0 ; 1 34460 1 6 6 7 442 Ditto ... 11 33 6 17 0 10 0 i 2 64360 1 10 12 12 470 Ditto ... Lll 17 0 17 0 10 0 | 1 24360 1 5 13 7 412 Ditto ... 12 30 3 17 0 10 0 j 1 34460 1 10 11 12 428 Ditto ... 13 30 3 17 0 9 3 1 34436 1 10 23 12 407 Ditto ... Ll4 17 0 17 0 9 6 1 2 i 4 4 3 6 1 5 6 7 371 Ditto ... 14 34 0 17 0 9 6 2 3 4 4 3 6 1 10 11 12 459 Double Ward. 15 37 0 j 17 0 9 6 1 4 4 4 3 6 2 12 13 15 398 ' Idiots ... 16 23 6 ! 17 0 10 0 1 24058 1 10 15 14 285 Day-room. ... 17 10 17 0 10 0 1 24040 1 ! j | Infirmary wards The infirmary is kept very clean and in excellent order, but it will be seen from the above over-crowded. return that the wards are now over-crowded. In the summer they are not generally full. Fever cases. There is no special room for convalescents, who are sent into the house as soon as they are able Nurses. to leave the infirmary. Out-door fever cases are sent, to the fever hospital. The nurses are not paid, but receive extras in diet, and wear a different dress from the inmates. Exercising yard. An exercising yard is provided for every class, also gymnastics for the boys, and swings for the girls. There is an abundant supply of water from an artesian well, raised by force-pumps to the cisterns, of which there are seven for the house and two for the infirmary. Water. Cisterns. Baths. There are seven fixed baths in the house, two in the receiving wards, two in the infirmary; besides two hip and shower-baths. There is a constant supply of hot water on every landing of the infirmary, until 10 at night, furnished by a steam-boiler. There is one dust-bin for each portion of the house, seven in all ; these are emptied only once a-month. Drainage bad. The drainage of the house is very defective, owing, it is said, to the very slight fall that can be obtained to the river. From the basement, there is no drainage whatever, the refuse water requires to be pumped up to the level of the drains. Beneath the garden, at the front of the house, are two large cesspools, which are emptied about once in six months. Large cesspools. Closets. There are 18 water-closets for the house, besides 10 for the infirmary. There are also about 13 sets of privies in the yard. for the RECEPTION and TREATMENT of CHOLERA CASES. 27 On the former occasion an empty house was taken, near the workhouse then existing on Provision for cho- Maidenstone Hill, for cholera patients ; but very few cases were brought to this house, the greater era « part having been treated at their own homes. The Guardians entertain no doubt of obtaining abundant room in the neighbourhood in the Provision for outevent of cholera approaching, when the Board will be prepared to make arrangements for the door cases casesout-door poor. In this district 243 cases of cholera occurred in 1832. There were 149 deaths, and 94 recoveries. In the event of cholera occurring in the house, the persons attacked could be moved to the Provision for the wards, No. 8 and 16, in the infirmary. No. Bis a day and sleeping room, now occupied by house, epileptics and idiots. It has a separate entrance ; it is situate upon the ground floor of the west wing of the infirmary, and has no communication with the wards above or contiguous ; it is used for males. There is also a small room attached which would serve for nurses or convalescents. If so used, the present, occupants could be moved immediately to the County Lunatic Asylum. No. 16, on the female side, occupying the ground floor of the east wing, exactly corresponds with this, and could be made equally available for females. Suggestions. — It must not be forgotten that this house was severely visited by dysentery Suggestions. about three years ago, the remote causes of which were very obscure ; and it is possible that Former occurrence the same circumstances which then favoured the spread of that disease might again combine of dysentery in this in the event of a cholera visitation. It would therefore be advisable to preserve the arrange- house, ments for the house, and for the out districts distinct, as we have suggested above. Not only does this appear advisable on account of the circumstance just alluded to, but also Necessity forcauon account of the very defective drainage, which must still, however careful the means adopted tion. to prevent accumulation, be regarded as the great defect of this otherwise well-arranged house ; and one which it may be hoped is still capable of being remedied, so that, the large cesspools may be removed, for whatever may be the care bestowed in rendering the other arrangements conducive to health, still these arrangements can never be regarded as perfect so long as it is requisite to retain upon the premises for six months together the drainage refuse of a house containing more than 1000 inmates. We have stated that the infirmary wards are at present over-crowded, and if we had calcu- Infirmary wards lated the cubic space allowed to each of the present inhabitants, as we have done in most ver y crowded. instances, a very different result would have appeared from that given in the table above, which proceeds according to the number of beds. For example, No. 13 ward appears to give 407 cubic feet to each person, but on the day of our visit it gave only 184 to each then inhabiting it. Another of the children's wards we observed to be particularly crowded, several beds containing four in each. The table will show the extent to which the limits are exceeded. The ventilation in the infirmary wards is mainly dependent upon perforated zinc plates in Ventilation not the ceiling, communicating with air-bricks in the walls, while other rooms are furnished with sufficient, windows hung in the centre, or windows in the roof. For the reasons specified in our general remarks, we think none of these methods good or sufficient. No. 21. ST. GEORGE'S IN THE EAST. This workhouse, situated in Charles-street, Old Gravel-lane, is of irregular form, and Structural and built upon made ground, extending about 7 feet in depth, below which are 13 feet of clay, turf, other arrangements. &c. The neighbourhood is very crowded with habitations of the poorest description. Fronting' Situation, the house on the west side, and close to it, is an enormous dust-heap, causing the greatest Neighbourhood. inconvenience, especially when refuse matter is burnt, at which time the windows of the house Nuisance. are obliged to ba closed. There is also an animal charcoal manufactory adjacent. The Numbers of inhouse is limited to 800 ; it contained 745 on the day of our visit. It has four sick wards, two mates. being for each sex, of the following dimensions :—: — Sick wards. Windows. „. Beds. C " b ™ Wards. Nob. Length. Breadth. Height. Doors. ,' * eet ° ° ¦ places. per No. Height. 'Width. j Single. Double Person Ft. In. 1 Ft. In. I Ft. In. Ft. In. Ft. In. Men's Sick Ward 2 48 6 18 3 | 7 3 1 4 3 8 2 10 1 14 .. 458 Men's Fever Ward . 13 26 0; 14 6' 10 0 1 1 5 0 4 4 19 .. 419 I Lantern skylight. Women's Sick Ward . 4 37 0 21 o'. 12 0 1 5 7 1 I 3 10 2 13 , 1 621 Women's Fever Ward* 23 45 0 31 0I 10 6 2 16 2 3 5 1 10 j 2 610 1 skylight. * This consists of two rooms. There are besides these, two infirm wards for men and four for women; also two lying-in wards, one for married and another for single women ; and an epileptic ward. The wards devoted to the men, both sick and infirm, with the exception of No. 13, are Ventilation insuffidefective in height ; but those appropriated to the females are better constructed, baing lofty, cient. well lighted, airy, and clean, with plenty of room for the exit of air, but no sufficient means for ensuring an uniform entrance. In the women's wards each window is furnished with a pane inclining inwards, and covered by a lifting flap, as in the mode usually adopted for ventilating E 2 28 REPORT on the CAPABILITIES of the METROPOLITAN WORKHOUSES churches; an arrangement which leaves the ventilation entirely under the control of the inmates. In the men's ward, however, there are no means for the ingress of air except by ventilators over the door, which are not sufficient for the purpose. Generally the cubic space permitted to each person in the sick and infirm wards is above the average of workhouses. Thus in five wards it exceeds 600 cubic feet, the highest being 629 ; in one it exceeds 500, in three 400, and in three only does it range below 400. One however, namely, the married women's lying-in ward, gives only 246 feet per individual. Cubic space exceed ing average. The accommodation for the sick in this house is quite insufficient as compared with the number of inhabitants, for to 800 inhabitants, the full allowance, there are only 23 sick beds for men, and 26 for women, three of the latter being double beds ; in this return, also, the nurse's bed is included. The two fever wards, included in the above return, have the advantage of being detached from the main body of the house, being situated in two small buildings forming a kind of wing on either side. The women's fever ward, though returned as one room, consisting, in fact, of two separate apartments. One of them is ventilated by two air holes with iron gratings outside ; these air holes are on a level with the floor, opening under the beds a bad situation, as they can always be covered over at the will of the inmates. The second apartment is ventilated by a lantern skylight with windows in it turning on the centre; each of these rooms has also a single window., but otherwise no provision for ventilation. No. 13, on the men's side (the men's fever ward), is constructed precisely like the second apartment of No. 23. Some accommodation is thus afforded for fever cases, but so inadequate is it that, by preference, these cases are sent generally to the fever hospital ; and we were informed that the cost of this for the quarter ending at Michaelmas amounted, at a guinea per head, to 45 guineas. Insufficient accommodation for sick. Fever wards. Large number of fever cases. There is one medical officer for the house. There are no paid nurses, but the inmates employed as nurses receive extras in diet. An artesian well, carried 80 feet into the chalk, with a reservoir 45 feet deep, in which the water rises to 20 feet, ensures a constant and ample supply of water to the house; there are nine cisterns which are kept constantly filled by a force-pump. Medical officer. Nurses. Artesian well. Cisterns. There are two fined baths and a hip bath, but no slipper bath. This house is deficient in water-closets, of which there are only three, besides one in the lobby. There are five privies in the yards, which are flushed three times a-week. This house has a good drainage fall, but being near the water, bad smells occasionally pass up the drains. The occurrence of offensive odour occasionally has also led to the supposition that there is a cesspool still remaining upon the premises. "The drainage of this house appears to have received much attention, with a view to rectify the unpleasant odour occasionally observed. We have already stated that, the present amount of accommodation for the sick in this house is not equal to the requirement. The returns which we have given relative to the cubic space allowed to each sick bed show that, as far as the accommodation extends, there has been every desire to make it beneficial ; and the wards themselves, especially those for the females, are exceedingly good, but more are required, and too many sick are obliged to be kept in the infirm wards! It is in contemplation, however, to take a piece of ground adjoining the workhouse for the purpose of enlarging the building. With reference to any sudden or immediate requirements, there appears to be little capability of appropriating any portion of the present building for cholera cases, unless the two small fever wards, which have the advantage of a comparatively isolated position, were employed for this purpose ; every fever case being sent to the fever hospital, and other cases being elsewhere distributed in the house. Thus about 20 beds might be appropriated to cholera cases, probably a larger number than would be requisite ; but it must be observed, that this would take away two of the four sick wards now used, and deprive the house of half the present accommodation for the sick, which is already insufficient. . t The only provision that was suggested to us was that afforded by a contiguous house in Old Gravel-lane, containing four small rooms, with 26 single, and two double beds. This house is used to 'afford a temporary relief to the pressure which is felt from the want of sick beds in the workhouse. This house is quite unfit for cholera cases, and is only held by sufferance of the Dock Company, to whom it belongs. It is old and dilapidated, and is approached by a descent of about 5 feet below the level of the street. Though it was proposed that the upper part only should be occupied, the lower part being without flooring and quite untenable, still it cannot be recommended for the purpose of treating cholera cases, though it is said to be the only house at present known as being available. Indeed the apparent difficulty of obtaining any adequate provision for the reception of cholera cases in this district would alone justify the suggestion which we have made of employing the fever wards of this workhouse in the event of other means failing. In this district there were 224 cases of cholera in 1832. The deaths were 123, reco- Baths. Deficient in waterclosets. Smell from drains. Provision for cholera. Old house inGravel lane. veries, 101. Suggestions. — We recommend additional ventilation for the wards Nos. 1, 2, 3, and 13 especially, and also for the nursery. We think the supply of water-closets for the house very Better ventilation suggested. inadequate to the number of inmates. The artesian well would supply amply a much larger number with water. We also think that means should be taken to ascertain with cartainty whether a cesspool exists, and that if so, it should be removed. We also beg to call attention especially to the nuisance mentioned as existing in the dustyard opposite the house, which, from the constant sifting and other modes of disturbing its contents, proves an incessant, nuisance, especially when the dust is allowed to accumulate as at present, when it is at a discount, and the heap in proportion enormous. Additional waterclosets. Cesspool. Dust-heap a great nuisance. for the RECEPTION and TREATMENT of CHOLERA CASES. 29 No. 22. CAMBERWELL WORKHOUSE Is situated near the New Church, Camberwell ; it stands on a mixture of clay and sand. The neighbourhood is not crowded, but is very badly drained. The house and outhouses are admirably arranged for external ventilation. The house, as at present built, is adapted for 320 persons ; but an additional wing is now Number of inmates nearly completed, which will accommodate 80 additional inmates. The number in the house at present is 328. The wards for the sick are three in number, and contain 37 people ; their dimensions are as Sick wards, follows : — T.r- , Cubic Windows. „. -p t t Wards. Length. Breadth. Height. Doors. ™* Beds. *iicli No. Height. Width. P "***' Person. Ft. In. Ft. In. Ft. In. Ft. In. Ft. In. No. I— Women . 29 3 18 6 11 0 1 3 5 3 3 4 1 12 543 No. 2— Women . 29 3 18 6 11 0 1 3 5 3 3 4 1 11 498 No. 3— Men . . 39 6 16 0 9 2 1 8 8 0 3 2 1 14 348 The means for ventilation in wards No. 1 and No. 2 consist of a hopper placed over each Ventilation, door, so as to allow of an orifice 3 feet square, through which the air enters from the corridor. This hopper is frequently closed during the day, and always at. night. For the exit of the foul air there is an opening in each ceiling measuring 2 feet by 6 inches, communicating with a shaft which passes to the top of the house, and is covered by a cowl. This opening was also 11 a f J.l- 1 /• 1 1 ,1 , • TT • 1 closed, on account of the descent of cold air upon the patients. Upon examination, however, it was found that, so long as the hopper is open, there is an upward current through the shaft ; but when it and the doors and windows are closed, the cold air passes down. At the time of the visit, it was suggested that the hopper should be fixed open permanently, so that, during both the night and the day a large quantity of air should be admitted : this was done, and, after a fortnight's trial, no complaint has been made. In the men's sick ward there are no means for the admission of fresh air, but there are three ? openings into the false roof, each measuring 12 inches square. This ward is very close. Gas burns in all the wards, without ventilating tubes. There is one medical officer, who supplies Medical officer. medicines. There are two pauper nurses to each ward. The nurses only remain a very Nurses. short time. There are not any stretchers, only a sedan chair. The water is supplied from Water. wells and from the Vauxhall Waterworks. The charges of the latter Company are so high that it is proposed to give up taking water from them, and to use that only which comes from the wells. There are three tanks on the top of the house. There are four cesspools ; into one of these 13 privies empty themselves ; from this cess- Cesspools, pool there is an overflow-pipe, which leads into a common ditch ; this ditch communicates with the sewer about 400 yards from the house. At one time the contents of the closets were Open sewer, allowed to pass directly into the ditch, instead of passing through the cesspool, and the ditch was soon choked up, and the cesspools were again made use of. All the cesspools have overflow-pipes into this ditch. Austin's patent closet is in action here, and answers exceedingly Water-closets. well. There are no convalescent wards. An open dust-bin receives the solid refuse. There is no slipper bath. During the last visitation of cholera a house was hired in the parish ; it was, however, very Accommodation for dirty, and the mortality in it is reported to have been much greater than among those patients cholera patients, attended at home. The new wing, now completed, is well suited for the reception of cholera patients. Cases of cholera reported in 1832,217; deaths, 107; recoveries, 110. Suggestions. — The wards require efficiently ventilating. The privies and cesspools should Suggestions, be abolished ; but it appears that this desirable object cannot be attained until the sewer, which is 400 yards distant, is carried up to the house. A bath-room should be provided for the sick ; the dust-bin covered over ; covered litters should be provided. No. 23. CHELSEA WORKHOUSE, Situated in KingVroad, Chelsea, stands on a dry, sandy soil, 20 feet in depth. The neighbourlood is not very crowded. The house consists of a central building, from which two wings are ontinued on one side, and form three parts of a square ; on the other side there is one ving. A nightman's yard, a slaughter-house, and piggery, abut on the back of the men's Neighbourhood. nfirmary. On one side is a burial-ground, in which, at times, many interments are made ; and within 100 yards of the house is another burial-ground, which has, for 22 years, been be general burying-place of the parish, and in which 28 interments lately took place in the space of three days. The front of the men's infirmary looks upon the stone-yard, in which are sometimes 50 stone-breakera at work at one time. The prescribed maximum number of Number of inmates. inmates is 558, the present number is 517. The number of sick persons at the time of the Sick wards. visit was 70, who occupied four wards having the following dimensions: — 30 REPORT on the CAPABILITIES of the METROPOLITAN WORKHOUSES t»t. , Cubic Windows. v - T ? Wards. Length. Breadth. Height. Doors. f ire ' Beds. * eetto ° — places. each No. Height. Width. Person. Ft. In. Ft. In. Ft. In. Ft. In. Ft. In. No. 18 . . 37 6 19 6 9 0 1 5 5 0 4 3 2 14 469 No. 58 .. 20 8 20 0 11 7 1 4 3 6 3 6 I 9 553 No. 59 .. 20 0 18 0 11 7 1 4 3 6 3 6 1 8 540 No. 72 . . 