Chapter II: The Westminster Infirmary (1)

About a twelvemonth after the Act was in operation I appealed, through the medical journals, to my brethren in the provinces as to the arrangements that had been made in their respective localities. A large number of letters from all parts of England and Wales were sent to me, and with the information thus furnished I prepared a paper which I called "Chaos," in which I turned into ridicule the arrangements that had been made, showing that the Department, faithful to its traditions, had made a complete mess of the administrative arrangements. This paper, read at the meeting of the British Medical Association at Sheffield, attracted a good deal of attention both in the medical and general Press. It materially acted in evolving order out of the chaos into which the subject had drifted, owing to the indifference and incompetence of those who had drafted the measure.

In the spring of 1872 I was informed that the alterations and enlargement of the old Workhouse of St. James's, commenced at the time when the Westminster Union was formed, were complete, and that Mr. French, who had been the medical officer of the workhouse and parish of St. James's for upwards of forty years, was about to retire on a superannuation allowance of L200 a year. I was told that the Chairman of the Board, a Mr. Bonthron, a Scotch baker living in Regent Street, had selected a fellow Scotchman, one Dr. S., as Mr. French's successor, and as Mr. Bonthron claimed to be omnipotent at the Board, this gentleman's appointment to the vacancy was considered to be certain. In the course of a few days I heard that a formidable opponent to Dr. S. had appeared in the person of Dr. M., who was also a Scotchman. In due course the election took place, when Dr. M. was elected. This resulted from a protest on the part of certain members of the Board who resented the predominance of Mr. Bonthron. When apprised of the result of the election, I remarked that Dr. M. could not take the office as he did not possess the necessary legal qualifications. On the following Saturday morning a member of the Board told me that a letter had been read at the meeting of the Guardians, held the previous evening, announcing that the election of Dr. M. was null and void, as he held no surgical qualifications. As his election had surprised all the Guardians, because it proved that the Chairman had not the influence he claimed, my informant advised me to apply for the office. At first I hesitated, but upon being urged again I assented. The same evening I called on Dr. M., told him of my intention, and asked him for the support of his friends. To my utter astonishment he told me he had made up his mind to try again. "Nonsense," I said; "how can you get a diploma from the College of Surgeons?" "Oh," he replied, "I have arranged all that; I have a splendid memory, and I remember all my anatomy and surgery." As I had every ground for the belief that he had never attended lectures on surgery, nor attended the surgical practice of an hospital, inasmuch as I had known him ever since he had come to London, I saw that, without collusion with some one in authority, it was impossible for it to be done; but, as he appeared determined, I left him. As soon as it was known that I seriously intended to compete for the appointment, testimonials in my favour were forwarded to me by several eminent physicians and surgeons, by Members of Parliament, among them one of a very flattering character from Mr. C. P. Villiers, M.P., the ex-President of the Poor Law Board, who strongly recommended me to the Board of Guardians, those lady visitors who had known me at the Strand, and others. Two days before the election took place I was surprised by a visit from Dr. M., who called to inform me that he had passed his examination at the College of Surgeons the night before, and now asked me to retire in his favour. On my declining to do as he wished, he said it was very hard I would not, as he had incurred an expense of upwards of L60 to get the diploma. Prior to the election my friends entered into a compact with his supporters to the effect that if I was in a minority on the show of hands my name was to be withdrawn, when they would support him, but if I was in the majority his friends would support me. This occurring, I was elected, to the great surprise of the Chairman, who looked on me as a dangerous person, seeing that I had taken an active part in bringing about the formation of the Union, whereby St. Anne's had been joined to St. James's, which had the effect of somewhat increasing his poor rate assessment in St. James's--for St. Anne's, a poor parish, had considerably improved its position by being put into union with St. James's, which was comparatively a rich one.

Having at this time received an invitation from the Irish Dispensary Medical Officers Association to address them at the College of Physicians in Dublin, I did so, when Sir Dominic Corrigan, Bart., M.P., was in the chair; and I afterwards spent a very pleasant week there, visiting the North and South Dublin Workhouses, the latter having 4,000 inmates, with a large staff of visiting physicians and surgeons, besides resident medical officers. It is one of the finest hospitals in Dublin, and the arrangements for the efficient treatment of the sick poor were in the highest degree creditable to the Irish Poor Law, now the Local Government Board.

