[The Standard, 17. und 18. November 1869]

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The Standard, 18. November 1869. S. 6.
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ST. PANCRAS WORKHOUSE INFIRMARY.

MORE DEATHS AND SPECIAL VERDICTS.

Nov 18 Anmerkung von Jenny Marx

Yesterday Dr. Lankester, coroner, empanelled a jury at the College Arms, Crowndale-road, on the bodies of eight deceased persons, six of whom had died in either the St. Pancras Workhouse or Infirmary. These cases are entirely distinct from those which were opened last week and stand adjourned till next Monday.

Prior to the jurors viewing the bodies the Coroner briefly addressed them, stating that although his ideas were objected to he still entertained an opinion that inquests ought to be held upon every pauper dying in a workhouse, as well as in prisons or lunatic asylums, and recent events had justified him in coming to that conclusion. As some of the cases the jury were about to investigate were on persons who had died in St. Pancras Infirmary or Workhouse, it would be for the jury to say upon the evidence produced whether the deaths had resulted from any circumstances which had taken place in connection with that institution.

The first infirmary case was on the body of Jane Harvey, aged 35.

Dr. James Ellis said—I am medical officer of St. Pancras Workhouse infirmary. Deceased, Jane Harvey, was admitted to the Infirmary suffering from pleurisy and inflammation of the lungs, and was placed in the small ward, known as 25 ward. There were four beds in that ward whilst deceased was there, but there are seven now. She was admitted on November 9, and died on November 11. The ward in which she was placed is about half the size of this room (a good sized parlour). The ventilation is by the windows, but the amount of atmospheric space is by no means sufficient for the patients, and there is in that ward always a foul atmosphere and stench. If the windows are opened it is exceedingly dangerous to the patients in the foggy weather, as the cold air rushes in upon them, and they prefer the warmth under any circumstances. Mr. Solly and Mr. Carter both examined this ward when they went over the infirmary.

The Coroner.—And both Mr. Solly and Mr. Carter declared the atmosphere of all the wards to be very foul.

Witness.—Yes, the stench from this ward like the others comes in a great degree from the water closet, and although for some time the water closet has been closed up it still continues. I have made a post-mortem examination. I found the brain much congested and the ventricles thickened and gorged with blood, and there was also congestion throughout the lungs, which were in the first stage of pneumonia, and the pleura on the right side was also in an extreme state of inflammation. The cause of death was from inflammation of the lungs and pleura, no doubt accelerated by the foul atmosphere, the stench, and want of ventilation.

Dr. Ellis wished to read a report he had made to the board of guardians, dated Saturday, 13th.

A Juror.—Is that the report ordered to lie on the table?

The Coroner said he did not think they ought, in that particular case, to go into the general question; therefore, unless the report bore upon the state of this particular ward he thought they had better not hear it.

Dr. Ellis said it did.

Several of the jury expressed a wish that the report should |44 be read.

Dr. Ellis read his report, which was as follows:—“Copy of Medical Officer’s Report. Nov. 13, 1809.—I received instructions from the visiting committee to remove from the infirm to the temporary infirm wards those male patients who had been sleeping on the floor, and to place more bedsteads in the wards occupied by females, so as to do away with the necessity of patients sleeping upon the floors; these instructions were at once carried out, and no patients have since done so. The male patients remained one night in the temporary infirm ward, and on Friday additional accommodation was found by using the second-class officers’ dining room for male insane patients, and appropriating for the use of infirmary patients a comfortable room on the first floor, in the male insane wards, capable of holding, as a makeshift, twelve beds. The board will be glad to learn that the removal of those patients has not resulted in any serious aggravation of their disorders, and I have every reason to believe good results will follow. I feel it my duty to add that further accommodation is desirable. On Friday evening several gentlemen, amongst whom I recognized the vicar of St. Pancras, went round the wards, and I am told by the patients and night nurse that one of them went into 24 ward on tiptoe, and opened the ventilator about ten minutes before the others came up On Saturday night, between nine and ten, a good many persons visited the infirmary; and I am told by the patients that one ordered the nurse in charge to take the dressing off the sores of the patients legs, which was done. There were 33 patients in No. 24 ward, which gave only 587 cubic feet to each patient, and when I visited the ward at seven o’clock this morning (Sunday) the air was excessively foul, though the ventilators at the ends of the wards were open. The night nurse reports the unwholesome smell to have suddenly become intensified as soon as the rain came on in the early morning. On referring to my weekly report book I find that, on September 18, I reported the existence of bad smells, of a sewage-like nature, in No. 24 ward: but no steps have been taken to remedy the evil till this week. Reports were also made on the existence of bad smells and defects of the bad drainage on May 15, April 24 and several other occasions. In February of the present year erysipelas pervaded, which was believed to be owing to the crowded state of the wards, and the cause in one case was traced to defects in the closets. I also beg respectfully to remind the board that on June 19 I reported the beds as full, and asked for instruction; also on July 24 I was obliged to send patients to the house that were not well, having no room for the more urgent cases. Inquests have been held on four cases, and the jury returned verdicts that death was accelerated by the bad state of the atmosphere of the wards. Up to Wednesday there were 58 instances of sleeping on the floor.”