5> 0 18 8 7 4 1 10 6 4 3 6 1 37 202 436 3 6 The average space to each sick person is 441 cubic feer, the largest space being 553, the lowest 202. Ventilation. In ward, No. 18, for the sick men, there are four circular brass ventilators in the floor for the admission of air, all of which had been closed for several weeks ; there are also four openings into the false roof above, from which, however, there is no communication with the external air ; whenever the door is closed, the air re-enters the room from the false roof. The ward is very close. In each of the women's sick wards there are two openings into the false roof, but not any in the floor. These wards are also very close. The women's sick ward, No. 72, which has lately been appropriated to the sick on account of the recent unusual pressure of sickness, contain, 15 double beds and 7 single, the average space to each patient being only 202 cubic feet, and there are no means for ventilation. The fever patients are sent to the fever hospital. There is one medical officer, who supplies medicine from his house. The exercise ground is much too small. Cholera cases in The number of cases of cholera on the last visitation was 186, there being 82 deaths and 1832. 104 recoveries. Accommodation for During the former visitation of cholera there was no separate cholera hospital, the patients cholera patients. were attended at their own houses. The Board has not yet taken into consideration what measures it would be desirable to carry out in case of a second visitation: they have lately established a new ward, capable of holding 12 patients ; and, at the time of the visit, they were fitting up a second ward, suitable for six or eight more, in the expectation that these wards will be at liberty, after the present unusual pressure of illness, for cholera patients. Suggestions. Suggestions. — The wards should be efficiently ventilated; the privy should be removed; the stone-yard, in front of the infirmary, should be converted into an airing-yard; baths should be fitted up for the use of the sick ; the dust-bin should be covered. No. 24. POPLAR WORKHOUSE Situation. Is situated in High-street, Poplar. It stands on an acre and three-quarters of ground, which is composed principally of silt. The house consists of the main building, which faces High- street, and of one wing, which runs back from its eastern extremity. The neighbourhood is not Neighbourhood. very crowded. The chemical works on Bow Common, nearly a mile distant, frequently cause very unpleasant smells ; but there is a still greater nuisance, in the shape of an open sewer 9 feet, in breadth, which forms a stream at the back of the workhouse, to part of which it is directly contiguous. This sewer receives the waste liquor from gas-works in the vicinity, and is, at times, very offensive : it runs, for a distance of three-quarters of a mile, quite open, Number of inmates, and no arrangements have yet been made to cover it over. The prescribed maximum number Sick ward. of inmates is 600 ; at the time of the visit there were 514. There are 12 wards for the sick, 4 being in the house, and Bin the fever hospital, about half a mile distant. The dimensions of the wards are as follows :—: — Workhouse. Cubic Feet Wards. Length. Breadth. Height. Doors. Windows. Fire-places. Beds. to each Person. Ft. In. Ft. In. Ft. In. No. 1 .. 38 9 23 9 11 9 2 8 1 17 590 No. 2 .. 33 6 17 0 12 0 2 5 1 11 633 No. 3 .. 33 2 22 7 11 2 2 4 1 20 511 No. 4 . . 25 6 23 4 11 2 3 6 2 12 619 Hospital in North-straet. No. 1 . . 11 4 14 3 8 1 1 2 11 No. 2 .. 11 4 14 0 8 1 2 2 1 No. 3 .. 22 9 11 6 12 2 2 -J 1 | S; 54 5 4 : : 8 J fi '.° >i '! ? 1 ! No. « . . 1 1 6 14 6 8 1 1 1 1 No. 7 . . 9 10 22 4 7 2 1 1 1 No. 8 . . 11 0 15 2 7 7 1 1 1 J The average space for each sick person is 603 cubic feet, the largest space being 633, the lowest 511. The sick wards situated in the house occupy the top-floor : they are large, clean, • for the RECEPTION and TREATMENT of CHOLERA CASES. 31 and light. The means for ventilation consist of apertures in the ceiling 1 , which open into shaft?, Ventilation. passing through the false roof, and having Day's Wind-guard on the top. In ward No. 1 there are two of these apertures, each measuring 14 inches by 6; in each of the wards, Nos. 2, 3, and 4, there is one of these apertures; and in Nos. 3 and 4 there are also air-bricks : and when the rooms were built, apertures, 5 inches square, were made in the chimneys, near to the ceiling; but they have been closed for many years, on account of the smoke entering the room through them. In one of these rooms, where a Canadian stove had been fixed instead of the fire-place, at the time of the visit, the covering to the aperture was removed, when it was found that there was a very powerful upward current. When the doors of these wards are closed, there is a downward current into the room, but whenever they are opened the air passes upwards. The Canadian stove, which stands in the room about 5 feet from the fire-place (now filled up), adds greatly to the comfort of the inmates. The hospital, in North-street, is an open space, with but few buildings near it. It formerly was the house and shed to a nurseryground ; it is very old, and the rooms require warming and ventilating. In the large room there are five openings into the false roof, on the top of which cowls are placed. There is one ward for convalescents. There is one paid nurse for the hospital in North-street, the rest, are Nurses. paupers. The water is supplied from the main of the East London Waterworks, and from a well. Water. There is one slipper-bath and portable baths for the sick. There are 10 water-closets, well Water-closets, supplied with water, close to the sick wards. There is one cesspool, measuring 10 feet square, Cesspool, which receives the contents of the closets and one privy : there is an overflow-pipe from this cesspool into the open ditch above alluded to ; this cesspool was opened five years ago ; it gives out bad smells at times. There are also two privies, which are emptied once in 18 months. Privies. The burials take place twice a-week. There is sufficient room in North-street for cholera patients, who would be required to be Accommodation for removed from their houses ; and the number of out-door medical officers could be increased. cholera patients. Cases of cholera reported in 1832, 179; deaths, 101; recoveries, 78. Suggestions. — The wards in the house, and in North-street, require warming and ventilating. Suggestions. There should be a bath-room near the sick wards ; the cesspool and privies should be removed, and the house-drains tapped. The open ditch ought to be covered. No. 25. ST. PANCRAS WORKHOUSE Is situated in the Kings-road. It stands upon a stiff clay soil, occupying, together with its Situation, yards and gardens, about 5 acres of ground. It is built so as to allow of full external ventilation. A burial-ground, belonging to St. Giles's parish, abuts upon the men's infirmary : in this ground it is stated that a great number of burials take place. The solid refuse matters are used for manure in the garden. The maximum number of inmates is 1670. The house was full at the time of the visit. Number of inmates There are 1 1 wards devoted to the sick, the dimensions of which are as follow :—: — Sick wards. ikt- j Cubic w a t « wui »• v* n Windows. f . F t Wards. Length. Width. Height. Doors. ,. c Beds. gach No. Height. Width. Person. Men's Wards:— Ft. In. Ft. In. Ft. In. Ft. In. Ft. In. No. 1 25 6 18 6 11 0 1 2 3 4 3 4 1 11 415 12 persons. No. 2 .. .. .. 11 452 No. 3 .. .. .. •• 10 498 No. 4 .. .. .. .. .. 11 452 Women's Wards : — No. 1 66 6 20 0 12 0 .. 10 7 0 4 0 .. 27 591 No. 2 71 6 20 0 12 0 .. .. 33 520 No. 3 .. .. .. .... .. •• 30 572 No. 4 66 6 20 0 12 0 .. .. 31 516 Sick Ward Women . . 11 6 20 0 12 0 2 7 0 4 0.. 4 690 No. 13 20 0 10 0 12 0 .. 1 7 0 4 0 .. 4 600 No. 6 14 3 10 0 12 0 .. .. 3 566 No. 5 14 3 12 0 12 0 .. .. 3 680 Sick Ward Men ... 21 6 12 0 10 4 .. 26040.. 3 838 The average space to each sick person is 572 cubic feet ; the largest being 888, and the smallest 415. The men's infirmary is apart from the main building, and abuts upon the bury ing-ground of St. Giles, in which interments are daily occurring. It consists of four wards, two on the ground-floor and two on the first story. No. 1, on the ground- floor, has two windows. The air is admitted by two apertures, each Ventilation. 9 inches by 5, in the wall close to the floor, with an external grating. There are also two gratings, each a foot square, in the ceiling, which open into a space between the ceiling and floor, and communicate thence with the open air by gratings : air is also admitted beneath the flooring. A small door, a foot square, opens upon the burial-ground, and is left open daily for air. No. 2. Ground-floor; same as above. No. 3. The first floor. There are no openings below, and the gratings above are nearly covered. No. 4. Ditto. 32 REPORT on the CAPABILITIES of the METROPOLITAN WORKHOUSES The women's infirmary is a separate building, open in front and behind, and consisting of two stories, two wards being fen each story. In ward No. 1, ground-floor, there are 14 orifices for the admission of air at the lower part of the door, each an inch in diameter. Of four gratings at the upper part, each about 18 inches square, and opening into the space between the rafters, three are nailed over. In ward No. 2, the gratings at the upper part are nailed up. There are 14 one-inch orifices at the lower part of the door. In the windows there are eight ventilating panes, which consist of two pieces of glass, each two-thirds the size of the wooden frame, placed before each other ; the outer one fixed to the upper, the inner one to the lower part of the frame, and separated from each other by a space of about three-quarters of an inch. Ward No. 3, there are four grated openings into the space between the rafters. Ward No. 4, three of the four prated openings through the ceiling are closed. In ward No. 31, in the house, which is used at & k - & . . V iii? i i c ,•! ,- mi ¦ • xl- _1 ..,:<.U present for the sick, there are 12 beds and no means of ventilation. This is the case also with the small wards. There are fire-places in all the wards. Fever patients are sent to the fever hospital. There are no wards for convalescents. There is one medical officer and one assistant for Medical officer. the in-door patients. There is a superintending matron to the infirmary. All the nurses are paupers The medicines are supplied by the medical officer. There is a double bath for the 1 _ r . ¦,'¦'¦ -i i . ,i « • r> f-.-^i.- r l~ Bath. infirmary. There is a water-closet to each ward in the women's infirmary ; for the four wards Closets. in the new infirmary there is one closet; there are portable pans for the rooms. The privies Privies. in the yards are in a most offensive state ; some of them, with iron pans, were choked, nearly to the level of the seat, requiring, from their bad construction, to be emptied daily. Accommodation for There is no accommodation here for the reception of cholera patients ; out-door arrangements cholera patients. must therefore be made. In the year 1832, 186 cases of cholera were reported in this district: there were 111 deaths and 75 recoveries. Suggestions. Suggestions. — The wards require efficiently ventilating. The men's infirmary should be removed: its present contiguity to St. Giles's burial-ground is very objectionable. All the privies should be abolished, and better arrangements substituted. — See Suggestions, p. 54. No. 26. HOLBORN UNION. The workhouse is situated in Grays-inn-lane, upon high ground; the neighbourhood being densely populated, and the habitations generally poor. The house is of irregular form, having been enlarged and altered since its original construction. The limit to the number of inmates is 750, but in this number were included 200 children, who required sleeping wards and school-rooms. The children have been recently removed to Tooting, consequently the house is now capable of accommodating a greater number. On the day of the visit it contained 765 ; the number has since reached 803. J „...,.. . t mi n 11 • .11 -11 • «1 J i "1_ Situation. Number of inmates. Children recently removed. Large proportion of The proportion of sick in this house is very large. The following table will give the details sick. of the arrangements provided for them :—: — Windows.. Fire . Cubic Wards. No. Length. Breadth. Height. Doors. places. Feet. No. Height. Width. Ft. In. Ft. In. Ft. In. Ft. In. Ft. In. Second Floor— Men's In- A. 8 67 0 17 6 8 8 1 9 .. •• 1 58 320 firm and Sick Ward. Arnott stove. Ditto ditto B. 40 6 23 4 8 8 .. 10 .. .. 1 fireplace. Second Floor — Men's 9 29 6 18 0 8 8 2 6 .. .. 1 11 390 Fever Ward. Basement— Men's Sick 17 57 8 16 7 8 5 3 10 .. .. 2 26 308 Ward. Ground ' Floor* — Men's 18 67 0 17 0 10 3 3 10 .. •• 2 26 521 Sick Ward. Second Floor— Women's A.38 34 4 31 4 7 9 2 6 .. .. 2 51 342 Sick and Infirm Ward. Ditto ditto B. 58 3 20 3 7 9 9 .. .. 3 Ground Floor— Women's 26 48 4 22 10 10 0 1 5 5 9 4 0 2 26 430 Infirm and Sick Ward. First Floor — Women's 28 46 6 17 9 10 0 1 5 .. .. 1 20 413 Infirm and Sick Ward. Ditto ditto 29 48 0 23 10 10 0 1 5 6 0 3 6 2 32 360 Second Floor— Women's 30 46 6 17 6 7 9 1 5 4 0 3 6 1 16 394 Fever Ward. Second Floor— Women's 31 48 2 23 10 7 9 1 5 4 0 3 6 2 26 346 Sick Ward. Children's Sick Ward .40 21 6 20 4 7 9 3 3.. .. 26 130 Boy's Sick Ward .. 21 18 6 10 9 8 6 1 1 .. .. 1 7 241 Ditto ditto 22 19 5 16 0 11 0 1 3 .. •• 1 8 429 Children's Sick Ward . 23 14 10 12 10 8 8 2 4 .. •• 1 5 330 * This is the ward proposed to be used for cholera patients, should such a ward be required. It has a separate entrance at S.W. corner, and an opening into a large paved yard at N.W. It may with ease he converted into two wards with separate entrances. for the RECEPTION and TREATMENT of CHOLERA CASES. 33 The sick children, it will be seen, have four separate wards, the men three, and the women two ; but there are also seven other rooms (counting the double rooms as two) in which the infirm and sick are mixed together. To this we have expressed our objections in the general remarks at page 55. There are three medical officers for the house, one attending the men, one the women, and one Medical officers, the children. There is one paid head nurse, six not paid, besides helpers. Nurses. Fever cases are often sent to the fever hospital for want of room in the house. It was Fever cases. stated that the sum paid to that hospital for fever cases sent from this district in the last quarter amounted to 55 guineas. This house is upon the high service from the New River Company. There is also a well Water. 35 feet deep. The supply from this, however, has been lately rather deficient, since the sinking of a well in the brewery adjacent. There are large tanks, holding together about 10,000 gallons, from which the water is distributed by a force-pump to numerous cisterns at Large tanks. Cisterns. the top of the house. There are two fixed baths for the receiving wards, one slipper, and one shower-bath. Almost every sick and infirm ward is supplied with water-closets; some with two; and Closets. there are several privies in the yards. There is a small cesspool connected with the vagrant ward. On the former occasion a large house was taken in Greville-street, afterwards converted into Provision forchothe Greville-street Hospital. About 25 beds with proper bedding were sent from the house. * era - Inquiry has been recently made for some similar provision, in the event of its being required, but at present with no prospect of success. If no such provision can be made, which, perhaps from the large number of sick in the house would have been the preferable plan, the ward to which we have made reference in the Large ward in above table would furnish excellent accommodation for perhaps as many cases as might be house, expected to require removal in this district. In 1832, 165 cases of cholera occurred in this district ; 46 died; 1 19 recovered. Suggestions and Remarks. — The water supply in this house is so excellent that we cannot. More extensive use help suggesting a more extensive use of it, both in respect to baths, of which there are none of water suggested. except in the receiving ward, and also for a better system of flushing the yard privies which is at present done by hand. The ventilation might also be improved. The passages are sufficiently large and airy to admit Improved ventila-* of the suggestions which we have made in our general remarks on ventilation being here carried t - n ti°nout with effect. The children's sick ward, No. 40, is too crowded. 26 beds, according to our returns, being Children's ward too placed in a room '20 feet square and not 8 feet high. crowded. crowded. The room, No. 21, used as a temporary ward, on account of the number of sick, and the No. 21 very much room adjoining are also much crowded. Some of the beds should be removed, and means crowded, and withprovided for ventilation of which it is at present destitute. The state of the water-closet also out ventl atlon atlonrequires attention. No. 27. CLERKENWELL WORKHOUSE, In Coppice-row. The house, built in the form of a parallelogram, commands a good fall to Situation, the river Fleet, about 150 yards distant. This house contains at present, 550, but will soon be capable of receiving 600 inmates. Number of inmates. For this number of persons there are only two sick wards, giving together 40 beds. There is Sick wards. at present, however, a temporary sick ward for the women, with 17 double beds, and having 32 inmates. Besides these there are many sick in the infirm wards of which there are eight. The sick Sick in infirm and infirm together amount to 150. wards - The following are the sick wards :—: — Windows. v - Beds. No. „, . Wards. No. Length. Breadth. Height. Doors. ™* of In- ~!™{ c No. Height. Width. P "" S ' Single. Double mates ' Ft. In. Ft. In. Ft. In. Ft. In. Ft. In. Women's Temporary Sick 5 63 4 18 0 8 0 1 6 3 8 4 2 2 ..17 32 285 Ward. 4 4 0 3 7 Women's Sick Ward . 23 70 2 17 4 9 6 1 7 5 7 3 7 2 20 .. 20 580 4 4 0 3 7 Men's Sick Ward .. 21 70 2 17 7 8 2 1 7 4 8 3 7 2 20 .. 19 640 4 3 7 7 3 Fever cases are almost always sent to the fever hospital. They are only taken into the Fever cases re house under great necessity. A small ward at the top of the house is then used for the purpose, moved. The sick rooms have abundant provision for the exit of air, in the shape of large openings in Ventilation. the ceilings, covered with iron gratings, and communicating with air shafts; but ihere are no means provided for its entrance. F 34 REPORT on the CAPABILITIES of the METROPOLITAN WORKHOUSES The New River Company furnishes an abundant supply of water. There are two large Wa^er. tanks over the baths, and two under the pavement in the yard. The sewers are flushed by an Tanks. Sewers flushed by engine three or four times a-week. cn £ me - There is a cold plunge bath, a warm and a slipper bath. engine. Batlls - On the last occasion a large house was taken containing room for about 30 persons. The Provision for cho- greatest number received into it, however, at, any one time, did not exceed 10. Some proa" " vision of the same kind would be again required, as no portion of the house could be used for the purpose, there being only two regular sick wards for a house containing 550 inmates. Hence the necessity for mixing the sick with the infirm. In 1832 there were 143 cases of cholera in this district, of which 65 died and 78 recovered. Suggestions. Remarks and Suggestions. — This house has an excellent fall to the sewers. It is abundantly No closets for supplied with water. One of its chief defects is the entire absence of water-closets in the house, house °or sick. even in the sick wards ; night-stools being used in the latter. We would recommend a water- closet to be supplied to each sick ward. The men's privy in the yard is in a very faulty state, but the Guardians have determined to have this removed and rebuilt in a better situation Small accommoda- for the drains. When this is done an improved plan of construction should be adopted. Another defect, consists in the very small amount of accommodation for the sick, and the tion for sick. consequent necessity for placing so many of them in the infirm wards. No. 28. ST. GEORGE, HANOVER SQUARE. This workhouse is situated in Mount-street, fronting the street to the north, but having an open space at the back, partly occupied by a nearly disused burying-ground, the vaults only Situation. being opened, but no new graves allowed. Number of inmates. This house has accommodation for 430 persons, and in the winter is always full, though not Sick wards. generally so in the summer. It contains eight sick wards, three for women and five for men, having beds for 34 sick persons, with an average space of 581 cubic feet to each sick bed. At the time of our visit 79 of these beds were occupied. The sick wards are not detached from the workhouse., but form a portion of it. The following are their dimensions :—: — „,. , Cubic Windows. Be(] Feet Wards. No. Length. Breadth. Height. Doors. single. per No. Height. Width. Person. Ft. In. Ft. In. Ft. In. Ft. In. Ft. In. Men's Sick Ward . . 