I also visited the Richmond Lunatic Asylum, situated on the outskirts of Dublin, at that date under the superintendence of Dr. Lalor, who, I understand, was the first physician who introduced vocal and instrumental music as a means of relieving the insane. There I witnessed one of the most extraordinary sights it was ever my lot to see. I will give a sketch of the tableau. In the foreground sat a young lady discoursing most eloquent music on a harmonium, immediately behind her there stood some young Irish women, three or four of them, singularly beautiful, with music in their hands, accompanying her; behind them were older women, and then on to the old and weird, all joining most heartily in the performance. The fringe of this female gathering of nearly 100 performers were harmless imbeciles and idiots. I stood and listened some moments whilst this singular performance continued. I was so struck with the beauty of one of the Irish girls that I asked her history, when I was informed that her condition had been induced by a disappointment in a love affair. It was the old story of love followed by desertion, and she had been admitted some six months before in a state of maniacal excitement. She was too young and altogether too pretty to be an inmate of a lunatic asylum. Dr. Lalor also showed me a typical case, exhibiting the truth of the opinion I have long held, that of all the forms of insanity, none are so uncertain of having been really cured as those which have exhibited symptoms of homicidal or suicidal violence. The patient in question had been admitted when suffering with a homicidal tendency but had steadily improved, and his name was on the list of those to go before the Visiting Committee for discharge on probation, when a startling incident occurred. He had secreted one of the knives used in the asylum about his person, and he had, when unobserved, whittled away the thick, blunt portion used in the asylum, until he had given it a sharp cutting edge, from handle to point; when, raising his right leg up, he cut through the calf down to the bone, severing the muscle completely. This patient, Dr. Lalor told me, had been employed on various offices of trust, and that he was commonly considered to be completely cured, and altogether harmless. I obtained one of the old knives used in this asylum, had it copied, and, having got the sanction of the Board for getting several, used them all the time I was at the Westminster Union, in the male and female insane wards. The cutting edge was about two inches in length, but the rest of the knife was about the twelfth of an inch thick. It was impossible for lunatics to do any harm either to themselves or others with such knives.

On my return to London I was informed that my appointment to the Westminster Union had been confirmed by the Local Government Board.

A day or so before the 23rd of June an appointment was made by Mr. French for me to go over the House with him, and to have the establishment formally handed over to me. I went, accompanied by a young Irish physician, recently one of the resident surgeons of an Irish hospital, with whom I was in treaty to be my assistant. I had never been in this workhouse infirmary before. Shortly after my arrival Mr. French joined us, and, in company with the head nurse on the female side, we went through the female part of the establishment. The nurse was most elaborately "got up." We went on and examined each patient, a large number of whom were in the wards--in fact, although it was midsummer, the place was full. I noticed bed-cards over each patient's bed, but as I could not make out what was given to the patients, I asked what was being done for this and that case. To my astonishment Mr. French said, "Nothing; I do not believe in physic, and therefore do not give the people anything." Presently we entered a large ward where a woman, evidently in great pain, was lying in bed, writhing in apparent agony. After ascertaining the nature of the case, which was one of colicky diarrhoea, I asked, "Well, what do you here?" to which he replied, "Nurse, give her a glass of Number Two." With that, he pulled me into the centre of the ward, and giving me a friendly nudge of the ribs, laughingly said, "What do you imagine is Number Two? Why it is peppermint-water coloured; I never give any physic." Feeling by this time somewhat disgusted by these remarkable confessions, seeing that his stipend was L350 a year, out of which it was arranged by the Board that he should supply these medicines. I dropped his company, and went on examining the people independently. Mr. French speedily buttonholed my young companion, and went on looking at the patients with him. At last our visit came to an end, and on coming out of the male sick wards he shook me warmly by the hand and wished me the same happy official life as he had had. He had hardly got out of hearing when the young Irishman commenced to reproach me with having transferred Mr. French to him; saying, "I take it, sir, as a very unkind thing that you should have done so, as I was shocked at his boasting that he never did anything at all for these poor sick people."