In answer to the Jury,

Dr. Ellis said that nothing had been done until last week to remedy it. Since then it had been as bad as ever.

Elizabeth Turner.—I am a patient in 25 ward, and have been there one month. The smells are very bad, and they come in puffs from the water closet. The effect it has is that the tongue becomes dry, and then I begin to vomit.  No. 24 ward is worse than 25, because there are more patents there. There are six patients now in No. 25 ward. No. 24 was so bad that I begged to go into 25 only last nights; in 25 the patients had to remove from the fire because the stench that came up by the fireplace was so bad. We feel the stench more at night than in the day. When the windows are open the cold is so great that the patients cannot bear it, and when we shut them up we are suffocated by the smell. I have been in 24 ward for four months, and in 25 one month. The deceased in the night she came in complained very much of the smell and closeness of the ward.

Margaret Cain.—I am a paid nurse in 24 and 25 wards. I gave evidence as to 24 wards the other day. I have heard the patients complain of the bad smell and have noticed them myself; it comes from the closet. It has been closed up but that has had no effect. I have reported this to the doctor. The smell was very bad this morning; it is much worse at night than in the day. I do not think it can be got rid of by merely rinsing by a pail of water. The deceased when she came in did not look like a dying woman.

At the request of Dr. Ellis, who stated that imputation had been cast upon him that be had for a particular object ordered all the ventilators to be stopped up, thus causing the foul atmosphere of which these poor people had died, the night nurse was examined.

Ellen Pitt.—I am night nurse. I do not consider any of the infirmary wards are in the condition they ought to be. The smells in every ward are very bad, and nothing had been done to remedy the evil until last week; but in spite of what has been done the smells are as bad as ever. I have repeatedly reported No. 25 ward as being bad with regard to ventilation. On the night deceased, Jane Harvey, came in she complained of the closeness of the place, and said, “I shall be suffocated here”; and when the windows are open the cold is so great I cannot bear it. Dr. Ellis never ordered me to shut the window on any particular night.

The Coroner,—There is no ground whatever for the assertion, if any such has been made, that Dr. Ellis gave orders for the windows or ventilators to be closed on any particular night.

Mr. Watkins, a guardian, here called upon the coroner to allow him to cross-examine this witness, and, having had permission, he called upon the witness to state whether she had not, during the past week, told some one that Dr. Ellis had ordered her to close up all the ventilators of the wards on the occasion of Mr. Solly and Dr. Carter visiting the infirmary.

The Witness denied that she had made any such statement.

Mr. Watkins said he was prepared to prove that this statement was untrue, and tendered himself as a witness.

The Coroner said if Mr. Watkins was prepared to state that the atmosphere was not foul, and that all the evidence the jury had beard was perjury, he would hear him.

Several of the jury objected, and Mr. Watkins said he objected to the evidence of the nurse Pitt as being untrue.

Coroner,—Why we have the evidence of another paid nurse that the wards smell as badly this mornings as they ever did.