1 28 4 17 0 10 6 1 2 5 7 4 0 8 632 Ditto .. 2 28 4 17 0 10 6 1 2 5 7 4 0 8 632 Ditto 3 27 0 16 6 10 6 1 2 5 8 4 0 9 504 Ditto—New Prince 34 6 22 0 10 6 2 4 5 9 4 0 13 603 6 27 0 16 6 10 6 1 2 5 8 4 0 9 504 Women's Sick Wards— 23 0 17 0 10 4 1 2 5 7 4 0 8 614 Princess. Ditto ditto 27 0 16 0 10 4 1 2 5 7 4 0 9 516 Ditto— Queen 58 0 15 4 13 0 2 4 7 10 4 0 18 647 Provision for cho- We found that the Guardians had suggested the use of a detached room at the back of the lera cannot be pro- house, which it was proposed to divide by a partition so as to make two apartments, but no cured in bouse seC ond entrance could be obtained to this room, which also, in other respects, appeared to us convenience "*" yei T unsuitable for the purpose suggested. The only alternative appeared to be to take two rooms in a detached wing of the building — one used for infirm women, and the other for the women's sleeping-room. These are situated over the women's dining-room, and have been suggested by the medical officers as better suited to receive cholera patients ; but if this wing were so used, the whole of it must be appropriated, which would displace 74 inmates, for whom no other provision could be well made. We do not therefore see that any provision for cholera cases can be made in this house. It is supposed that there would be no difficulty in obtaining accommodation out of the house. The number of cases in this district in 1832 was 125 ; deaths 74 ; recoveries 51. Two medical officers are attached to the house. 13 nurses are employed, all being inmates Medical officers. unpaid. There are no wards for convalescents, nor any space for exercise. The means for ventilation in some wards consfst of perforated zinc plates in the windows, Nurses. Ventilation. and in others of square apertures in the walls, to which are fitted wooden traps turning ver- tically in the centre. The wards, at the time of our visit, were airy and apparently well ventilated, but these means of ventilation are insufficient for the night. Water is supplied in ample quantity by the Grand Junction Company, arid is distributed Water. Cisterns. from a large reservoir to numerous cisterns. The house contains two fixed baths for the able-bodied, with supplies of hot and cold water, Baths- and two slipper baths. Water-closets. There are seven water-closets— five for the house, one being on each staircase, and two for the yards. There are no privies nor cesspools. for the RECEPTION and TREATMENT of CHOLERA CASES. 35 No. 29. SHOREDITCH WORKHOUSE Is situated in Kingsland-road, and occupies three acres of ground. There are several courts in the neighbourhood, which are very crowded and in an unhealthy state. The house consists of Neighbourhood. a main building facing the road, comprising three stories, and of wings attached to each end running backwards ; at a short distance from the house, and behind it, are the fever hospital, infirmary, and other buildings. The maximum number of inmates is stated to be 830; "Number of inmates, but there are 1000 at present. The number of sick is 150, for whom there are 12 wards, 6of Sick wards. which are for fever patients, and are situated in the fever hospital. The dimensions of the wards are as follows : — „,. . Cubic Wards. Length. Width. Height. Doors. * ire " Beds. „" t0 No. Height. Width. Person. Ft. In. Ft. In. Ft. In. Ft. In. Ft. In. No. 6— Third Floor .. 30 4 18 0 10 0 1 6 6 0 6 3 1 12 455 No. 7— Fourth Floor .. 30 4 18 0 10 6 1 3 5 0 3 6 I 11 486 No. B— Top of South Win X 59 0 18 3 10 6 1 4 5 0 3 6 2 20 567 No. 9— Ground Floor, North 28 0 18 3 8 0 1 2 4 9 3 6 1 8 255 Wing. 6 ample. No. 18— Top of South Wing j320183} I 0 6 2 5 5 0 3 6 2 18 627 No. 19— Top of House . 78 0 18 3 11 6 2 13 11 of them 2 31 521 5 0 3 6 Fever Hospital. No. 1 23 • 0 15 0 13 0 1 3 8 0 4 3 1 9 498 No. 2 23 9 16 6 11 6 1 3 6 8 4 3 1 9 498 No. 3 23 9 16 6 15 0 1 3 5 2 4 3 1 9 729 No. 4 23 0 15 0 13 0 1 3 8 0 4 3 1 9 498 No. 5 23 9 16 6 11 6 1 3 6 8 4 3 1 9 498 • No. 6 23 9 16 6 15 0 1 3 5 2 4 3 1 9 729 The wards for the sick which are situated in the south wing 1 , the one in the north wing, and Ventilation, another in the front of the house, are ventilated by means of holes in the walls communicating directly with the outer air, and by holes over the doors ; and in the upper floors, channels, mea- suring 9 inches by 6, pass through the false roof, and are covered by cowls; but ihe orifices for the ingress of the air being closed on account of the draughts of cold air, these shafts, instead of giving exit to the foul air, are a perpetual annoyance from allowing ingress to the cold air, which descends with great force. One of the wards, situated on the ground floor, is dark, and contains eight double beds, occupied by 16 people, without, any means of ventilation. Gas burns in all the wards without any provision for carrying oft' the products of combustion; and in several instances the closets are placed inside the wards; they should be removed to the staircase. It appears very desirable that the infirmary should be converted into a general hospital for the sick. The fever hospital has lately been erected, and consists of Fever hospital, six wards, having an average space of 575 cubic feet for such patients. At the time of its Ventilation. erection provision was made by the architect for the admission of cold air in summer and of warm air in winter ; also for the egress of foul air by an opening into a. shaft at the upper part of each ward ; but at the time of the visit, the cold-air apertures were closed, no air entered by the warm-air orifices, and there was no passage of air away by the foul-air flues; so that these wards were very close. There are three paid nurses, the rest being paupers. The water is Nurses. supplied from " the main " by the New River Company, but it is not carried higher than Water. 25 feet from the ground ; the tanks at the upper part of the house are filled by forcing: ttumps. The water is complained of on account of its frequently smelling of gas. During the former visitation of cholera a fever ward was set apart for patients ; and there is Accommodation for no fear on the part of the Board that they will not be able to accommodate them again should cnoleia patients, there be occasion. At the present time the house is so full, that there does not appear to be any possibility of removing the patients from the hospital into the sick wards of the main building. If this could be accomplished, two of the hospital wards would be well adapted for cholera patients. The number of cases of cholera reported in 1832, 107; deaths, 57; recoveries, 50. Suggestions.— -The fever wards of the hospital now devoted to fever cases might be set, apart Su«^estions for cholera patients; but the means of ventilation and warming should be improved. Water ts ' should be laid on to the fever hospital, so that the supply for baths and closets should not be dependent upon the rain-water tank. Several of the wards are already condemned ; a new building should be erected as soon as possible. The old wards placed at the top of the house should be effectually warmed and ventilated; this could be accomplished without difficulty. The dust-bin should be covered. Each gas-burner should have a tube to carry the products of combustion up the chimney. F2 36 REPORT on the CAPABILITIES of the METROPOLITAN WORKHOUSES No. 30. PADDINGTON WORKHOUSE, Neighbourhood. Situated at Westbourne Green, stands on a clay soil, which is well drained. The house and grounds occupy 5 acres 26 perches. It is open on all sides, and has recently been erected. Number of inmates. The hospital for the sick is detached from the main building. The prescribed maximum number of inmates is 225 ; the number at the time of the visit was 214. The number of sick Wards for the sick, was 20. There are five wards approximated to them, the dimensions of which are as follows : — In the Hospital. Windows. -. Jgubte Wards. Length. Breadth. Height. Doors. ™£ Beds. *™™ No. Height. Width. Person. Ft. In. Ft. In. Ft. In. Ft. In. Ft. In. No. 49— For Men . .. 16 6 16 0 10 0 1 16 11 0 3 2 1 6 440 No. 50— For Men . .. 16 6 16 0 10 0 1 16 11 0 3 2 1 6 440 No. 51— For Women . . 16 0 17 0 10 0 1 .. .. •]• 6 453 No. 54— For Women .. 16 0 17 0 10 0 1 .. .. I 6 453 An infectious Ward in the 15 0 14 0 10 0 1 .. .. 1 4 453 house. The average space to each patient being 446 cubic feet; the largest is 453, the smallest 44o. Ventilation. The means for ventilation in the four first wards consist of openings, 18 inches square, at the top of the room, and apertures below for the admission of air. Cold air enters through these apertures so quickly whenever they are open, that the patients are obliged to have them all closed. In the main building the means for ventilation consist of apertures below, communicating directly with the external air, and of openings above, entering a shaft which passes to the top of the building, and where it ends a stove is placed to draw upwards the foul air. Upon examining this stove, its connexion with the shaft was found to be such that it cannot answer the purpose intended. Moreover, the orifices intended for the admission of air were all closed. Gas burns in the rooms without a ventilating tube. There is one medical officer, and one paid nurse for the infirmary; the rest are paupers. There is one fixed bath for the sick, and one which is portable. The water is abundant. It does not appear pi-obable that there will be much available room in this house for the reception of cholera patients. The distance also so great from the residences of the poor that a building more centrally situated would be advisable. There were 85 cases of cholera reported in 1832, there being 29 deaths and 56 recoveries. Suggestions. Suggestions. — The rooms require warming and ventilating. Water-closets should be fixed in the yards. No. 31. STRAND UNION WORKHOUSE. Situation. The workhouse of the Strand Union, situate in Cleveland-street, Fitzroy- square, stands upon an acre of ground, of which the buildings occupy about one-third. A small portion of the ground was formerly used as a burying-ground : but no interment has taken place for eight years. Plan of construe- The house is in the form of the letter H; the front facing the west. At the back, sepation. rated by the women's yard, is a detached building of two stories, used for the infirm women. and termed the infirmary. On the north and south sides, towards the back, are the workshops for men and women, with sleeping-rooms above. In front of them, on each side of the house, are two small detached buildings, termed the North and South Lodges. The North is used for lying-in wards ; the South for the better class of inhabitants. These two lodges consist of two stories each, containing six or eight beds. The one last mentioned would afford some Number of inmates, accommodation for cholera cases, as will be presently more particularly specified. This house Small number of contains 600 inmates ; but for this number there are only two sick wards, one for each sex, sick wards. exclusive of the insane and lying-in wards. These wards contain 25 beds for women and 23 for men = 48, and are of the following dimensions :—: — No. Windows. v - Cubic Wards. of Length. Breadth. Height. , c " Beds. Feet Ward. No. Height. Width. P laces# per Bed. Ft. In. Ft. In. Ft. In. Ft. In. Ft. In. North-east side of House— 2 57 0 18 0 9 7 8 4 6 4 6 1 25 393 Women's Sick Ward. South side of House— 3 58 0 18 3 8 0 8 4 C 4 6 1 23 368 Men's Sick Ward. Ventilation im- From these returns it will appear that the space allowed to each bed is very small. The perfect. ventilation, moreover, is very imperfect. In the women's ward (No. 2) there are eight airbricks in the upper part of the walls. In the men's (No. 3), three apertures in the ceiling for the exit of air, but no provision for its entrance, except by the door or windows. for the RECEPTION and TREATMENT of CHOLERA CASES. 37 There is one medical officer for the house, with a nurse and helper for each ward, selected Medical officer, from the inmates. Nurses. The supply of water to this house is derived partly from the West Middlesex Company, Water, and partly from two springs, from which it is distributed by three pumps. At the top of the Tw ° wells. house are two large cisterns. There is, however, a great deficiency of water-closets, as there Defective supply of are only two of these for each side of the house and one privy in each yard for 600 persons. closets and privies. There is one fixed bath with hot and cold water, and three slipper-baths. In this workhouse provision might be made for the reception of about four cholera cases in Provision for chothe South Lodge, mentioned above. A standing order of the Board provides for the employ- ler * '" a mall de " ment of this part of the house in cases of fever, when that, disease prevails. This, therefore, tached od S e< might be converted into a receptacle for cholera cases, for which its detached position very well fits it. The rooms are small, being only 11 feet long by 15 feet 3 inches broad; and the one 8 feet 8 inches, the other 7 feet 8 inches, in height ; but they could be so arranged as to give accommodation for two persons of each sex. These rooms are sufficiently well lighted, and Requires ventilaare each furnished with a fire-place ; but if employed for cholera cases, they would require to tion. be provided with proper means for ventilation, of which they are at present destitute. In fact, this point should be at, once attended to, as in any case the occasional employment of these rooms for the reception of fever cases would call for this addition. Thus some accommodation, though very small, may be provided in the event of cholera The accommodaattacking the inmates of the house : but some larger provision should be made for the out-door tion for c h°j era t icon xi a a c l i jan j it • a l- j* a •-* cases quite madecases. In 1832 there were 84 cases of cholera and 37 deaths in this district udacs, xv 1OO& uißie were ot cases vi uuuiera. ciuu. o/ ueaius hi uns uiswici. auate Suggestions and Remarks. — The infirm wards form a large proportion in this house. The „ o-gestions and women's infirmary constitutes a distinct building, having three large wards, one 75 feet, re marks. another 43 feet, and a third 32 feet in length, besides two other wards in the house; giving in Large proportion of all five infirm wards for females, besides one for men. In the female infirm wards were infirm, many sick, who could not for want of room be received into the regular sick wards. On the other hand there are only two sick wards, and in these the beds are so crowded as to give a maximum allowance of only 393 cubic feet per bed; these wards are very deficient in proper means for ventilation. The cesspools, of which there are three, furnished each with overflow drains to carry off' the Cesspools and wells fluids into the sewer, should be removed, and the drainage re-arranged, so as to carry off all on same premises, the refuse without retaining it upon the premises. This house furnishes an example of the remarks which we have made at p. 52, showing the objections against having cesspools and wells contiguous, for the percolation from the cesspools must of necessity affect the quality of the water, derived from superficial springs, adjacent to them. More water-closets should be supplied. No. 32. ISLINGTON WORKHOUSE, In the Liverpool-road. This house, contained within a boundary wall, is built fronting the south, somewhat elevated above the surrounding parts, and Tolerably open. It contained Situation. 414 inmates on the day of our visit ; the limit is 420 ; the average about 350 Number of inmates. Seven rooms are devoted to the sick in the infirmary, containing 70 beds, besides 10 other Sick wards in debeds in the lower rooms, and two convalescent wards for women ; giving together 32 beds, tached infirmary. There is also a convalescent day-room for men, without beds. The following seven sick rooms constitute the infirmary, which forms a detached building ; an eighth ward is occupied by the master : — No. Windows. v . p Cu . b j. c of Length. Breadth. Height. Doors. j^" Beds. T Ward - No. Height. Width. Person. Ft. In. Fr. In. Ft. In. Ft. In. Ft. In. Ground Floor 3 27 0 17 5 9 7 2 2 6 0 5 0 1 10 449 Ditto. ... 1 30 3 17 5 9 7 2 26050 1 10 500 One-pair ... 2 30 4 17 7 8 3 2 25333 1 10 434 Two-pair . . C 29 6 17 7 8 3 3 2 5 0 3 4 1 10 430 Ditto .... 5 30 4 17 7 8 3 2 25034 1 10 434 Three-pair .. 8 29 6 17 7 8 0 3 2 4 3 3 4 1 10 430 Ditto. ... 7 30 4 17 7 8 0 - 24334 1 10 434 There is a dispensary upon the premises, supplied by the parish. The inmates are employed Dispensary supplied as nurses, with gratuities in money and extra diet. by parish^ Water is supplied, by the New River Company, to two large tanks in the yard behind the Water supply house. The infirmary is furnished with two large cisterns in the roof, supplied from the tanks cisterns by force pumps. There are eight closets in the infirmary, but only one in the house. There are also six Water-closets, single privies and two double sets in the yards. These are flushed three times a week from p r : v : 00 the cisterns at the back of the house. There are two baths in the receiving wards, and one slipper bath. Baths The house commands a good drainage- fall into the main sewer. All the cesspools have D ra m a g e< been removed. The Guardians are prepared to engage a house of adequate dimensions, if one can be Provision for choobtained for that purpose ; but, failing in this, the large room used as a work-room for the lera « Large room. 38 REPORT on tlic CAPABILITIES of the METROPOLITAN WORKHOUSES women, and termed the B'eather-room, could be made available. This room, the main portion of a one-story building, is quite detached from, though adjoining the house. It measures 85 feet in length by 20 feet in breadth, and has an average height of 13 feet, and contains about 23,800 cubic feet. It is well boarded, dry, and warm, and is lighted by a continuous window running along the greater part of one side of the room. In the event of this room being required for cholera cases, it might be divided by a central partition, giving two rooms of nearly 12,000 cubic feet each; a second partition might then be run up cutting off a portion from the ends of each of these rooms, so as to make two smaller ones — the one for nurses, the other for a supernumerary medical officer to sleep upon the spot. The two principal rooms would then give ample accommodation for 20 beds, 10 for each sex, besides smaller rooms with accommodation for nurses and medical attendant close at hand. The room already contains one fire-place, but, when divided, would require one or more Arnott's stoves. Some other simple alterations would be requisite, such as the formation of a second entrance door, and possibly some alteration of windows; but the latter appear at present to be amply sufficient in extent. The room is furnished at one end with a large sink, and an abundant supply of water. The women who would be displaced by this employment of the room might probably have a temporary workshop erected upon the premises for their use, as ground exists available for this purpose. Former provision. On the former occasion, in 1832, a house was taken in Queen's Head-lane, containing 12 rooms, and about 20 beds, which were sent from the house. Nurses were employed at a guinea and a-half a week : 60 cases of cholera, and 39 deaths, occurred in this district in 1832. Suggestions. Suggestions. — The infirmary is deficient in ventilation, as, except in the two lower rooms where the ventilators are so constructed as not to be available in cold weather, no special means for ventilation are provided. The house, however, is so constructed as to admit of free ventilation at comparatively little expense. The staircases are well aired by means of large ventilating apertures between each landing, giving a sufficient circulation of air. No. 33. ROTHERHITHE WORKHOUSE Neighbourhood. Is situated in Lower Deptford-road, Rotherhithe, and stands on a clay soil. The neighbourhood is not crowded. There is a chemical factory employing nearly 100 people, situated about. 