The next day I entered on my duties. On taking my seat in the consulting-room the master brought in and laid before me a large volume, the Workhouse Medical Relief Book. I turned over the pages for the week, and noticed the names and extras ordered for the sick. I saw that ham, sausages, tripe, fish, eggs, were entered rather frequently. At last I said to the master, who was standing by, "You surely have not all these people on the sick list in the House! I did not see a third of this number when I went over the House yesterday." "Yes," he replied, "they are here;" on which I said, "Let everything remain as entered in the book until I can arrange to go over the establishment and see them all, which I will do this week." I then went through the sick and infirm wards. On going through the wards I ordered what in my judgment was necessary for the sick in the way of medicines, much to the astonishment of the head nurse, who stared at me in a half-dazed manner. There was one patient with a very foul and offensive ulcer, for whom I ordered a charcoal poultice: she came to me before I left the House to ask me "what I meant." I replied, "A charcoal poultice." She then said, "I never heard of such a thing before." I then asked her how long she had been there; she said eight years. The next day I had occasion to order a carrot poultice; I met with the same astonishment and ignorance of what was meant. At last she frankly stated that she was about to learn her duties, for nothing of the kind had ever been used by her before; and further, she said that as she never had any medicine to give the people, she had not troubled herself much about the patients; indeed, I learned on inquiry that she used to be in waiting to see the doctor each morning, and so soon as he was gone she considered her duties were over, and she returned to her own sitting-room till next day. I could never get her to give my medicines as directed. Apart from this indifference as to medicines, she was kind to the patients and respectful to me. On the male side I found a superintendent nurse who really knew her duties. She confirmed the statement voluntarily made by Mr. French, that no medicines were ever provided for the sick. She also said that the Guardians knew all about it, and that they treated it as a great joke. This was not correct as regards some of the Guardians, as I subsequently ascertained. It was known to the St. James's section of the Board, but repudiated by those of St. Anne's. Seeing that we had had a medical inspector and self-called medical adviser for five years, whose duty it was to visit this Workhouse infirmary, his failure to discover these omissions was in the highest degree remarkable; but then the system prevailed at the Local Government Board, and our Workhouse Infirmaries Association had utterly failed to alter it. The reason for all this was not far to seek.

On the day after, in company with a pauper inmate, told off to carry the Medical Relief Book, I went through the wards for the purpose of seeing the infirm men and women who were on extras. I found on the women's side that, as it was leave-day, many had gone out, and therefore drew the inference that if they were well enough to go out they could dispense with sausages, ham, tripe, eggs, &c., entered against their names, and could eat the ordinary infirm diet provided by Dr. Markham's diet table, which I saw hung up in the wards, which diet table had been drawn up from the form drafted by our Association some years before. It is curious that he claimed it to be his, without any reference to any one. Whilst going through the female wards some of the inmates returned drunk, one old woman very much so. She at once proceeded to ask me who I was, and what I was doing there. On my replying that I had come into the ward to see why she was on a diet of daily sausages, she tartly replied, pulling up her petticoats and showing both her legs, which she struck with her hands, "For these bad legs." I at once ran the pen through her name. She lived in the House years after that, but she ate no more sausages. I learned on inquiry that this fat old woman, who could go out and return drunk, had had sausages, nominally, as her dinner for two years. I write nominally because I learned afterwards that in the matter of diets an extensive system of exchange obtained throughout the House without any check or hindrance on the part of the officials. It took me the greater part of four days to see all the infirm people on extras, but the result was satisfactory, as it enabled me to put the establishment so far as the diets were concerned, on an economic basis. The clerk of the Board assured me at the time that I had caused a saving of some hundreds of pounds, a statement which I honestly believe was the truth.