Mr. C. A. Lockart Robertson, M.R.C.S., and medical superintendent of the Sussex County Hospital, said he was well acquainted with wards of hospitals and public institutions, visited St. Pancras Workhouse a little before twelve on Sunday last. Found the whole of the wards frightfully overcrowded, with a most unpleasant smell, in spite of the large amount of window and door opening which existed—a proceeding he considered most improper, especially at this time of the year, on account of drafts. The smell, which was beastly to a degree, came mainly from the water-closets. There was no ventilation, he observed, except from the windows. The two long wards (11 and 24) were much overcrowded, recollected the small ward, No. 25, having a water-closet closet closed up. The atmosphere was very bad, worse than the other wards, although it was midday, and all the ventilators open and acting.

By the Coroner.—Should think it impossible to obtain medical success with patients in such wards. Examined some of the patients, and found two cases of continued fever. They were of the typhoid character, and he looked upon it as most dangerous to have them in such a place amongst so many others. Indeed, he looked upon it as absolutely consigning people to their graves thus to crowd them together. No doubt, the death of a person suffering from disease of the lungs would be accelerated by such atmosphere as he found. Should say that any attempt to improve such a place would neither be beneficial to the ratepayers nor the sick poor.

Ellen Hill, another nurse, was called, and, in answer to Dr. Ellis, denied that he had ever given her any special instructions to close up the ventilation. It had been left to her discretion.

Mr. Richardson, a guardian, wished some other nurse to be called, but the Jury considered they had heard enough; and after some discussion with the coroner as to the propriety of communicating with the Poor-law Board as to the antagonism between the guardians and the medical officers,

The Jury returned the following verdict:—“That the deceased, Jane Harvey, died from the mortal effects of inflammation of the side and lungs, accelerated by the want of sufficient sanitary precautions in the ward in which she died in St. Pancras Infirmary.”

The Foreman added that the jury wished to append the following:—“That in the face of the antagonistic feeling existing between the board of guardians and their medical officers, and their repeated inattention to their reports, that the coroner be requested to communicate with the Poor-law Board on the subject.”

The second inquest was on John Watts.

Dr. Ellis said deceased was admitted on Oct. 12, and placed in No. 6 ward, and was found dead in bed on the morning of the 8th instant. A post-mortem revealed the fact that deceased had died from congestive apoplexy, which had, no doubt, been accelerated by the impure atmosphere of the ward.

James Ryley, a patient, said there were 24 men in this ward, and the smells were still so bad that the previous night even, notwithstanding the fog, they were glad to have the windows open. The smells were much worse in the summer, but all the patients still complained of them. Never heard of Dr. Ellis giving a general order to close the windows.

By the Coroner.—This is the ground floor or rat ward (laughter). Had had them running over his bed, and used sometimes to sit up at night and have what was called a rat hunt (renewed laughter).

Verdict—“That John Watts died from effusion of serum on the brain, accelerated by the impure air of the ward in which he was placed in St. Pancras Infirmary.”

Elizabeth Ramsay, seven months old, was the third workhouse case, and was in the infant nursery with her mother. There were 23 children in the ward, and 10 women.

Dr. Hill, the workhouse surgeon, said the child was in good health till the 6th instant, when the drains were opened, and the soil left exposed in the basement. This made several of the children ill, and caused the deceased’s death. He had no doubt from examination of the body that it died from the effects of the inhalation of sulphuretted hydrogen, contained in the soil referred to.

The Jury returned a verdict “That Elizabeth Ramsay died from the poisonous effects of sulphuretted hydrogen proceeding from the drains of the nursery of St. Pancras Workhouse.”

In consequence of the great length of the sitting the coroner discharged the jury in two other cases, and postponed them.

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The Standard, 17. November 1869. S. 6.
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SICKNESS AND DISTRESS IN LONDON.