250 yards from the house, which gives out very unpleasant odours. A tidal ditch surrounds part of the house and premises ; both of these are nuisances. The house is open on all sides, and consists of an old building facing the road, and of a new portion built about ten years since, situated behind the main building, and at right angles with it. This new portion contains the sick and infirm wards for men, the sick wards for women, the school-room and Number of inmates, bed-room for children. The stated maximum number of inmates is 340; the present number is 202. The number of sick wards is two, and at the time of the visit they contained 23 Sick wards. patients. The dimensions of the wards are as follows :—: — Windows. ?. J*J Wards. Length. Height. Width. Doors. . *' re " Beds. * eetto ° ° " places. each No. Height. Width. Person. Ft. In. Ft. In.! Ft. In. Ft. In. Ft. In- Men's Sick Ward. . 30 0 10 6 17 0 1 4 5 0 3 4 1 12 466 Women's Sick Ward . 30 0 10 6 17 0 1 4 5 0 3 4 1 13 412 Ventilation. Although these wards are exposed to the open air on three sides (as the building is only one room thick), and although there are plenty of windows and window ventilators, and the house stands in an open space of ground, they were exceedingly closa at the time of the visit in the afternoon. Besides the ventilators in the windows which do not open at the top, the only other plan of ventilation consisted of holes near the door, which allowed the air to pass from the ward below into this room. The mode of construction of this and some other wards is very objectionable ; for the ward below communicates with the one above by a staircase, which is in reality a large shaft for the egress of the foul air from the rcom below, which passes into Water-closets. the sick ward above every time the door is opened. No water is laid on to these sick wards. Nurses. There are no closets, and the patients use night-chairs. There is a pauper nurse to each ward. The yards are much too small for exercise. Water is supplied by the Southwark Water. Company, but only to the basement story of the house, whence it is carried to the wards, &c. Cessnools There are six cesspools, one being placed under each privy : some of these cesspools have a depth of 10 feet of soil, and each has an overflow-pipe into the sewer, which is large enough to be capable of carrying away the drainage of the house ; these cesspools require emptying Privies. four times a-year. The privies are dirty and damp, and are in a yard near to the house. Accommodation for The Board has not yet taken into consideration the subject of the cholera. During the cholera patients. former visitation the patents were attended at their own houses. The rooms in the building are so close and low, that it would not be advisable to admit cholera patients into them ; but the infirm patients might be removed from the infirmary into the body of the house, and their wards used for cholera patients. Cases of cholera reported in 1832 in this district, 21 ; deaths, 19; recoveries, 2. for the RECEPTION and TREATMENT of CHOLERA CASES. 39 Suggestions. — The sick wards require ventilating and warming, and means should be adopted Suggestions, for preventing the foul air rising from the ward below into that above. Water should be laid on, and water-closets provided. Water-closets should be placed in the yard, and the cesspools and privies abolished. The tidal ditch ought to be filled up. Baths, with an abundant supply of warm and cold water, ought to be added to the house and the infirmary. The dust-bins should be covered over. Covered litters should be provided. No. 34. KENSINGTON WORKHOUSE Stands upon a gravel soil; its immediate neighbourhood is not crowded. This house is very Neighbourhood. old and ill adapted for its purpose, and a new one is in the course of erection and nearly completed. The limit to the number of inmates is 263 ; the number at the time of the visit was Number of inmates 268. There are seven wards devoted to the sick. Sick wards. w i Cubic Windows. F - F . f Wards. Length. Breadth. Height. Doovs. J^ Beds. J^ No. Height. Width. Person. Ft. In. Ft. In. Ft. In. Ft. In. Ft. In. Men— No. 4 .... 33 3 21 5 12 0 1 55040 1 14 607 Men— No. 5. ... 30 3 21 6 12 0 1 55440 1 10 774 Women— No. 6. .. 30 2 21 6 12 0 1 5 .. .. 1 11 713 Women 16 0 12 3 11 6 .. 13 0 4 9 1 5 450 Ward. J6 0 12 0 11 7 .. 13 0 4 9 1 5 441 Ward 22 8 12 10 8 7 .. 2 4 10 2 8 1 6 408 Fever Ward. ... 28 3 710 95 .. 3 2 10 2 8 2 8 263 The average space in these wards is 522 cubic feet; the largest is 744; the smallest 263, in a fever ward. All these wards are very close, and smell unpleasantly, although some of them are large and Ventilation, not crowded. They have not any means for ventilation, with the exception of three, which have communications with the false roof; but all of these are closed on account of the cold air passing down them, The fever ward is dark and close, and opens upon the stone-yard. There is one medical Medical officers, officer, who supplies the medicines. There is one nurse to each ward ; all are paupers, and Nurses. some of them receive from 1* 6d. to '2s. 6d. per week. The yards for exercise are too small. There are two cesspools in the yard, which receive the contents of the privies. There is one Cesspools, bath. The burials take place twice a-week ; the dead-house is situated close to one of the sick Dead-house, wards, and is very offensive in summer. Cases of cholera reported in IS3'2, 18; deaths, 15; recoveries, 3. The subject of the cholera has not been considered by the Board ; this house is not calcu- Accommodation for lated to receive patients who connot be attended at their homes. The officers of the establish- cholera patients, ment do not know of any house which could be taken for cholera patients. Suggestions. — The wards might be ventilated and warmed at a very trifling expense. Suggestions. Covered litters should be provided. The cesspools and privies should be removed. No. 35. HACKNEY UNION. This house is built directly upon the gravel, at a sufficient elevation to command a situation fall of from 20 to 30 feet to the marshes. It is most advantageously placed in a perfectly open position, free on all sides, and fronting the north in the main road. A new infirmary has just been completed, and the house generally is undergoing such exten- New infirmary, sive alterations and additions that it is not possible to give a corresponding return with those of House undergoing the other workhouses. For example, the sick are distributed in various parts of the house ; extensive alterathe infirmary not being yet occupied by them. We have therefore not attempted to make any ons onsmore specific returns relative to the present accommodation for the sick than will be found in the particulars of the present number of beds so occupied, &c. The return, therefore, as far as it relates to rooms, ventilation, &c, has reference to the accommodation which is now in progress, and which will shortly be available for the sick ; also to that which could be provided immediately in the event of cholera becoming epidemic ; for the infirmary is in a sufficient state of preparation to be made available for cholera cases, even if occasion should immediately arise. We shall therefore again more fully notice this building. The present number of occupants is 487; the limit 522. The future accommodation, how- Number of inmates, ever, when the improvements are completed, will reach nearly 700. There are at present five sick wards for the men, containing 33 persons, and three for the women, containing 32. Sick wards. The number of infirm of both sexes together is 55. There is one medical officer for the house. There are no paid nurses, but the inmates are Medical officer, employed as nurses, with extras in diet. The water is supplied from the main by the East London Company. There is one large ser- Water. 40 REPORT on the CAPABILITIES of the METROPOLITAN WORKHOUSES vice-tank in the yard, and two large iron tanks at the top of the house, besides a lead cistern over every closet, supplied entirely by the high service. It is in contemplation also to sink a well. There are two fixed and one slipper bath. Two more will be added to the schools, and one to the infirmary. When the additions are complete there will be water-clossets in every floor throughout the house and infirmary. That is, for the infirmary, 6; for the house on the women's side, 7; children, 6; men, 12 ; in all, 31, exclusive of others not for general use. Baths. Water-closets. There are no cesspools. The drainage is by main drains into a 12-feet drain in the public street, with apparatus for flushing. .9 , T 111- • • 1 Drainage. It istn contemplation to have convalescent wards and a large exercising ground. The new infirmary contains six wards, measuring 22± feet by 16, and 10 feet high. These rooms are ventilated by air-bricks in the outer walls, covered inside by wooden flaps ; and in the upper stories by Day's wind-guard ventilators, communicating through the roof to the outer air. There are two grated openings in the ceilings of the two upper rooms, but no venti- New infirmary. lation in the rest, except the air-bricks mentioned. Ob the occasion of the last epidemic, all the cholera cases were treated at their own homes. Should another epidemic arise, and it should be found necessary to remove any cases to the workhouse, ample provision could be made in the new infirmary. It appears that in this event the whole of the new infirmary could be appropriated to this purpose, giving 6 rooms, each containing 3630 cubic feet, which would allow of 4 beds in each ward, with more than 900 cubic feet to each bed. Thus the infirmary could supply, if necessary, 12 beds for each sex, or 24 in all,— a far greater number than in all probability will be required in this comparatively healthy neighbourhood, besides furnishing 6 smaller rooms in the same building, which would serve for the accommodation of nurses, medical officers' sleeping room, &c. Provision for cholera. This house possesses no means for removing cholera patients, except a police stretcher. For this purpose a covered litter would be required. Only five cases of cholera are returned as having occurred in this district in 1832. These all died. No covered letter. Suggestions. — The ventilation of the new infirmary does not appear to be well contrived. The air-bricks are so placed as to open on a level with the floor of the wards, and are guarded inside by wooden valves, which, being within reach of the inmates, will, as experience of this form of ventilation has always shown, be liable to be closed at the time when ventilation is most wanted, namely, at night. We doubt also if the form of ventilation employed for the upper wards, namely, Day's wind-guard ventilators, to which the air is intended to be led uowards by grated openings in the ceilings of these rooms, will be found to work well without ¦T .7 O r O .11 /• .1 _1 1 /» _f „' I xU,* Suggestions. some further adaptation ; as from the absence of any other channel for access of air, whenthe doors and windows are closed, it may be expected that the draught by the chimney when the fires are lighted will cause the air to descend by these apertures, and thus create a constant downward current. To avoid this, and to ensure the ventilators acting as passages for upward currents of air, we have suggested the insertion of wooden hoppers over the doors to communicate with the passages, which are themselves very airy. If these rooms should be required for cholera cases, and the alterations in the mode of ventilating which we have suggested should be made, stoves or other warming apparatus would be required for the staircases. With these exceptions, we think the provisions of this house, in regard to sanitary arrangements, excellent. Suggestions for warming infirmary No. 36. EAST LONDON UNION, BISHOPSGATE WORKHOUSE. This workhouse is situated in Dunning's-alley, Bishopsgate-street, in the midst of a denselypopulated neighbourhood, consisting chiefly of small and poor houses, let out mostly intenements. The house is of quadrangular form, enclosing a central paved yard, measuring 90 feet by 30 ; this beinff the only place for exercise of the whole of the inmates, the number of whom is 396, consisting entirely ot females. Situation. Neighbourhood. Small exercising yard. Number of inmates Sick wards. Two wards are appropriated to the sick, giving 37 beds. The dimensions of the wards are as follows : — Windows. F - Cubic Wards. No. Length. Breadth. Height. Doors. Beds. Ft. In. Ft. In. Ft. In. Ft. In. Ft. In. Fever Ward ... 35 37 0 21 0 9 0 2 54139 1 11 635 Sick Ward ... 36 65 0 18 0 9 0 3 74139 2 26 438 Infirm wards. There are also two infirm wards,— one, No. 21, on the first floor, containing about 12,090 cubic feet, has 22 beds, of which 15 are double and 7 single, allowing only 326 cubic feet to each person if all the beds are filled. The other infirm ward, No. 30, contains the same number of beds, and has the same dimensions. The number of persons in the former was 33, and in the latter 35 on the day of our visit, so that in neither were the beds then quite full. There is one medical officer for the house, one superintending nurse or assistant matron for the sick wards, who is paid; also unpaid nurses or helpers in each sick ward. Medical officer. Nurses. 41 for the RECEPTION and TREATMENT of CHOLERA CASES. The ventilation of the sick and of the infirm wards respectively is very unevenly arranged; Ventilation. and we mention the latter here chiefly for the purpose of contrasting two examples of excess and defect of ventilation, that is, as shown in the sick and infirm wards respectively. In the sick or fever ward, No. 35, which is on the third floor, there is a louvre board, measuring 2 feet 6 inches by 3 feet 3 inches, with fixed bars over the door leading from the passage. This admits air to the room from the passage, which latter is also well ventilated. In the ceiling of the room itself are two large openings. One of these measures 4 feet 2 inches by 3 feet 8 inches, and leads to an enormous wooden shaft of corresponding dimensions at the base, but diminishing upwards as it passes through the roof of the house. This aperture can )ae closed and opened at will by a sliding trap, running parallel with the ceiling. Besides this, there is also another opening in the ceiling, measuring 2 feet 8 inches by 2 feet, which is Covered over by a board. But the second of these is kept closed, and the first alone would be sufficient for the ventilation of the entire house if it had been placed in a fitting position, as, for instance, at the top of one of the staircases, where it might have served to draw off the stagnant air. But from its position and disproportionate size, so large a quantity of cold air must be drawn down it, into the room, when there is a free draught up the chimney, and when the door is closed, that the occupants would naturally be led to keep it covered, as the means of closing it are always at hand. Thus the means intended to preserve ventilation become inoperative from the excess of the arrangement. Now it. will be observed that of the four rooms which we have taken for the sake of comparison, viz., the two sick and the two infirm wards, the sick or fever ward of which we have just spoken, as supplied with excessive, or rather, it may be said, enormous means for ventilation, is that which of the four gives the largest space to each person, namely, 635 cubic feet per bed, all of the beds in this ward being single. In the second sick ward, No. 36, which contains 26 persons, the number of cubic feet per bed is reduced to 438 ; but here there are no means for ventilation, except a louvre board, measuring 3 feet 4 inches by 16 inches, over one of the doors. This, however, leads to a passage, the windows of which are kept open during the day. But a single opening of this size, the ventilation through which is necessarily much reduced by the transverse bars, is quite inadequate in itself to the ventilation by night, at least, of a room 65 feet long, and containing so many persons. This room communicates with the first-mentioned by a second door, but when this is closed it can derive no benefit from the means for ventilation which the former possesses. In the two infirm wards, again, the number of cubic feet per individual is reduced to 326, when the beds, double and single, are all occupied ; but here a louvre board over one of the doors supplies the only means for the entrance of fresh air; so that in rooms containing beds for 35 persons, with imperfect ventilation, and that, only at one end, the air at night must necessarily be very stagnant; though by day, when there is a free draught from the passages, and with the advantage of a door at either end of the room, the change is sufficient to keep the air fresh. This house is well supplied with water both by the East London Water Works and also by Supply of water, a never-failing well in the yard, supplying the cisterns of the house by a force-pump. There Cisterns and tanks are also large tanks in the back yard. The drainage is very good. There are no cesspools, and all the sewers are flushed twice Drainage, a-week by filling the cisterns with the force-pump, and letting the water loose through them. Flushing. There are five water-closets for the sick wards and four privies for the rest of the house, Cosets and privies, including one in the yard. All these, with one exception, have cisterns on the top. There is one bath, with hot and cold water, in the receiving ward, and one slipper bath. Baths. The rooms are all lime-whited twice a-year, or oftener, if necessary, in the sick wards. Lime-whiting. Fever cases are not removed from this house. There is one covered litter. Fever cases not This house does not appear to possess any room that could be employed for cholera cases, removed. There are no detached buildings, and even if a room could be spared for the purpose, it would -r, 1 c , i i • vi • * i v i •a. i. v- v • l i \> Provision for chobe very undesirable to introduce cholera cases into a house which is so cramped for space, j era# both from the small size of the central yard and from the contiguity of surrounding buildings. We think a better system for changing the air in the sick rooms by night is required. No return was made of cholera cases occurring in this district, in 1832. No return of cho- lera cases in 1832. No. 37. EAST LONDON UNION, ALDERSGATE WORKHOUSE, Situated in Aldersgate-street. The house forms three sides of a quadrangle, and is rather Situation. closely surrounded ; but the neighbouring houses are tolerably good. The limit of numbers is Neighbourhood. 210; the number at the date of visit 188. This house is for men only. Three wards are Number. appropriated to the sick, viz. :—: — Sick wards. Windows. V ' „ n.,w- Wards. No. Length. Breadth. Height. Doors. — , Beds. V" D ' C No. Height. Width. I)laces " leet - Ft. In. Ft. In. Ft. In. Ft. In. Ft. In. Second Floor. . . 3 36 016 0 9 6 3| j * J " jj} 1 14 390 Ditto ... 7 25 0 17 0 9 6 ] 46026 1 11 367 First Floor ... 8 25 0 19 G 9 10 1 66036 1 14 340 G 42 REPORT on the CAPABILITIES of the METROPOLITAN WORKHOUSES Infirm wards. There are also many bedridden in the infirm wards, which contain 36 beds. Medical officers. There are two medical officers. The Guardians have directed a paid nurse to be appointed. Nurse. A distinct wardsman has been always appointed for each sick ward, under the superintendence of the master and matron. Water. Water is supplied by the New River Company. There is also a well, giving an unlimited supply. Baths. There is one fixed bath in the receiving ward. Cesspools. Two small cesspools are connected with the washhouse drains, which are emptied about once in three years. There are only two water-closets in the sick wards ; in the rest night-stools are used when Water-closets. Privies. required. There are two privies in the yards. The sewers are flushed every moraine. Provision for cho- This house does not appear to offer the slightest accommodation for cholera cases. There era- is no return of the number of cases occurring in 1832. Suggestions. Suggestions. — The necessity for night-stools in the sick wards should be avoided by an additional closet. The privy in the vagrant yard needs improvement. The drainage should be altered so as to admit of the cesspools being removed. No. 38. WEST LONDON UNION This workhouse forms two sides of a quadrangle. The front is in West-street, Smithfield. The neighbourhood is crowded and the habitations bad, but rapidly improving, in consequence of building alterations. At the back of the house is a yard which proves a great nuisance, Situation. Nuisance. requiring the windows to be closed in warm weather. Number of inmates. The limit of number is 500. There are 7 sick wards, giving 102 beds, all of which are Sick wards. single except 7. The following are the details of the sick wards :—: — Windows. v . Beds. jFJIL Wards. No. Breadth. Height. Doors. V^ each No. Height. Width. ' Single. Double Person. Ft. lv. Ft. In. Ft. In. Ft. In. Ft. In. Women's Sick Wards . 