It might be a matter of wonder how this could be, but having regard to the very large amount of extras purchased from day to day, none of which were supplied under contract, it can be well understood what an opportunity was given for large prices being charged for such extras, as practically no check existed on the cupidity of the tradesmen (selected by the master) who supplied these things. I do not state that such was the case here, but unless some good understanding existed between those who ordered and those who supplied, how is it possible that masters of workhouses, with their limited incomes, should succeed in leaving at their deaths so much money, as many of them do? I was informed that the old master who preceded Catch at the Strand Union had gone there after failing in business as a tradesman in Covent Garden, that he held office as master twelve years, and when he died that he left some L2,000.

I found on inspection of the specially infirm, paralytic, and wholly infirm, that the women were located in wards 16, 17, and 18, and on inquiry discovered that there were no conveniences whatever for the instantaneous removal of excreta, and yet this condition of things had not been discovered by the Government Inspectors or by the medical advisers, or if it had been no steps had been taken to alter it.

On my first visit to these wards I noticed some black patches in the corners of the compartments, which stood out very distinctly from the recently whitewashed ceiling and walls. Noticing some days after that these patches had increased in size, I asked the nurse what it was due to, when she quietly said, "Those are bugs." So soon as I could I saw the master, and told him of it, and asked him to see to it. He did not say he would or he would not, he only laughed. Finding some days after that nothing had been done, I again saw him in his office, when I told him that I must insist on those bugs being removed. The labour master was present, who remarked, "Well, doctor, as you make such a fuss about the bugs I will see to it for you" (evidently regarding the matter in the light of a personal favour); and the bugs were swept down into a dustpan by hundreds and put into the fire and burnt. This was told me by an eye-witness, who was present whilst it was being done.

I do not wish it supposed that the master was harsh or cruel; quite the reverse, he was very kind to the inmates. But he had lived long enough in the service of the Poor Law not to be fully aware that no good would accrue to him or his by too much zeal in the performance of his duty. He calmly let things slide; consequently there was more drunkenness on liberty days than could be possibly imagined, and was unchecked, and although I repeatedly begged that the names of all persons who were on my sick list who had been allowed to go out should be reported to me if they came home drunk, I never could get my wishes attended to, though occasionally it happened that I discovered the circumstance, especially when an accident occurred.

I was not wholly unprepared for this laxity of discipline, as some few days before entering on my duties I met the ex-chaplain of the Strand Workhouse, who, whilst congratulating me on my return to the Poor Law service, said, "You will have a great deal to meet with at St. James's. I have taken the duty there for the chaplain occasionally, and the scenes of drunkenness and quarrelling among the inmates on their return home on liberty days, which I have witnessed, exceeds anything you can imagine." One of the most terrible exhibitions of this kind I ever witnessed was on the first Christmas Day after my appointment. The subject having previously been brought under the attention of the Board, an order was issued that for the future this indiscriminate permission to the inmates to leave the house on Christmas Day should be stopped. It will hardly be believed that on the next Christmas Day the Chairman took upon himself, most presumptuously, to go to the House and give permission for them to again go out. The scene that occurred that night was the most disgraceful that ever happened in the history of a workhouse. Several of the drunken inmates on their return home fought like demons. I and my assistant were engaged for some time in dealing with the injuries that were caused. I must state that I never saw the master so justly indignant as he was at the impertinent interference of this Chairman, in setting his authority and that of the Board at defiance in the way he had done.

Finding that no dietary for the sick and infirm had been adopted at the House, I at once drew up a form which continued in force until ill-health caused my resignation. It was similar to that which I had introduced at the Strand several years before. There was one diet for which I claim especial credit. It was framed with the view of dealing with capricious appetites or severe sickness. It was called Number Five, or _ad. lib._, and consisted of either eggs, fish, a chop, beef-tea, or arrowroot, or anything else of the same value. It was enjoined that the nurse should at 8 a.m. ask what these special sick would take for dinner. When she had ascertained the wishes of the patient, a statement on a diet-sheet showing how many of each description of diet would be required was sent down to the kitchen. At the end of the week the cook handed to the master's clerk the number of each diets she had supplied, who then proceeded to distribute these among all those who were on _ad. lib._ diet. It might appear on the master's side of the Medical Relief Book that A or B had had a chop daily, whilst in reality the dinner might, by this arrangement, have been changed every day. This plan of dealing with capricious appetites has since been adopted in several workhouses.