Nov 17 Anmerkung von Jenny Marx

Nearly six weeks ago reference was made in the columns of this journal to the appearance of relapsing fever—otherwise known as “famine fever”—among the poor of the metropolis. Mention was made of the fact that 70 cases had been received at the London Fever Hospital between May 1 and October 1, out of which number as many as 30 cases were admitted in the last 15 days of the period. The number has continued to increase, so that a few days ago there were no less than 120 cases of this nature at the Fever Hospital, in addition to others treated at home. Every bed that can be spared for patients suffering from this disease being occupied, it has become necessary to provide against the probability of further demands. Accordingly it has been proposed that a temporary building should be erected on ground belonging to the authorities of the Fever Hospital, whereby 60 additional beds should be made available for patients of this class. This plan, it appears, will be carried out, with the co-operation of the managers of the Metropolitan Asylum Board, under the sanction of the Poor-law Board, the asylum managers also undertaking to provide temporary accommodation on their building site at Hampstead. The gravity of the crisis is increased by the fact that, in addition to the epidemic of relapsing fever, there is an enormous amount of scarlet fever in the metropolis, which, at the Registrar General states, “has fallen with all its violence on the East districts.” Hence the Poplar Board of Guardians, on the recommendation of Mr. Gray, one of the medical officers of the union, have applied to the Poor-law Board for permission to re-open their North-street Infirmary for the reception of fever patients. The sanitary condition of the district is also under careful consideration on the part of the Poplar District Board of Works. Mr. Ellison, the medical officer for the parish of All Saints, Poplar, has prepared statistics showing nearly 100 deaths from scarlet fever as occurring in that portion of the district since April last. In eight instances there are two deaths, in one there are three deaths, and in another instance there |45 are as many as four deaths in one house. It has been decided to erect a mortuary and a disinfecting house for the parish of All Saints (which is simply and really Poplar, including the Isle of Dogs). For the purpose of collecting the clothes, bedding, &c., of fever patients, an iron truck will be used, with a tight-fitting lid. The infected articles will be conveyed in this truck from the dwelling to the disinfecting house, where the truck with its contents will be fumigated by means of burning sulphur, ignited in a sort of iron tray, which draws in and out underneath the truck, the bottom of the truck being perforated to allow of the entrance of the vapour, while a metal tube inserted in the lid of the truck carries off the fumes from the clothing into a chimney. Thus the clothes themselves receive no handling, and their transit through the street in the first instance is accompanied with no danger to the public. It is also contemplated to increase the sanitary staff of the board, and to commence a house-to-house visitation.

Relapsing fever is not a conspicuous ailment in poplar at the present time, though it exists to a certain extent. It has doubtless been kept down by what we may call the superior liberality of the Poplar Board of Guardians. It seems to predominate in St. Giles and Whitechapel. It is said that this disease has been imported from the Continent. That such was the case last year seems tolerably evident, according to the researches of Dr. Charles Murchison. The Polish Jews have an unenviable notoriety for this miserable complaint. But the visitation this year does not seem clearly traceable to that source, and there is too much reason to fear that it has a home origin. It naturally occurs to a population after a period of protracted privation. Where every sanitary precaution is taken this disease may yet arise, though it is aggravated and extended by the depressing and polluting influence of foul air, whether from bad drainage or overcrowding. Of itself, relapsing fever seldom kills, but it finds a ready ally in typhus, by which it is often followed. The victim of relapsing fever is sorely enfeebled, and the vigour of the constitution is seriously impaired. The citadel thus undermined soon falls, and the famine fever is perhaps most to be dreaded as preparing the way for another disease more fatal in its character. Relapsing fever thus conceals itself from view, so far as the statistics of the Registrar General are concerned, but is nevertheless, a very dangerous foe to the lives of the poor.