7 32 9 18 4 9 3 1 4 5 9 2 11 1 11 1 329 Women's Fever Ward 21 26 0 17 0 10 0 1 3 6 4 3 5 1 10 .. 442 Children's Sick Ward . 9 17 0 16 5 16 2 1 3 6 10 2 10 1 Front Ward, Men's Sick Ward . . 16 39 5 18 0 10 5 1 5 6 6 3 4 1 15 .. 497 Back Ward, Ditto ditto 16 20 0 16 10 10 10 1 3 4 11 3 4 1 8 .. 455 Ditto ditto 4 24 0 16 0 9 8 1 2 5 0 3 4 1 10 .. 371 Men's Fever Ward .... 40 0 16 6 10 10 1 43624 2 2 7 444 Women's Sick Ward . 10 37 6 17 10 10 0 1 5 5 8 3 10 1 16 .. 415 There is also a convalescent room for men. Exercising yards. There are two exercising yards. Water. Water is supplied by the New River Company. Baths. There is one fixed bath, one slipper, and one shower bath. Closets. Thirteen water-closets are provided for the house, and there are two privies in the yards Privies, which are flushed daily. Cesspools. There are two cesspools communicating with the drains. Provision for cho- The females' sick or fever ward, No. 21, on the first floor, is a good room, and would be tera. very suitable for cholera cases if no other place could be provided. As, however, there are only two female sick wards, it probably could not be easily so appropriated. Of the four men's sick wards, the fever ward, which is at the top of the main building, is decidedly the worst, and quite unfitted for the reception of cholera cases. It is very badly ventilated and smells very close. On the day of our visit it contained two single and seven double beds, the only ones, we believe, remaining in the house. The double beds appear to have been since removed from this ward. "~ — In all probability a sufficient amount of room could be obtained out of the house. Some premises in the street could probably be made available. No return of cholera cases was made for this district in 1832. Suggestions. — It is recommended that the cesspools should be removed, and attention paid to the ventilation, especially of the men's fever ward. Suggestions. for the RECEPTION aud TREATMENT of CHOLERA CASES. 43 TABLE Showing at one view the Amount of Accommodation that could be provided for Cholera Cases in the Thirty-eight Workhouses. Note. — This table proceeds according to the rate of sickness during the last epidemic, that district being placed first in which the greatest number of cases occurred. East and West London are placed separately at the end, no return of the number of cases which occurred in those districts having been made. No. Name of Workhouse. Provision for Cholera. 1 St. George the Martyr . No provision can be made in the house. 2 St. Olave, Southwark . . No room, in consequence of alterations. 3 St. Saviour .... Very poor accommodation in a small detached house. Quite inadequate for this district. 4 Whitechapel .... Very good and probably ample provision ; seven rooms in one wing of workhouse containing about 4200 cubic feet in each room, with accommodation for medical officer and nurse. 5 Christchurch Whitechapel . No provision can be made or advised in this house. 6 St. Giles- in-the-Fields and Sufficient accommodation ; a large infirmary has been lately erected. St. George, Bloomsbury. 7 Lambeth ..... The house is full. 8 St. James, Westminster . The house is nearly full ; there is not any probability of separate wards being set apart for cholera patients. 9 St. Margaret and St. John's, There is a separate house, which was used as a cholera hospital Westminster. in 1832, containing four rooms. 10 St. Martin-in-the-Fields . Additional wards have lately been erected which provide sufficient accommodation for cholera patients. 11 Bermondsey .... There is no room here. 12 St. Marylebone . . . The house is full ; there is no accommodation at present. 13 Ratcliffe There is no room. 14 Mile End Old Town . . This house receives the fever patients of the Stepney Union ; the fever wards would, therefore, afford accommodation. 15 Limehouse This house is for children, and there is no room. 16 Wapping The house is over-crowded. 1 7 St. Mary, Newington . . The house is nearly full ; there is no accommodation for cholera patients. 18 Bethnal Green . . . The house is full ; the Board think of sending out general inmates and of giving them out-door relief and of taking in cholera patients. 19 St. Luke, Middlesex . . Detached fever house, with excellent accommodation. 20 Greenwich Two detached rooms in the infirmary. Other provision advised for out-door cases. 21 St. George-in-the-East . Scarcely possible to provide accommodation in the house, and none at present known out of doors. 22 Camberwell .... A new wing detached from the main building has been lately erected, and will afford good accommodation. 23 Chelsea Two wards capable of holding 18 persons have lately been fitted up on account of the late increase of sickness. 24 Poplar There is a separate hospital well situated, and containing eight rooms. 25 St. Pancras .... The house is quite full ; it would not be advisable to admit cholera patients here. 26 Holborn ..... A large ward on the first floor of the workhouse, at present allows 520 cubic feet to each of 26 beds ; might be divided into two rooms with a separate entrance to each. 27 Clerkenwell .... No accommodation whatever. 28 St. George Hanover-square Doubtful if any provision can be made in the house. 29 Shoreditch St. Leonard's . The house is now overcrowded. If the numbers are diminished, two wards could be appropriated. 30 Paddington ... . The house is nearly full; it is too far from the abodes of the poor to be suitable for cholera patients. 31 Strand. . . . . . A small detached building forming the South Lodge. Very inadequate. 32 Islington, St. Mary . . The large detached feather room can be used. It might be divided by a partition into two apartments, giving nearly 12,000 cubic feet to each room. 33 Rotherhithe . . . . The wards in the infirmary might be tised. 34 Kensington .... The house is full, and not calculated to receive cholera patients. 35 Hackney The whole of the new infirmary, capable of affording 900 cubic feet to each of 24 beds, besides accommodation for medical officer, nurses, &c. The following districts made no return in 1832: — 36 East London — Bishopsgate No accommodation whatever. 37 ? Aldersgate . No accommodation whatever. 38 West London .... None can be recommended in the house. Premises in the street can probably be obtained. _ Table showing the amount of accommodation for cholera cases in each workhouse. 44 REPORT on the CAPABILITIES of the METROPOLITAN WORKHOUSES General Remarks on the Amount of Accommodation for Cholera Cases, afforded ly the different Workhouses. By the returns given above, it will be seen that in many of the workhouses as now constituted no accommodation whatever can be provided or recommended for cholera cases ; whilst in others an amount sufficient to meet expected emergencies may be easily procured ; and in some, as for example the new infirmary of the Hackney workhouse, even more than can on any reasonable calculation be requisite may, without inconvenience, be supplied. And further, it will be found that the amount of accommodation in the various houses will be sometimes greatest where it will be the least required, and least where it would be the most desirable. This result of the inquiry might, perhaps, have been expected, because where the workhouses are situated in densely populated and unhealthy neighbourhoods, there will be generally less accommodation for the inmates, less space, less opportunity for exercise, ventilation, and other requisites for maintaining health. So that even if rooms could be set apart in such workhouses, it would not be desirable to send cholera cases into them; for neither would the patients have so good a chance of recovery as at their own homes, however destitute, nor would the inmates of the house generally be safe from the invasion of the disease, where so many untoward circumstances combine to favour its development or diffusion amongst them. On the other hand, where the districts are more healthy, and where both on this account, and also from our experience of the former epidemic, we may fairly infer that fewer cholera cases will arise, from the neighbourhood being less crowded, and thus affording greater scope for carrying out proper measures for the preservation of health, in such districts we may expect that there will be less demand for the removal of persons from their own abodes, whilst there will, from the same cause, be also more than the necessary accommodation in the workhouses for them. This is the more to be regretted, because the nature of the disease and the rapidity of its progress render the removal of the sick to any distance very objectionable in itself, and often imposssble, so that no arrangement could be entered into between two or more houses with a view to mutual accommodation which might, perhaps, under other circumstances, have been suggested as a temporary expedient warranted by pressing necessity.. Some idea may be formed, though necessarily an imperfect one, of the adequacy of the accommodation which the different workhouses appear capable of affording to meet the anticipated evil, by comparing the extent of this accommodation with the returns of the number of cholera cases which occurred in each registration district in the year 1832, as set forth in the table furnished by the Sanitary Commissioners at page 15 of their Report. For the purpose of making this comparison as direct as possible, we have at the end of our description of each workhouse, as above given, added the number of cholera cases and the number of deaths which are reported to have occurred in the corresponding districts during the last epidemic. These we give on the authority of the table just referred to ; but it should at the same time be observed that the Sanitary Commissioners submit these returns as offering only approximations, and any inference to be drawn from them must therefore be qualified by this circumstance, and also by the consideration that the extent of the provision for the reception of cholera cases should be regulated, not so much by calculations founded upon the number of cases that have formerly occurred, or that may be expected to occur again in any given district, as upon the known character of the locality, in respect of the physical condition of the inhabitants, the nature of their dwellings, the prevalence of destitution, and other important considerations ; since it cannot be too constantly borne in mind, that the arrangements which we suggest in this Report have reference to the removal of only the most destitute, and those whose abodes are totally unfitted for the curative treatment of the sick, and that they never apply to the removal of the sick to cholera wards or hospitals, whether in or out of the workhouse, as a measure of universal or even general expediency ; but that, on the contrary, wherever it is practicable, the patients should be treated at their own homes. For it is not here, as with fever, in which last the removal of the sufferer from the locality in which his disease was contracted is often a step of primary necessity to his cure, while in cholera, even where the for the RECEPTION and TREATMENT of CHOLERA CASES. 45 occasions for removal are urgent, the disadvantages are too often found to counterbalance the benefits, except in the very early stage of the disease, and while the powers of life are yet equal to the agitation and exposure necessarily attendant on the change of place. This important difference in the circumstances of the two diseases, if generally understood and duly observed, will tend greatly to diminish the number of cholera patients who would otherwise be removed from their abodes. And still further will the number of removals be diminished, by the rule being observed that such removal should be permitted only in the very earliest stages of the disease. This rule should never be deviated from. As then it appears that in a large number of the workhouses which we have inspected no fitting reception can be afforded for the destitute, and those deserted through groundless fear of contagion, it becomes necessary that some other provision should be either immediately made, or at least kept in view, in every such instance. When, then, we have found the houses so crowded, or otherwise on account of their construction or general arrangement unfitted to receive cholera cases, and especially where the usual sick or fever wards were already insufficient for the number of sick in the house ; and where these were badly constructed, and either placed among or adjoining to the healthy wards, and not sufficiently detached from them, we have in all such houses pointed out the circumstances which appeared to us to offer sufficient grounds of objection against the introduction of cholera cases into them ; and for these we would suggest the provision of that accommodation out of the house which other establishments are found capable of affording within their walls. With this view we have mentioned, in connexion with the description of each of these workhouses, any such external accommodation as we thought might be provided in case the necessity for it should arise. We fear, however, that in some instances at least much difficulty and opposition will have to be encountered in the engaging of separate buildings or houses for the reception of cholera cases, on account of the prejudices which are in general entertained, founded upon the imagined infectiousness of this disease — prejudices which we have endeavoured, as far as possible, to remove, and at the same time to point out their attendant evils, in the general suggestions which we have given at the end of this Report. Whilst then we agree with the Sanitary Commissioners in discouraging generally the formation of cholera hospitals for the purpose of removing the sick indiscriminately to them, especially in the advanced stages of the disease, still we have thought it necessary in all cases, where no adequate provision could be found in the workhouse, to ascertain as far as we could whether some arrangement might be made out of the house, and within such short distance as to admit of supplies being sent immediately from the house, and such other requisites furnished, together with medical and other attendance as the exigencies of the case may demand. Finally, as a caution against injudicious and hasty preparation, and to show how necessary it will be to calculate the probable exigencies of each district before the arrangements are finally decided upon, we think it right to mention that, during the former visitation of cholera, much money was wasted in the preparation of special hospitals, where none were actually required, and that " in one of the healthiest parishes in the metropolis, no fewer than four district " infirmaries were established, and in one, if not in two of these, the number of " patients did not exceed four or five." General Observations and Suggestions regarding Ventilation, Warming, Supply of Water, Baths, Cesspools, Drainage, §c. The extent to which it may be necessary immediately to carry out any or all of the suggestions which we have given in the preceding paragraphs will remain in a great measure contingent upon such further advices as may be received regarding: the advance of cholera in the direction of this country. There are, however, certain points to which we must next refer, and which we esteem to be so important, as measures of general precaution, that we think they should at once receive attention. We have accordingly under the present heading, given the result of our observations upon all those points to which, as 46 REPORT on the CAPABILITIES of the METROPOLITAN WORKHOUSES we have stated at the beginning of our Report, we thought it necessary to direct our inquiries, as matters bearing upon general health and the treatment of disease, accompanying our remarks by such suggestions as we think may tend to improve the physical condition of the inmates of workhouses in general, and place them in a position which would render them less prone to be attacked by cholera, or better fitted to resist its ravages, should that disease spring up amongst them. Recommendations of the use of wards for cholera cases contingent upon their previous improvement. For we wish it to be understood that in every case where we have pointed out certain wards or other portions of workhouses as suitable for the reception of cholera cases, our recommendations of their use for such a purpose should be considered as entirely contingent upon the previous or contemporaneous carrying out of such suggestions for the improvement of these particular portions of the house ; or of certain alterations in the existing arrangements, as in the ventilation, drainage, and other matters, as we have thought it necessary to be made, before persons affected with cholera could be with any degree of prudence received within their walls. Ventilation. Necessity for improved ventilation. Among the foremost matters which appear to us to call for immediate and personal supervision, with a view to improvement, stands the question of ventilation. By no circumstance perhaps have we been so forcibly struck, in the course of our inspections, as by the constant, we may with truth perhaps say, universal defects, which we have met with in respect to the carrying out of this most important principle for the preservation of health. Upon a careful review of the memoranda which we have made regarding the ventilation of the 38 houses which we have visited, there is not one, including even those recently built, to which we could point as offering a satisfactory example of ventilation conducted upon sound principles. In making these remarks we wish to be distinctly understood as clearly separating the question of the efficiency of ventilation from that of the desire on the part of the Boards of Guardians and Directors in general, to make the ventilation sufficient. Of the latter, we have never found occasion to complain, but, on the contrary, have generally, in pointing out specific defects in the existing ventilation, perceived every disposition to adopt a more perfect system, and in some cases we have ascertained that large sums have been expended with this view, as for example in the Lambeth Workhouse, where a sum of 150£. has been recently devoted to this purpose, though without the result of obtaining a perfect or even tolerable ventilation. Yet, in the course of our inspection, we have seen nearly every variety of ventilation attempted, but still not regulated by any one governing principle, which in all such matters is essential. Examples of erroneous and defective ventilation. Of the want of such a principle we can be at no loss to adduce examples, either from the instances already given in the preceding pages, or in many others which occurred to us in the course of our visits. From the former we may quote the instance of the fever ward in the workhouse of the East London Union in Dunning's-alley, as given at page 41, where in this single ward, which affords a greater amount of cubic space to each bed than any of the rest, and on that account would require a less constant change of atmosphere, the means for ventilating are so disproportionately large, as to be capable of serving for the airing of the entire house, if placed in a fitting position, but from the present situation being such as to afford no opportunity for communicating with other wards, these last are left unassisted by it, whilst they are themselves not only deficient in means for ensuring change of air, but also at the same time afford much less relative space to each bed (sick and infirm) than in the room first mentioned. The intention in the first instance was no doubt to give to this room, as a fever ward, an advantage in regard to frequent change of air; but as we have universally found to be the case, where the means are not well apportioned, excess of air becomes practically a defect, because the inmates of such rooms, if they have the power of regulating the ingress of air, by having access to the ventilators, invariably close them when the superintendent's back is turned, and especially at night, when, from the doors and windows being closed, and the fire extinguished, the circulation of fresh air is reduced to the lowest amount. While on the other hand, if the ventilators admitting cold air are badly contrived, and cannot be closed at will, the inmates become so clamorous, and so many examples occur of ophthalmia, or other for the RECEPTION and TREATMENT of CHOLERA CASES. 