Although five years had passed away since the Metropolitan Poor Law Act had become law, no attempt had been made to carry out the dispensary clauses until after my election, and one of the first things I had to do was to put the dispensary in order. I had been taught a lesson in economic prescribing whilst at the Strand, and therefore was enabled to speedily arrange for a pharmacopoeia. I also drew up a formula for the supply of large bottles of simple medicines, which were placed in charge of the nurses, for administration in trivial ailments so common among the aged poor. I also introduced bed pulleys, to enable the sick to assist themselves in rising, or in getting in or out of bed. I also ordered small shawls for the aged women and woollen jackets for the men--a great comfort to those who were suffering from consumption or bronchitis, the principal affections I had to encounter.

I have stated that although it was midsummer the House was full of sick people, which arose partly on account of the sickness that prevailed in the worst part of St. Anne's and similarly in that of St. James's, and also to the fact that the Chairman had opposed the transfer of any of the sick to the Sick Asylum Hospital, at Highgate, to which the Westminster Union, in conjunction with the Strand, St. Giles's, and St. Pancras, was affiliated. He had opposed the junction of the two parishes on personal grounds, and being beaten, had, in conjunction with his party, obstructed the removal of the acutely sick.

As medical officer I did not object to this, for as the sick wards were extremely good and were all that I had desired to carry out when I initiated the Workhouse infirmary movement, I simply complied with the wishes of the majority of the Guardians not to send any one away. I had held office some weeks when, in the autumn of the year, I encountered Dr. Drydges in Regent Street. This gentleman, who had acted temporarily whilst Dr. Markham was ill, had about this time been permanently appointed to be Metropolitan Inspector, Dr. Markham having resigned. He came up to me and said, "I was coming to the Westminster Union to learn why it was you did not comply with the law, and send your acute sick away." "Oh," I replied, "that is soon explained; it is because the majority of the Board will not let me." "Indeed," he said; "you must do your duty, even if the Board object to it." To which I replied, "I did that at the Strand, and your Secretary called on me to resign because I was not sufficiently respectful to the Guardians. I shall comply with the wishes of the Guardians now, and not with that of the Local Government Board, as they would throw me over." To which he rather angrily replied, "You speak to me like that, when I am an Inspector, and you only a Workhouse medical officer?" To which I answered, "And who, pray, made you a Poor Law Inspector. Why, if it had not been for me and my initiation, neither you nor Dr. Markham would ever have been Inspectors." "Oh," he replied, "I did not know you had had anything to do with it." "I think," I said, "if you will trouble yourself to inquire you will find what I state to be correct." When I broke down in 1886, and he had to call and see me, he was then most kind and sympathetic, and I take this opportunity of stating as much.

This refusal on the part of the majority of the Board, led on by this Chairman, to allow me to send suitable cases of sickness to the Asylum Hospital, was in the highest degree absurd, seeing that the ratepayers of the Union had to pay their proportion of all expenses at the Asylum Hospital, and for the beds to which the Union were entitled; and although this Workhouse infirmary was a perfect paradise in comparison with the den at the Strand, still the House had not been arranged on the principle that all the sick should be retained in it. My nursing staff was insufficient to enable me effectually to deal with the great number of sick persons there at the time of my entrance on my duties. One illustration will suffice. There was a man in an infirm ward who had been under Mr. French some five or six years. He did not belong to Westminster, he was kept there because he alleged he was so ill that he could not bear the fatigue of journeying some sixty miles in the country. He was a healthy-looking man about forty years of age. He always lay in bed with his knees drawn up, and constantly asserted that he could not stand nor walk, nor put his legs down. He complained piteously of his sufferings. I exhausted every conceivable treatment, but all without the least apparent benefit, as he never owned to being any better for my attention to him. This went on for two years, until I began to get suspicious of him. One day an inmate of the ward, who had recovered and left the House, called on me at my private residence. On seeing me he said, "I have called to thank you for your kindness to me, and also to tell you that you have been deceived by that man Webster, who you have done so much for. He is an impostor. He can walk as well as I can, and, what is more, does walk about." "Nonsense," I replied; "he says he cannot get out of bed, and the nurses confirm it." "Well," he continued, "he takes very good care never to allow them to see him get out of bed, he takes his constitutional walk about the wards between 2 and 4 a.m., when the lights are down, and most of the inmates asleep." "But, surely," I said, "the night nurse must have seen him, and if so she would report it to me!" "Oh," he replied, "she hardly ever comes into the ward during the night, she is generally in her own room fast asleep--she gets herself called when she is wanted." I made some further inquiries, and finding that there was evidence of deception, I sent him to the Asylum Hospital with a letter to the superintendent medical officer, giving his history, and telling him of my suspicions, and asking that he might be carefully watched by reliable persons. He came back in a fortnight, having been found out. He was immediately transferred to his settlement, where doubtless he recommenced the game of deception, having found it answer so well.