According to a paper just issued by Mr. Simon, the medical officer to the Privy Council, 73 cases of relapsing fever were admitted into the London. Fever Hospital in the first nine days of the present month, besides a few cases admitted into other hospitals. On the 10th inst. there were 138 cases in the Fever Hospital, and the wards were over flowing. From the beginning of the year to the evening of the 9th inst. 280 cases had been admitted into hospitals, and four attendants at hospital had caught the complaint. Out of the 284 cases only one had proved directly fatal. These are evidently not the full statistics of the disease, for it is stated that in the middle of October “not a few” suffers from relapsing fever were found remaining in private houses, in Whitechapel and St. Giles’s. Referring to the hospital cases, we find that these came from 156 houses, of which 48 were in Whitechapel, 24 in St. Giles’s, 9 in Bethnal-green, and 6 in St. Pancras, the remainder being scattered in various parts of the metropolis. Out of the 280 patients, Whitechapel has furnished 64, St. Giles’s 50, Bethnal-green 27, Camberwell 24 and St. Pancras 9. The number attributed to Camberwell is really fortuitous, the cases, with only one exception, having all been found in the casual wards of that parish. In other parts of London, also, the casual wards have been found to contribute patients of this class, and danger exists lest the tramps afflicted with this disorder should convey the infection to other parts of the kingdom. At present relapsing fever appears to be limited to the metropolis. Mr. Simon refers to the fact that the hospitals in London are now full, and no accommodation can be expected in these institutions which shall be adequate to the probable growth of the epidemic. It is consequently urged that those districts where the disease exists will be very seriously endangered, if special hospital accommodation be not at once provided. As an instance, we may mention that Mr. Liddle, the medical officer of health to the Board of Works for the Whitechapel district, in company with Mr. Vallance, the clerk to the guardians, waited on the authorities of the London Hospital on Monday, to learn whether any possible provision could be made for fever patients by that institution. The reply was in the negative, the hospital being completely full (to the extent of 502), of its ordinary patients.

The presence of scarlet fever in Whitechapel is shown by the following statistics, compiled from the books of the medical officers of the union:—In the three months ending October 2, there were 135 cases of scarlet fever, as against 17, in the corresponding quarter of last year. The deaths from this disease were 82 against 11. From October 2 up to the 6th of the present month, 60 fresh cases of scarlet fever have appeared, and 30 deaths have occurred. “Continued fever,” strange to say, including typhus, typhoid and relapsing fever, shows a decrease in the last quarter, as compared with the previous year; but relapsing fever, taken by itself, would palpably lead to a different issue. Moreover, since the completion of the quarter (October 2), there have been 60 cases of continued fever in Whitechapel in the space of five weeks, which is in Whitechapel in the space of five weeks, which are in a higher ratio than the December quarter of 1868. We must likewise observe that there were only 25 cases of scarlet fever in the December quarter of 1868, as against 60 in the first five weeks of the present quarter, the deaths from scarlet fever (30) in those five weeks being more numerous than the attacks in the whole December quarter of 1868, the deaths from scarlet fever in that quarter being but 19.

It is not only the present but the prospective condition of the eastern parishes which excites anxiety—we might perhaps say alarm. The existing hospitals are taxed to the full extent of their resources; but it is by no means clear that epidemic fever is at its height. Even if scarlet fever should decline, there is the ominous advance of the famine fever, in all probability to be followed by typhus. Viewing the contingencies which now beset the public health, particularly the enormous difficulty of battling with contagious disease in the crowded dwellings of the London poor, it is impossible not to feel the importance of prompt and united action on the part of the local authorities. Boards of guardians and boards of works ought to join hand in hand against the common foe. Happily this is already the case in some |46 districts, though we fear it is not so in all. We have mentioned some of the precautions which are being taken in Poplar. In Whitechapel Mr. Liddle has recommended certain measures to the Board of Works, which is at the present time under consideration. These may be enumerated under the somewhat formidable number of six distinct heads. First, the erection of a mortuary; secondly, the establishment of a disinfecting house; thirdly, a carriage for the conveyance of infected persons; fourthly, a place in which dead bodies may be kept while undergoing post-mortem examination; fifthly, a house of refuge for the reception of persons living in a room where infectious or contagious disease exists; and sixthly, a house which might be used as a hospital for the reception and treatment of persons suffering from fever and other infectious disorders. The first, the third, and the fourth of these recommendations cannot be considered extraordinary; but the others are evidently belonging more immediately to a period of special danger, though evidently of use at all times. It is easy to find in Whitechapel masses of houses which seem only adapted to generate pauperism and fever. Whether such dens ought to exist for the benefit of landlords and the burden of ratepayers, is a practical question, the solution of which must come at some time or other. Fever in such places is like fire. The inhabitants pay rents and starve. Sickness seizes the people, and the public have to defray the cost. Finally, all these symptoms are aggravated in times of distress, such as those which now beset the working classes.