47 signs of unequal distribution of air, that the ventilating apertures are boarded over, or otherwise covered so as to be rendered inoperative, and thus the first error is replaced by an opposite and worse extreme. Almost every house that we have visited has furnished us with an illustration Necessity for of the necessity for rendering the regulation of the ventilators independent of "on 'ofthe^entnl*" the inmates ; that is, of placing the power of regulating them beyond the control tion independent of of any but those in authority. Yet without the previous adoption of an approved the inmates « system for regulating the admission of air, we do not well see how this change can be effected. One of the most striking features which we have observed in the course of our inspection is the universal prejudice against, or, as it may not perhaps be too strongly termed, horror of fresh air entertained by the inmates, and consequently we have found ingenuity almost exhausted in endless contrivances to prevent its ingress into the rooms by the apertures contrived for that purpose. Thus whenever, as is generally the case, these apertures can be closed by a valve or trap and string, intended to regulate the quantity of air admitted by them, or to serve for their temporary closure, we have found these openings generally closed by day, and upon inquiry, have learned that they are universally so closed at night. Again, if the apertures are not furnished with an internal Objections to cold valve, but the air is allowed free entrance at all times, then, if these are near air, and contri- vances to prevent the floor, they are usually covered over or stuffed with the clothes of the its entrance. inmates, or, from want of attention, they become so choked with dust, especially on the ground floors, that we had sometimes found it difficult to discover them ; and even where the openings are higher up, we have seen them obstructed with paper pasted over them so like the colour of the walls as to elude a cursory glance. Yet it may be said that the prejudice is not so much against the admission of fresh air as against that of cold air ; and we believe that if fresh air could be supplied, even in however large a quantity, which was not at the same time cold, the prejudices of the poor against its admission would in a great measure be done away. We look upon this circumstance, therefore, as furnishing one of the main principles upon which all ventilation should be conducted, and as at the same time giving the clue to any method which can with reason be expected to be favourably received and adopted by the poor. Such then are the objections which are generally entertained against ventila- Air-bricks. tors as now contrived for the purpose of admitting cold air directly from without. These ventilators we have usually found in the form of small iron gratings or " air-bricks," inserted in the outer walls, so as to admit air directly into the rooms through corresponding internal apertures which are either quite open or covered by a second iron grating, or perforated metal plate, or else closed by a regulating flap or valve as just described. The situation of these internal openings is generally on a level with either the floor or the ceiling. Another mode of admitting the external air directly into the rooms is by Ventilation by window panes. some one or more of the various contrivances for rendering one of the window panes available for ventilation. We need hardly specify the perforated zinc plates, bars of glass obliquely placed, and either fixed or moveable, and apertures partly covered by a metal plate, or filled with a revolving wheel. The latter have justly become nearly obsolete. The perforated zinc plates we have sometimes found to answer well, but they are not adapted to many situations, and in some instances where too great a current of air was admitted by them, the medical officer has been compelled to order their removal, because they produced ophthalmia, and other ailments, in the occupants of the beds immediately below them. The parallel thin plates or bars of glass, if rendered moveable, are liable to the objection which we have pointed out, as applicable to all moveable ventilators ; but where they are fixed, and their situation is judiciously chosen, so that the cold air may not fall directly upon the individual below, they are sometimes found to be of service. Ventilation by the window-panes, if care be taken in the adjustment, is perhaps one of the least objectionable modes of admitting air directly from without, and in some cases may be employed, as for example when, from structural defects in the arrangement of the house, air cannot be admitted from the staircases, or as a speedy and cheap mode of rectifying defects of ventilation in particular rooms, or in houses or buildings employed for temporary purposes, and not otherwise admitting of improvement. One of the most simple and least expensive adaptations of this method of 48 REPORT on the CAPABILITIES of the METROPOLITAN WORKHOUSES ventilating may be seen in the women's sick ward in St. Pancras Workhouse. The lower third of the centre pane of each window is cut away, and immediately in front of it is let in a second pane, of which the upper third is cut off. The two panes are then placed one over the other, so close as to leave a distance of about half an inch between their two surfaces. Thus a stream of air enters by the aperture left by the deficiency at the bottom of the outer pane, and passes into the room by that left at the top of the inner one, entering at an angle of about 30 degrees, thus — M 1 Example of the \y e nave ma de it a practice to inquire of the occupants of the several necessity oiatap a- rooms which we visited, if they entertained any objections to the plans of ventilation in use, and if so, on what grounds ? And in putting the same questions in this case, we found not only that the inmates of the ward did not object, but that this method met with general approbation. In another ward, however, where the same method was partially adopted, we found the window stuffed with paper ; and when inquiring for the reason, it was objected that two great a draught was caused. We mention this as an instance, showing the necessity for adaptation, and to prove that the same method of ventilation may be successful in one case as in another. For in these two instances the wards were of the same construction, upon the same floor, and in every other respect alike ; in the former case, however, almost every window had been supplied with a ventilating pane, so that the air entering at several points at the same moment was gradually diffused through the room without any particular individual suffering inconvenience ; but in the latter instance, where two points only were left for the air to enter, the individuals occupying the beds immediately beneath complained that they were in a constant draught, and hence the attempt to close the apertures altogether. It is further important to notice that in the second of these wards, the inmates were older than in the first, a circumstance which, in general, requires a corresponding modification in the forms of ventilation adopted, as the young bear a freer ventilation than the aged and infirm, which latter having less power of maintaining animal heat, require the admission of a warmer atmosphere. Air-bricks and We have next to point out some modifications of the modes of ventilation ventilators in the last mentioned, and to state what appears to us to be their relative merits and floors and ceilings defects. The air, instead of being admitted directly into the rooms, either by holes in the walls or apertures in the windows, passes by the air-bricks or gratings in the outer walls between the floors and ceilings, and then enters each apartment by circular ventilatiors let into the flooring-boards. Other openings are made in the ceilings, consisting of apertures of various forms and sizes, and either freely open or guarded by a grating, or by a valve or flap as before described, and by these it is intended that the foul air should pass out. Now, with regard to the first of these, that is, the circular ventilators in the floor, which can generally be closed at will by a key or other contrivance, and which are not unfrequently found obstructed or otherwise out of order, these cannot be applied to any but large rooms, and where there is abundant space between the ends of the beds, which is not often found. The latter forms intended to permit the exit of air are as often found to operate in the reverse manner. That is, they as frequently allow the cold air to enter as the warm Uncertain course and vitiated to pass out by them. We have frequently proved this, by holding of the air. a lighted candle or piece of paper to these openings, and have shown that the air often rushes in by the apertures intended for its escape, or that it may be made to pass in or out at the same aperture, by merely closing or opening a door or window of the apartment, or else, that it will pass in at some and out at others of the openings which were meant to serve only one of these purposes. This defect so constantly observed, may be shown in every case to depend entirely upon want of system in the arrangements ; which, whilst they provide often abundant means for the exit of air, leave none to ensure its steady entrance. We refer now more particularly to those cases in which ventilating openings are found only in the ceilings or upper parts of the walls. On inquiring in such cases, by what apertures it was intended that the fresh air should find ingress ? we have been invariably referred to the doors and windows for the RECEPTION and TREATMENT of CHOLERA CASES. 49 as furnishing the necessary means ; the fact being apparently forgotten that these are closed at night, when perfect ventilation is most required. Ilence the error in these constructions, which so constantly shows itself either by the insufficient airing of these rooms, which, though provided apparently with sufficient means for ventilation, often smell close, or else, in the constant complaints of the inmates, that the apertures in the ceiling send down such cold currents upon the beds immediately beneath them, as to prove that they, by night at least, serve a very different purpose from that which they were intended to fulfil. In some cases where we have found these objections urged, especially where the openings were placed in the corners of the ceiling, and conseq uently over the beds, we suggested the temporary addition of a board or shoot, placed at such an angle beneath the aperture as to direct the current of air away from the beds, and towards the centre of the room ; thus, in a measure, avoiding the objection constantly urged against these openings, and at the same time taking advantage of any mode of ingress for fresh air, in preference to excluding it altogether. On this account we prefer the remedy just described to another method which we found often adopted to break the downward current, namely, the fixing of a piece of board over these apertures, leaving a small space for the air on all sides ; for we found that in doing this the workmen are apt to exceed their instructions, and lean so much towards the system of exclusion, as to leave little space for the air either to enter or escape. We regard both these methods, however, as merely temporary expedients. We have thought it necessary thus particularly to point out the defects of these latter modes of ventilating, or rather of attempting ventilation, because we have found them to be so prevalent that there are few workhouses in which some examples may not be found, and in general the entire house, and especially the sick wards have no other means on which to depend for the circulation of air in the apartments. The leading error appears to lie in overlooking the fact, that in order to ensure sufficient change of air, places must be provided for its ingress as well as for its egress. The proposition when thus plainly put, appears to be so obvious, as to render the statement of it almost needless. Yet practically we have found that in the greater number of instances this is the fact which is completely overlooked and misunderstood ; and that while often abundant means are provided for the escape of air, its entrance by the doors or windows is the only conterbalancing arrangements. To provide, then, for the steady and regular supply of air to apartments so constructed constitutes the proper, and in some cases, only remedy called for ; because the means for egress, as will appear from the foregoing statements, in some houses already exist in a sufficient degree. To do this, and at the same time to avoid the objection against admitting the air directly from without, we would advise that where the construction of the house is such as to admit of the arrangement, the passages should be made the medium by which the air should enter the apartments. Admission of air to the rooms from the passages advised. With the passages a communication may be formed over the door of the apartment, by a large aperture, three feet square, which aperture may be protected by a board or hopper of corresponding dimensions, inclined inwards at such an angle as the case may require. These we have found in use in some places, but the wooden board or flap being generally moveable, and furnished with a cord, its closure at night is sure to occur. By fixing the board, however, at a given angle, which, by a simple contrivance of one or more screws might be made a variable one, for different periods of the year, a regulated supply of air to each apartment might be ensured, the draughts occasioned by its entrance through narrow apertures avoided, and the openings already existing and intended for the exit of air only, converted into channels which would constantly carry the air in the intended direction. In making these suggestions, as in some instances we have done upon the spot, we have been met by the objection that large openings will cause the apartments to be too cold, and would call for the addition of more extensive means for warming than already exist. But in this objection the fact is overlooked, that the currents of air which now pass into the apartments down the ventilating openings, create a greater amount of cold than would be occasioned by the admission of air in a better regulated manner and in a larger volume, II REPORT on the CAPABILITIES of the METROPOLITAN WORKHOUSES 50 by which means draughts are avoided, and a more equable temperature obtained. But it would be further desirable, especially in the case of sick wards, that in cold weather the air in the passages should be previously warmed, by an Arnott's stove, or other similar contrivance, a method which could be very easily and cheaply applied in the case of infirmaries or sick wards detached from the house, and one which would not only tend greatly to the preservation of health, but even on the score of economy, might, we think, be very well entertained, as it would diminish the amount of warming requisite for the internal apartments. The passages must We need hardly observe that in every case where ventilation is effected, by weather^ m m C ° ld means chiefly of the staircase and passages, it will be necessary that proper means be provided for ensuring a circulation of pure air in them. One or two more defects it may be necessary to point out in existing modes Ventilation of one sick ward into of ventilation. In some houses we have found openings in the ceiling of one another. sick ward, placed immediately beneath corresponding apertures in the floor of the next above it, and so on to the top of the building. Now, where these openings are connected with wooden air-trunks, running horizontally between, the floors into the outer walls or chimneys, so that the foul air is at once carried away, the objection we are about to urge cannot apply ; but when, as in many cases, no such precaution has been observed, but the warm and vitiated air from one apartment rises by its diminished specific gravity either directly into the next, or even intermediately into the space between the floor and ceiling, and so by other openings finds its way into the next apartment above, though these latter openings may not be placed directly over the former, still in every such case the plan is objectionable, because it allows of the atmosphere, which has been already deteriorated by one class of sick persons, being received into other apartments, and this through a series of several rooms ; the only admixture with the outer atmosphere which such air undergoes being that which takes place in the narrow space between the floor and ceiling, into which the air-bricks commonly open, but in which limited space the air of the lower apartments, instead of undergoing a complete change, would suffer only a very limited dilution. Foul-air flue open- A similar objection exists against the employment generally of large shafts ing into several or air-trunks, running through the house, intended to serve the purpose of Wards. j • _m ,m _ n i _•_ r. j.l- _ j. j._ *a - 1- _/• 1 • _1. •* 1 . drawing off the foul air from the apartments, with each of which it has one or more communicating openings. If in such cases sufficient care had been always observed to ensure the adequate entrance of fresh air to the apartments, these trunks, if not serving fully to carry off the vitiated atmosphere, might at least not operate injuriously. But with a misapprehension so prevalent as that which w r e have throughout had occasion to notice regarding the first principles of ventilation, and with the consequent tendency to misapply the means by which ventilation is sought to be effected, even when these means are not in themselves altogether objectionable, it cannot be expected that in many cases they should prove otherwise than useless, or even positively injurious. As, for example, in an instance which we have pointed out, where one of these large air-trunks had its origin in a lower room employed for the purpose of oakumpicking. From this room, in which the atmosphere was constantly offensive, the warm and foul air was drawn off by a large air-shaft ; but before the latter reached its outward destination it was made to pass by the other apartments, with each of which there was a communicating opening, intended to allow each room to make also its contribution of vitiated air to the shaft, but calculated, by an even chance, to act as a backward passage for that which was worse to enter the apartments, and thus add to instead of diminishing the unwholesomeness of the air contained in them. For it may be easily shown that upon the present system, in almost every case, the slightest change in the number of windows or doors, opened or closed, is sufficient to determine the set of the current in either direction. We think it unnecessary to say anything regarding supposed ventilation by doors, and windows opening by sash action, or turning upon pivots, or otherwise constructed so as to admit of partial or complete opening. These we have shown to be in many instances the only, and very constantly the chief means provided for renovating the air. Though, as they are always closed by night, they must obviously be excluded from that category. In concluding this portion of our subject, we have to observe that though for the RECEPTION and TREATMENT of CHOLERA CASES. 