7 JANUARY 1865, Page 20



SIR,—Will you allow me to offer a few observations respecting your article on workhouses in the Spectator of the 31st of December?

The scheme of a great pauper hospital for London is a gigantic one. A short time ago it was calculated that 50,000 sick passed through the metropolitan unions in a single year. Even could such a mass of misery be dealt with in one institution, the con- dition of the patients in the country workhouses would still re- main unimproved. May I venture to suggest that it would be more easy to accept the existing machinery of the workhouses and reform it in such manner as shall really meet the re- quirements of the case? To accomplish such a change, how- ever, a very different mode of dealing with the subject than those hitherto employed must be brought into action. A Parlia- mentary Committee sitting for three sessions, listening com- placently to all official evidence in favour of things as they

are—and contemptuously dismissing the counter-evidence against them of such witnesses as Miss Carpenter, Hon. Mrs. Way, Miss Twining, and several of Her Majesty's Inspectors—a Committee which finally ends its report (so far as medical relief is concerned) by the "lame and impotent conclusion'. of a recommendation to supply a little more cod-liver oil,5 will never effect any important amelioration in the state of affairs. To ascertain the real facts of the case, on which future reformation must be grounded, we need a different inquiry from this.

We need a commission composed of the first medical and surgical authorities in the kingdom, to investigate the actual condition of the workhouse hospitals throughout the country, and then afford us their judgment of what are the changes required to fit these insti- tutions to fulfil their proper purpose.

I presume it is superfluous to urge that, if we are to have such pauper hospitals at all, they ought to be suited to fulfil the purposes of hospitals, i. e., fitted to cure disease and to relieve suffering. Even the commonest economy points out the penny-wise and pound- foolish policy of keeping patients for months and years in work- house infirmaries restorable by a few weeks' good medical treatment to health and industry. As to the cruelty of the case there can be no question ; yet in every department which concerns the sick nine-tenths of our workhouses fail in the requirements which even the most strictly economical of our free hospitals admit to be indispensable. Instead of several medical officers, with the aid of the very highest skill whenever needed, the workhouses have usually one surgeon (often at the outset of his profession), who never calls in any one more experienced. Instead of abundance of medicines, making all known drugs (except musk and one or two more) available for every patient, the workhouses nearly in- variably lump the salary of the surgeon with his drugs, and leave him to debate the claims of justice to himself and mercy to his patient beside every sick bed, —the result being that all the more costly anodynes and tonics are well nigh unknown, precisely where the poor sufferers most need them. Instead of trained and paid nurses the workhouses have usually male and female paupers, who must be either incapable or vicious, else would they earn their bread elsewhere. Instead of proper beds and other appliances the workhouses have such couches as that of poor Daly, fitted very properly for an able-bodied pauper's night's rest, but utterly unsuited to the diseased and bed-ridden. These differences be- tween free hospitals and workhouse hospitals are not differences in matters of show or ornament,—a penny expenditure in such a direction in a place supported by enforced rates is an offence,— but they are differences in the efficiency of the institutions to fulfil their purpose. They make our workhouse hospitals the cruel and stupid anomalies they are, places for the cure of disease and relief of suffering where half the measures are neglected by which disease can be cured or suffering relieved.

Should such a Commission of Inquiry as I have supposed, fulfil its labours, the result would be the authoritative command to each Board to make such reforms as the Commissioners should deem advisable regarding the appointment of surgeons, the due allow- ance for drugs according to the number of patients, the payment of trained nurses, and the proper furniture of the wards. This done, Workhouse Medical Inspectors, performing similar duties to those

" Such is actually the result of the " Blue-B .ok " report. We ask in vain why the ladies mentioned above were summoned as witacases only to be insulted by the re- jection of their evidence as of no value?

who attend to the workhouse schools and lunatics, would pre- serve the system from ever falling back into its present con- dition.

One word in conclusion. There are many Boards who lack not knowledge or will to treat their sick aright, but power to do so out of their hardly raised rates. That such is the case, that thou- sands of sick poor are deprived of the means of recovery and relief under the present plan of union and parish rating is a sufficient argument (were none el-3e forthcoming) for a revision of this plan, for the equalization of rates over whatever larger areas may be needed to permit each union to treat its poor on the principles alike of economy and of humanity.—I am, Sir, yours, &c., FRANCES POWER COBBE.