The condition of a very large proportion of the London poor is very much the same as if the metropolis were in a state of siege. Multitudes are unable to get sufficient and proper food. It may be said that bread is not dear at the present time. But cheapness is a relative term, and breads at a low price is yet dear to the man who lacks the money wherewith to purchase the “cheap loaf.” The benevolent contributions of the public have enabled Mrs. Kitto, of St. Matthias, Poplar, to furnish children’s dinners at a cost to the recipient of only a single penny. But when the ticket is obtained by the parent it is a hard matter sometimes to find the penny. A case recently transpired in which three-farthings had been raised for this purpose by the sale of some old rags; but the other farthing was not forthcoming, and the tempting dinner was actually foregone, though we need hardly say that it would not have been withheld under such circumstances. Notwithstanding the so-called cheapness of bread, a family, consisted of father, mother, and six children, have been known within a very recent period to live on potatoes for a week. In another instance a widow maintained herself and two children for a like period of time on a most singular article. Having some semolina given her, she obtained a pennyworth of yeast, and made the semolina into bread, and this was the sole sustenance of a little family for several days. It is too much to expect that people thus circumstanced shall continue healthy. Want of employment, followed by poverty, also leads to overcrowding. How can fever be stopped in a district where it is common for a whole family to live in one room? Hence the necessity for hospitals and infirmaries. Again, how is the convalescent to become thoroughly well and fit for work? Certainly not in their dwellings. Unless the labouring classes can get work they cannot get wages, and without wages they cannot live, let the price of food be what it may. We fall back on the poor law; but here we find the labour-test often supplanted by the house-test, and the latter alternative is a frightful thing to the more deserving class. Still, according to the returns for the fifth week of October, there are more than 100,000 persons in the metropolis in the receipt of out-door relief. The in-door poor at that date were over 35,000. It is palpable that London could not receive all her paupers into the existing workhouses. It is lamentable also to observe that the metropolis has nearly 2000 more paupers than it had in the corresponding week of the previous year, and nearly 13,000 more than in the corresponding week of 1867. Poplar, indeed, shows a decrease in the last twelvemonths, for which we are probably indebted to emigration as well as to migration. There are now, we are told, about 600 empty houses in the Isle of Dogs, some of which can be purchased almost literally for nothing.

In the parish of St. Jude’s, Whitechapel, small but crowded, there is a population of nearly 17,000, presenting scarcely one satisfactory element in their condition. In their character these people are somewhat varied; some are honest, others are not so, but all are wretched. Among the more respectable portion, both here and elsewhere in Whitechapel, the cry is for work. One reason why this is so scarce is to be found in the collapse of the large sugar bakeries of East London. This industry is virtually at an end in Whitechapel and St. George’s-in-the-East, and a vast amount of distress arises from that cause alone. Coopers, Carmen, and shopkeepers suffer more or less in common with the workpeople. As usual, where poverty is most prevalent the poor rates are at a maximum, St. Jude paying at the rate of 5s. 6d. in the pound “to the relief of the poor”—a phrase which might sometimes be rendered in a contrary sense. Here and in other parts we find the health condition of the people far from satisfactory. Notwithstanding all the efforts of the sanitary authorities—often extremely praiseworthy—the people exhibit a state of body almost equivalent to a form of blood poisoning. Boils break out, slight injuries are extremely difficult of cure, and in many cases there is an unhappy craving for stimulants. The poor Jews are said to satisfy themselves with strong coffee except during the Feast of Purim, when some of them esteem it a sort of duty to indulge excessively in a more exciting beverage. That beer-shops and public-houses are far too abundant in many of the poorer districts of the metropolis, is a fact not to be denied. But those who most deplore it are often, conscious of the depressing influence of a visit paid to the dwellings of the poor, and feel it a reasonable precaution to imbibe a stimulant after their exploration. The administration of charity is replete with difficulties; the poor law appears powerless to prevent pauperism; sickness of a serious kind seems now inevitable, and unless employment can be found for these starving multitudes, it is difficult to foresee what will be the ultimate consequence.

Inhalt:

  • Social cases. 1869