51 we have pointed out many specific defects, and suggested some remedies, yet the nature of our investigations, and the brevity with which they were by necessity made, rendered it impossible for us to do more than classify our recommendations, because each house and each separate apartment would require personal supervision, with a view to the ensuring its correct ventilation. For we have found that even where proper measures had been adopted, these were rendered useless for want of supervision, as in a case where several apartments had been furnished with Arnott's valves, which may be included among: Arnott's valves the most advisable adjuncts to ventilation ; but these we found, though fully recommenaea recommenaeacapable of efficient action, had been tightly screwed down in each room, and upon inquiry we learned that they had been so from the day they were put up, so that they had never been actually in use. They were selected also without observing that they were of the size calculated for small rooms only, and not for workhouses. Whilst, therefore, in the report which we have given of each separate workhouse, we have been careful to point out its specific defects, we must refer for the remedies to the general remarks which we have now made, with the object of conveying our views regarding both specific defects and specific remedies, leaving the selection and adaptation of such remedies to be regulated by the possibility or propriety of their adaptation to individual cases.* Warming and Lighting. Upon the subject of warming we have comparatively few observations to make. In most of the houses, whether of old or new construction, we have found the ordinary fire-places employed, though in a i'ew the Arnott's stoves are in use. With regard to fire-places, we have to remark that they are liable to the Fire-places. usual grave objection of consuming a large quantity of fuel, while they warm only that portion of the room to which they are adjacent, leaving the other parts cold, and exhausting by the chimney, often unnecessarily capacious, a considerable portion of the warm air of the apartment — objections which cannot be urged against the Arnott's or other stoves of approved construction. Arnott's stoves These latter we have previously mentioned as applicable, especially to the warming of staircases and passages, with a view to their conversion into so many air-trunks for the conveyance of warm instead of cold air to the apartments for the purpose of ventilation, a method which not only does away with the constant objections made to the admission of fresh air on account of its diminished temperature, but which would tend much in our belief to equalize the temperature of the apartments in which the warmth is now generally so unevenly distributed. These points we think of especial importance, because we regard a warm and dry air as essential to the treatment of cholera, seeing that a cold and damp atmosphere is one of the most efficient causes of invasion of the disease. In some of the houses we observe gas is employed in the rooms, each of the Lighting. apartments having one or sometimes two burners. Whenever gas is used in the wards we recommend that means should be provided, such as ventilating tubes, for carrying off the products of combustion ; because every gas-burner being not only a consumer but also a deteriorator of the respirable air, care should be taken to remove the latter objection, as far as possible, especially in all sick wards. The above remarks upon ventilation and warming we beg to offer in reference to the subjects to which our attention was specifically called, in that portion of the Sanitary Commissioners' Report to which we were referred by our instructions. We now proceed to notice generally such other matters as we understood to be included in the term " other structural arrangements " upon " the requisite " alterations, adaptations, and additions" to which it might be necessary for us to " advise and report." * It will be observed that our suggestions throughout refer chiefly to the means for remedying existing defects in ventilation, or of improving existing arrangements, and not necessarily to plans to be adopted in the construction of new buildings. H 2 52 REPORT on the CAPABILITIES of the METROPOLITAN WORKHOUSES Supply of Water, Baths and Cleansing, Wldtewashing and Lime-whiting > and Painting. Among the points to which our inquiries were prominently directed, were the supply of water, the sources from which it was derived, and the purposes to which it was put. With reference to these subjects we have already, in the description of each house, entered into details sufficiently minute to furnish the requisite information ; but we have reserved for this place some general observations which we think it desirable to make in reference to all these points. Most of the work- Supply of water. houses, it will be seen, derive their supplies from some one of the several metropolitan water companies ; others depend entirely upon one or more springs or wells upon the premises ; while others, again, derive their supplies from both these sources. In general we have found the supply adequate to the present demand ; but as in many of these houses we have had occasion to point out defects which, if rectified, would call for a greater quantity of water being employed than is at present in use, our remarks must necessarily apply only to the present condition of these houses. Wherever there is an artesian well upon the premises, then the supply may be expected to be adequate to any requirements that are likely to be made. When, too, the supply is derived from water companies, any call for increased quantity that might be necessary could be made a matter of arrangement with such companies. But where the wells are dependent upon superficial springs, these would be generally found Weils inadequate to meet increased demands upon them. To the latter source of Wells. water supply, there are in most cases decided objections ; for when these wells Wells and cesspools are situated near large drains or cesspools, both perhaps in the same yard, the mises 3 . Same pre Raid contents of the latter percolating through their brick walls gradually mingle with the water of the springs, which are in fact too often supplied from sources of this kind ; so that the water used for purposes of life or health is, from the beginning, tainted by that which has already passed off with the worst refuse. In every workhouse we have ascertained the number of baths in use, both Baths. fixed and portable. Two of the former and one of the latter may be said to represent the average supply, but some houses possess no portable bath. The Aversion of inmates employment of baths in the workhouses, in a more general way than has hitherto of workhouses to been attempted, is a subject which we think is well deserving of consideration, the use of the bath. At present there appears to be no regulation compelling inmates to take a bath beyond that which they take upon coming in. And we learn that the increasing desire which has been lately manifested by the working-classes in general, to avail themselves of this important means of contributing to health as well as cleanliness, since the opportunities for it have been so largely increased, is not yet shared by those who resort to or inhabit the workhouses. On the occasion of one of our visits we were shown an excellent bath with plentiful supplies of hot and cold water, and furnished with every necessary comfort. The use of this, we were informed by the Guardians, had been freely and repeatedly offered to the inmates, but of the proffered privilege we learnt that they never availed themselves. And we have further, on more than one occasion, been assured by the master that the regulation of making the use of the bath a preliminary to admission to the house was one of the most effectual modes of diminishing the number of applicants. In fact the desire appears to be rather to avoid than to make use of this important element of health. With the experience, however, which has recently been afforded of the extensive employment of baths among the industrial poor we cannot but think that some efficient arrangement might be made for the more frequent use of the bath by the inmates of workhouses in general. The tabular view which we have given of each workhouse* will show the amount of provision in this respect which each possesses. We have noticed the subject as one relating to general health, but not as regards the treatment of cholera, in which the use of the warm bath has been found to be everywhere., prejudicial, chiefly on account of the great exhaustion which ensues from placing the trunk erect, the exposure of the surface of the body to the air, and from the movement and exertion inseparable from the employment of this remedy. Cleansing. The practice of scouring the floors with soap and water, at least twice a- * Pages 59-G4. igand for the RECEPTION and TREATMENT of CHOLERA CASES. 53 week, and sometimes daily, is almost universal in the sick wards of the different workhouses. In one instance only have we found dry rubbing practised. This latter, we should observe, is the only mode proper for employment in wards devoted to cholera cases, where a dry as well as warm atmosphere is essential. And even in others, especially sick wards, it would be desirable, at least during the time of a cholera visitation, to adopt the same precaution. The custom with regard to whitewashing appears to be, to give a fresh coat White-washin, of lime or whitewash twice a-year to each of the wards throughout the house. lim e-washmg. In some cases this is done in constant routine, the hands being always employed to whitewash each ward in succession as it can be spared. Lime-whiting, which we recommend in preference to white-washing, is not so often employed, though in several houses we have found it used, especially in the sick-waVds to which it is particularly applicable. The preference for whitening over lime, appears to depend on the latter not giving so white a colour to the walls, — a matter which is not sufficiently important to determine the balance against the superior claims of lime. We have generally found the houses in a satisfactory state in reference to this particular, with the exception too often of the fever wards, which we shall presently notice. Another practice which prevails in many houses, and which we would Painting. recommend for universal adoption, is the painting of the lower four or five feet of the walls in the wards, passages, and staircases. This allows of these portions being cleansed frequently, which cannot be done when the walls are whited. We think this of great importance in sick wards. We consider that in the event of any detached houses being required for the reception of cholera cases, as in many districts we find would be the case, great attention should be paid to the proper cleansing and lime-whiting, and afterwards drying of these previous to their being so used. And that during the whole time of their employment for such purpose, every means should be put in force with a view of preserving them in a state of cleanliness, provided that in the use of such means no damp is generated. Drainage and Cesspools, Water-closets, Privies, and Removal of Solid Refuse. In all large assemblages of human beings, one of the main questions bearing upon their general health is the mode in which excrementitious and decomposing matters are conveyed away from or retained upon the premises. In the preparation, therefore, of the questions to which we thought it desirable to obtain replies, we gave this subject a proportionate degree of attention. We did not, however, expect to find so great a difference in the arrangements of the different workhouses in respect of these matters as the results of our inspection have shown to prevail. With regard to drainage we have, on the occasion of each visit, ascertained Drainage, as far as we could the general condition of the drains, the extent of fall which the situation of the house would command, the practice with regard to flushing the drains, the means adopted to prevent the escape of noxious effluvia, and other such matters as we deemed it necessary to inquire into on the spot. And whenever we have found deficiencies in these particulars, we have taken occasion to speak of them in the special reports that we have made of each house. We have not, however, been able in all cases to get accurate information upon these subjects ; for though in many houses we found correct plans of the drainage, in others we could obtain no such assistance. As, however, our purpose was special rather than general, and as the more extensive question of general drainage has been so largely treated of by the Sanitary Commissioners, we avoid offering any further remarks upon this subject beyond those which we have already made in the special reports of each workhouse. We may observe, however, that in many cases the present main drains are such as not only not to fulfil the purposes of health, but, on the contrary, to prove essential causes of discomfort and disease. It does not, however, appear to us sufficient to leave the question of cesspools Cesspools. thus general ; for though we are glad to find that, in many cases, the cesspools have been entirely removed, yet from the foregoing accounts it will be perceived that no fewer than 17 workhouses still retain these nuisances upon their premises ; and in one instance which we have mentioned,* we had occasion to see one of these in process of construction, there being also three others upon the premises of old standing, so large as not apparently to have required Tage 11, 54 REPORT on the CAPABILITIES of the METROPOLITAN WORKHOUSES emptying from the time they were constructed. Now, although, in such cases as that of the Greenwich workhouse the necessity for these receptacles has been alleged, on account of the great deficiency of fall, yet in other instances no such difficulty exists, but the fall is acknowledged to be beyond question ample; as, for example, in St. Olave's, Southwark, where the new cesspool, to which we have just referred, was in process of building ; still there can be no purpose whatever served except an injurious one in these cases, where no impediments occur. Whilst, therefore, such cases as the former, where there are natural disadvantages arising from the position of the house may be made the subjects of further and more careful consideration, though we do not think the retention of the cesspools necessary ; in the latter cases we would recommend that, without further hesitation, the cesspools should be at once removed. For in regard to cesspools, the fact appears to be not generally understood by the officers of these establishments, that although they may be vaulted over, or otherwise perfectly enclosed, and covered by the gravel or paving of the yards in which they are placed (and to this we have been frequently referred as giving proof of their perfect enclosure), still the quantities of fluid which collect within them, until their contents reached the level of the overflow drain, and even afterwards when these drains become more or less obstructed, will gradually percolate through the loose brick-work, and so become diffused through the adjacent ground, which often constitutes the exercising yard of the inmates, or contains the well by which the house is partly, at least, supplied. And still more often is it forgotten that, with these fluids pass off the gaseous emanations which no brickwork can retain, and that these, the fluids and gases, escaping from largely accumulated masses of decomposing matter, and finding their way to the surface, are the portions Avhich are most prejudicial to health ; whilst the more solid parts that cannot so escape, and are the only parts really retained, become thus, in time, comparatively less injurious We have further to remark upon the great deficiencies which we have in many instances had occasion to notice in regard to the supply of water-closets and privies, both in reference to their number and construction. It will be seen that some of the workhouses have not a single closet in the house or even in the sick wards for the use of the inmates, and that in many the supply is greatly disproportionate to the number of the inmates. A glance at the tables of pages 59-64, will at once show the relative defects or advantages of particular houses in these respects. Such defects, though injurious to the health of all, are still obviously most so in the sick and infirm wards, where, in the absence of such provision, the employment of night-stools or other conveniences is rendered necessary, to the great detriment of the health of those by whom the rooms are inhabited. Objections to cess pools. Water-closets and privies. And although we are aware that abuses and inconveniences are sometimes alleged to arise from the use of closets in the house, still we have found such objections of least frequent occurrence when fhe supply was most efficient, nor can we think that, under proper regulation, objections on the score of misuse should be allowed to outweigh the advantages to be derived from such important adjuncts to health. We think, also, that there are few houses, however old or defective in construction, that would not admit of receiving these additions, especially as they might be built out from the walls, so as not to be included in the apartments. We also consider that the yard privies should be abolished, and, in their place, pans introduced having an abundant supply of water, or lead-lined water troughs, similar to those employed in the Whitechapel workhouse as described at page 13. The practice in regard to the collection and removal of solid refuse, such as dust, ashes, &c, appears to be, to collect it in dust-bins, which are emptied generally twice a- week. Sometimes, however, it is not allowed to remain at all on the premises, but is carried away daily, whilst we have found it retained as long as six weeks. We need only observe, that the oftener these matters are removed the more will the practice contribute to the maintenance of health, especially in warm weather, because, although we have generally found great attention paid to the prevention of any other than dust and ashes accumulating, still these receptacles are always more or less regarded as for common use, and, in any case, .they require frequent emptying ; and we may add, should always be covered. Removal of solid refuse. for the RECEPTION and TREATMENT of CHOLERA CASES. 55 Sick Wards, Sick Beds, Fever Wards, Means for Removal of Sick. Again we beg to refer to the tabular view given at pages 59-64, of the arrange- Varying amount of ments in the different workhouses, to show the very varying amount of accom- accommodation for modation which is provided for the sick in these several establishments. In the best arranged houses the sick wards form a detached building more or less distinct from the rest of the house ; and in some of these, as we have shown, the requisite provision for cholera cases might be made. But generally we have found the number of sick wards so small, especially when they constitute a portion of the house itself, and are not detached, that there would be no possibility of appropriating any of them for other purposes than those for which they are now employed. In fact, in many instances we found not only the sick wards quite full, but Number of sick also many sick distributed through the infirm or even other wards. It is im- understated. portant to notice this circumstance, because the returns which we have given of the number of sick are often below their actual numbers. This we found to be Reason for this. unavoidable, for if we endeavoured to get the numbers from the medical officer's list, we found that we should then include with the sick those who were not positively so, though they might require occasional medicine. On the other hand, if we went through the rooms and counted those in bed, then we should include many of the merely feeble and infirm. We have therefore only returned the numbers occupying the actual sick wards, and our returns must be so qualified. Consequently, in most cases the proportion of sick to the healthy will appear less than is actually the case. The employment of double beds in the sick wards is so rapidly disappearing Sick beds. that we have met with comparatively few instances of their use. In some, however, they still remain. The instances in which double beds are still employed in the sick wards, will be found in the tables pages 59-64. Among the other points which appeared to us to require examination, was Number of cubic the amount of cubic space per single bed or person, allowed in the sick and feet per sick P erson * especially in the fever wards. This we have endeavoured to determine as nearly as we could from the returns with which we were furnished ; but as the extreme dimensions of the rooms were generally given, whilst in many no allowance was made for sloping roofs, angles, projections, &c, our calculations must be regarded as appoximations in these cases, though giving the balance on the more favourable side.* We deem this to be one of the most important matters bearing upon the management of the sick, as well indeed as of the healthy. And whilst fully recognizing the difficulty as regards workhouses, of following with exactness any rule which shall strictly limit the number of beds according to the cubic space of the rooms in which they are placed, yet still in reference to sick wards, and especially in relation to the suggestions which we have to make regarding such provision as may be requisite for the treatment of cholera, we think it important to adopt some standard below which the amount of space for each bed should not if possible be allowed to fall. Much will necessarily depend upon the arrangements provided for ensuring change of air, but in every case we think that the aim should be to give 1000 cubic feet to each person, whilst in no instance should the standard be allowed to fall below 800. These numbers we give as furnishing the data upon which calculations may Mode of calculating be made to determine the number of beds that ought to be supplied in each of }5® ™"55ff o °(u C i 0 " the several wards or buildings, which we nave described in this Keport as can be accommocapable of receiving cholera cases ; and not only in these, but in. any others dated in an y s iven that may yet be determined upon for such purposes. So that when the selec- space ' tion of any such building or portion of it is in contemplation, the number of persons under cholera which it ought to accommodate can be easily and at once determined. And by the same rule, also, the amount of that which we have already pointed out may be measured according to the necessities of each house or district. In accordance with the suggestions of the Sanitary Commissioners, that Fever wards. " where there is adequate provision for fever cases, there will probably be suf" ficient accommodation for cholera cases," we made a point of ascertaining in all instances the practice with regard to the reception or otherwise of fever cases ; and in those houses where such cases were admitted, we carefully examined * See the tables in the Special Reports giving the number of cubic feet per person in every sick ward, and the General Tables, pp. 59-64, giving the highest, lowest, and mean for these wards. 56 REPORT on the CAPABILITIES of the METROPOLITAN WORKHOUSES the wards appropriated to this purpose. The amount of accommodation in this respect will be found given in detail in the description of each workhouse, and in the aggregate in the tabular arrangement at pages 59-64. In some few instances the fever wards are so constructed as to be made available for the purpose suggested by the Sanitary Commissioners. Yet in most, however, it will be seen that no such wards exist, the custom of sending all cases to the fever hospital being very prevalent. Insufficient cleans- One circumstance which we have observed with regard to the fever wards mg of fever wards. a pp ears to require attention : whilst the sick wards generally are white or lime- washed as often or oftener than the rest of the house, the fever wards in some instances have remained untouched for one or two years. On inquiring the cause of this, we found it attributed to the constant occupancy of these wards by bad cases, and the difficulty of finding an opportunity of whiting the walls ; but we think that if this point were more closely attended to, it might in some degree perhaps tend to diminish the very circumstance which is alleged as creating the difficulty. We have also observed too often that the fever ward is in point of construction, arrangement, ventilation, and even cleanliness, the worst of all the sick wards, whilst not only for the sake of the inhabitants, but of the sick and healthy generally throughout the house, it ought, if possible, to be the most airy and the best. Means for removal Since it is necessary that those attacked with cholera should, if required to of the sick. ijg removed, be kept in the recumbent posture, we placed among our questions one relating to this subject. In almost every house we found one and sometimes two covered litters, provided, with proper bedding, and suitable for the conveyance of such persons as it might be indispensably necessary to remove from their abodes. This mode of removal we suggest as the best, and generally the only one that ought to be permitted, because in other modes the body is allowed to be more or less erect, and the exhaustion otherwise consequent upon them is in proportion prejudicial to recovery. The best form of covered litter that we have seen is one which was furnished with a moveable basket-work, to receive the bedding, so that the patient might, as soon as brought to the house, be taken out, and carried to his bed upon this without the necessity for the least exertion or even change of posture. We strongly recommend this simple addition, which could be made to any of the fever beds or litters now in use ; for in a disease where the vital powers are so suddenly prostrated, every exertion on the part of the patient, even the least, becomes a serious impediment to his recovery. This contrivance would be especially applicable to those cases where the wards for the reception of the sick were not upon the ground floor. For though in most cases we have avoided recemmending any that are high up, on account of the difficulty of transport, still in some instances we had no choice. We advise that every house not provided with a covered litter should possess one, and in those districts where many cases might be expected to arise, more than one would be requisite, because the period which admits of the removal of the sick is so brief that the opportunity might be lost if the means were not at hand. Medical Officers, Dispensaries, Medicines, Nurses. Medical officers. The increased demand which would be made upon the services of the medical officers during the time of an epidemic visitation would in some localities be so great as to require an addition to the existing staff. The extent to which such increase must be made in each case would of necessity be regulated by the amount of prevalence of the disease, and the size and population of the district. And as it is contemplated to attend the poor at their own houses whenever this is practicable, such increase would be chiefly called for in regard to the attendants upon the out-door poor. But we think also that where separate houses are taken, or where wards are set apart in the workhouses for the reception of cholera cases, it would be generally requisite, and especially in the former case, to make a temporary increase in the medical staff, because the presence of a medical officer might be so constantly required, both by night as well as by day, that without such assistance the requisite attention could not be given to the sick. In considering, therefore, the arrangements that could be made either in or out of the several workhouses, we have kept in view, wherever it was possible, some accommodation for a medical officer or an assistant during the night. for the RECEPTION and TREATMENT of CHOLERA CASES. 57 Whenever we have had the opportunity of suggesting such an increase in the medical attendants to the Guardians in the event of its being required, we have found them prepared to meet the occasion to any sufficient amount. In making such arrangements as maybe requisite for medical attendance Necessity for giving upon the out-door poor in the case of cholera, we think it absolutely essential |Jj® "owtr onieTthat such arrangements should be made by the Board of Guardians as will ins? supplies withadmit of supplies of food, stimulants, &c, when necessary, being furnished out the J nf erven : without the delay which is sometimes unavoidably occasioned by the furnish- officers in the event ing of the customary orders through the relieving officer. For in the case of of cholera. cholera, when the time during which these supplies are of most value, must be reckoned not by days, but by hours or even minutes, the object of the intended assistance would be (sometimes at least) defeated if any delay whatever occurred in the administration of relief. We therefore suggest that in every case which the medical officer shall certify to be a case of cholera, such supplies of food, stimulants, or other necessaries, shall be immediately and at any hour granted, as may by him be deemed advisable, without the necessity for any other order than that attested by his own signature. In noticing the arrangements which obtain in each workhouse, in respect to Dispensaries, and supply of medicine, we have found that, in only five cases which we have {J 1 c e t h^ 1 ra edlcTf 1 ied mentioned in their place, the medicines are selected and provided through the officer Board, whilst in every other case they are furnished by the medical officer. We consider it right to notice this, because whilst the former plan gives to the sick the best assurance of efficiency, the latter cannot but be regarded as a contract, which, on the part of the medical officer, places his duties and his interests in very unfavourable contrast. In the former case each workhouse possesses its own dispensary. This, we think, should always be the case ; while, for the reason mentioned, no contract for medicines on the part of the medical or other officer should be entertained. In the treatment of a disease which so rapidly prostrates the vital powers, Nurses. and renders the individual utterly incapable of the smallest personal exertion, an adequate supply of properly qualified nurses and helpers would constitute an essential element. These, therefore, in the cases where out-door arrangements are made, we would suggest, should either be furnished from the best of those already employed in the house, whose places in the sick wards might be temporarily supplied, or else that they should be provided at the cost of the parish. A similar arrangement would be sometimes advisable for the wards set apart in the house, because the system generally followed in regard to the payment of the nurses is not such as, in our opinion, is calculated to render them efficient. We apprehend that the nurses ought to form a portion of the regular establishment, as in those cases where they receive wages for their services. But when, as is usually the case, the only remuneration afforded to them consists in slight extras of diet, their services cannot be regarded as other than precarious, and their experience must often be extremely limited. The burials take place usually twice a-week, and, in some places oftener, if Burials. necessary, as when the weather is very warm. We have generally inspected the dead-houses, and inquired into the practice Dead-houses. regarding them. They appear to be in general well placed, and suitable for the purpose for which they are at present used ; but should any great mortality arise, we doubt whether all of them would be found sufficiently capacious, because the experience which the former visitation afforded showed that, in the collapse of the disease, the semblance of death was so close in some cases as to lead to the belief that the person was dead, and in the too anxious desire to remove what was erroneously supposed to be a source of danger to the living, it is to be feared that some premature interments may have occurred. It is important, therefore, that to prevent the dreadful consequences of too speedy interment, the dead-house should be sufficiently capa cious to receive the bodies for an adequate period of time before interment, so as to prevent the recurrence of such frightful errors. And we may here take the opportunity of observing that one of the most striking facts in regard to the burial of those who die from cholera is, that those who are most engaged in performing the last offices, and in handling the bodies of the dead, have been among those who have conspicuously escaped the disease. This we mention chiefly with the intention of dispelling groundless alarm on this score. But it must be viewed as a matter distinct from the I 58 REPORT o» the CAPABILITIES of the METROPOLITAN WORKHOUSES question of decomposition after death, against the effects of which it is necessary always to guard, especially on occurrence of sudden and large mortality, where the main difficulty consists in avoiding the extremes of too much delay in the burials on the one hand, and for the reasons just given of too much speed, with its consequent dangers, on the other — a difficulty which can only be safely met by preconcerted and well-organised arrangements. Use of the tables explained. The following tables are constructed to show, at one view, by arrangement in parallel columns, the degree of variation observable in regard to the foregoing particulars in the several workouses. The order of arrangement is the same as that observed in the Special Reports, proceeding according to the amount of prevalence of cholera in 1832, in the several districts to which the workhouses belong ; that district being placed first in which the greatest number of cases occurred, and so on in a decreasing ratio, the last terminating with the healthiest district. It should be observed, however, that the three last workhouses, Nos. 36, 37, and 38, are excepted from this rule of arrangement, their corresponding districts having made no returns in 1832. And as it may be expected that, should the disease again appear, it will pursue much of its former track, so long as the same conditions which favoured its spread in 1832 remain unchanged, this order of arrangement is adopted to direct attention to the amount of improvement that may be immediately called for in each workhouse, by showing in what degree the present arrangements are adequate, or otherwise, to prevent the spread of the disease, should it break out among the inmates, or to render the workhouses fitting receptacles for the curative treatment of the sick. for the RECEPTION and TREATMENT of CHOLERA CASES. 59 Tables showing at one View the present Sanitary Arrangements of the Workhouses in reference to the Sick. Note. — These Tables refer chiefly to the arrangements made for the sick, but necessarily include those shared by the sick in common with the healthy. In this sense, therefore, the term fi Sanitary Arrangements'' must be understood. 1. Name of Workhouse . . *- '^^^ «" No. 2.-Sx. 845 2220 mates. 5. Present Number . . . 1014 . . 554 643 6GS 1900 G. Number of Persons in Sick 157 Go 7o 72 4S I rk E S ' No. 29.— Shoreditch. No. 30.— Paddington. No. 31.— Strand Union. 2. Situation ..... Kings-road. Grays-inn-lane. Coppice-row. Mount-street. Kingsland-road; Westbourne Green. Cleveland- st., Fitzroy-sq. 3. Neighbourhood . . . Open. Densely populated.; Open in front. Open at the back; house Has numbers of courts thick Open. Tolerably open. good. and crowded. 4. Limit to Number of In- 1670 750 550 430 830 225 600 mates. 5. Present Number . . . Full. 765 Full. 399 1000 214 Full. 6. Number of Persons in Sick Beds full. 202 44 79 150 20 48 Ward. 7. Number of Beds for Sick. 181 202 40 single, 17 double. 84 154, 8 double. 28 48 8. Number of Sick Wards . 13 9 infirm, mixed ; 7 sick. 3 8 12 5 2 9. Number of Fever Wards Not any. 2 Not any. Not any. 6 2 A small building, used when included in the above. necessary. 10. Custom regarding removal Sent to the Fever Hospital. Large numbers removed. Sent to Fever Hospital. Distributed through the There are fever wards. There are fever wards. of Fever Cases. house. 11. Situation of Sick Wards . In men's aud women's in- In the house. In the house. In the house. 6 wards in fever hospital, In hospital. In the house. firmary. 6 in the house. 12. Number of Infirm Wards . . 7 ; included in the above 8 • • • • 2 6 sick and infirm, mixed. 13. Convalescent Wards . . Not any. 1 for women. Not any. Not any. 2 Not any. Not any. 14. Number of Medical Officers 1 3 1 2 1 1 * 15. Nurses ...... 1 paid, the rest inmates. 1 paid, and 6 others, with All inmates. 13, all inmates. 3 paid, the rest paupers. 1 paid nurse aud 1 pauper 2 for each ward, inmates. helpers. in each ward. 16. Medicine, how supplied . By medical officer. By medical officer. By medical officer. By medical officer. By medical officer. Bf medical officer. By medical officer. 17. Places for Exercise . . . . 4 yards, small. None. Very small. . . Sufficient. Small yards. 18. Means for Ventilation of Defective. Defective. Defective. Detective. Defective both in the new Defective. Defective. Sick Wards. and old wards. 19. Number of Cubic Feet per 572 353 501 • 581 530 446 330 Sick Person, average. 20. Highest Number ... 888 521 640 647 729 453 393 21. Lowest Number ... 415 130 285 516 255 440 _ 368 22. Means for Warming Sick Fire-place, defective. Fire-places. Fire-places. Fire-places. Fire-places deficient. Defective. Fire-places. Wards. 23. Supply of Water ... . . New River Company and Water from Company. wrand Junction. Deficient on the main. Abundant. West Middlesex; also 2 well. springs. 24. Number of Tanks and . . Tanks for 10,000 gallons, Numerous. Large reservoir. 13 in house, 5 in fever hos- . . A cistern at top of house. Cisterns. and cisterns. pital. 25. Baths . . 2 fixed, 1 portable, 1 shower. 2 fixed, 1 slipper. 2 fixed, 1 slipper. 1 in fever hospital, and 1 for the infirmary. 1 fixed, 3 slipper. several portable ones. 26. Number of Water-Closets . . About 30 for house and Not any. 5 in house, 2 in yard. 2G Abundant. 2 for each side. for Sick, and Situations. sick. 27. Number of Privies, and Very filthy. 10 in yards. 1 for each yard. Not any. 10 . . 1 in each yard. Situations. 28 Cesspools . Small one in vagrant yard. Not any. \\ T ot any. Not any. Not any. _ 3 Remuval of Solid Refuse . Taken to the tr.irden. 3 dust-liins, emptied twice Open dust-bin, emptied Dust-bin, emptied weekly. Open dust-bin. Open dust-bin. Dust-bin, emptied twice a-week. once a-week. a vvccrv vvccrv-30. Burials . . Twice a-week. Three times a-week. Twice a-week. Daily. When required. . . 31. .Nuisances St. Giles's burying-ground. Not any. Not any. Not any. Not any. Nut any. Not any. 64 REPORT on the CAPABILITIES of the METROPOLITAN WORKHOUSES Table showing at one View the present Sanitary Arrangements of the Workhouses in reference to the Sick— concluded. 1. Name of Workhouse . . No. 32.— Isllngton. No. 33.— Rotherhethe. No. 34.— Kensington. No. 35. -Hackney. No. 36. —? East London No. 37.— East London No. 38.-West London Union, Bishopsgate. Union, Aldersgate. Union. 2. Situation Limehouse-road. Lower Deptford-road. Kensington Homprtnn n,,™,; „? n tv t. 1 singuw. tiomerton. Dunning s-alley, Bishops- Aldersgate-street. West-street, Smithfield. 3. Neighbourhood . . . Tolerably open. Not crowded. Open Very nnpn n sat^" street street-4. Limit in Number of In- > 420 340 2fi<> Very open. Densely populated. Rather closely surrounded. Crowded. mates. ° 1 ' 1 396, all women. 210 J allmen. 500 5. Present Number ... 414 202 968 d«7 „ 6. Number of Persons in Sick 70 23 "«£ rl uIL 188 Full. Ward. &y G5 31 39 96 7' Number of Beds for Sick . 70 05 rq R . 8. Number of Sick Wards .7 2 7 «-*« -* nMa f 37 30 80 single; 8 double. "'^olF^Cat 1"' 1 "'* 010 " 13 '"" o ''' 1 '" 1 ' 08^ 1 1 * 1 - C C * SeSSe " ttohos I> M - N.t,e™« d . Noneremoved. Set to feve, ho,pit,l. Not ,e ra ov e d 13. Convalescent Wards .. 3 Not any. ' Not any ivt x 2 • • 14. Number of Medical Officers 1 J 1 ""' j' ' Not any. Not any. 1 for men. 15 - NU ' MS I»»^ -ho have gra. lpa»pe,t.eachwa,d. N<,ta- yv aid. Inmata. 1 p.iJ head-nuL ; helpers Ho each wj. Ia m ,te, ' •23. Supply of Water . . Jhjtaj.h.O.p, »**M-^li