It may be here said, If you had not confidence in your nurses, why did you not get rid of them? For the simple reason that I had no power to do so. They were not selected by me, but by the Guardians, and therefore were not my officers, but the Board's. I once reported the night nurse on the male side (the woman who had allowed the malingerer to deceive me) for drunkenness, but I had so much trouble to get rid of her that I was not induced to repeat the experiment, added to which I was most grossly insulted by the master for bringing this woman's conduct before the Guardians.

In my opinion the medical officer should select and discharge all the nurses--of course, reason for this latter action being shown. I should have discharged several at the Westminster Union for neglect of duty and for general incompetence if I had had the power. Simple complaint would be attended by no beneficial result, as it would be a hundred to one that the nurse would be supported in her misconduct by some member of the Board, whose protege she might be. On mentioning this to an ex-workhouse medical officer, he told me that on having occasion to represent the conduct of the resident midwife, who claimed and exercised the right to go out on every Sunday for several hours, leaving the wards wholly unattended on every such occasion except by pauper helps, the only action taken by the Board as a return for it, at the instance of the midwife's friend, was the adoption of a resolution that a return should be prepared and laid on the Board-room table, showing the occasions when the medical officer went out and the length of time he was out, &c., &c. Of course he found out that he had achieved worse than nothing by his effort to check this abuse. This circumstance occurred in one of the largest of our metropolitan workhouse infirmaries.

When first I entered on my duties at the Westminster Union the chaplain there was a very energetic little man named Duval. I do not remember his Christian name, for the reason that he was known and spoken of as Claude Duval, and for a long while I supposed him to possess no other. At last I discovered that the name had been given him in joke, and that he was in no way connected with the celebrated highwayman. He most assuredly did not convey the idea that he had any brigand blood in his veins. He was extremely attentive to his duties, and deserved and had gained the respect of all the inmates and officers.

Frequently he organized entertainments for the aged and infirm. These were held in the dining-hall, which on all such occasions was crowded to excess. After I had held office about a year he desired me to provide an entertainment, which I did on several occasions, and my efforts met with much success. In the carrying out of these entertainments, which were musical and recitative, I had the assistance of my nephew, Mr. Julian Rogers, and his wife, who brought with them vocalists of a high order, who contributed much to the pleasure of the inmates. These entertainments were highly appreciated by the inmates, and were frequently attended by members of the Board, and by some of the ratepayers living in the neighbourhood. Now and then I used to read extracts suitable for penny readings. On two occasions my efforts took a higher form, when I gave a lecture on the "Ear and Hearing," and on "Sight and the Eye." The preparation of these lectures and the diagrams to illustrate them was a work of considerable trouble and some anxiety, but the signal success achieved on both occasions amply repaid me for any trouble occasioned. To show the appreciation of my audience for a joke, I will relate an incident that occurred during the delivery of my lecture on "Sight and the Eye." I was describing the function of the iris, or coloured portion of the eye, as an involuntary movable veil, which regulated the amount of light which should be admitted to the eye, and said that in order to make the veil complete it was covered behind with a black pigment, so as to exclude all light except that which passed through the pupil. I then told them that in certain animals this pigment was wanting, and not only there but in the skin generally, and instanced the white mouse, ferret, &c., and showed that all these animals had red eyes and always blinked and winked when exposed to a strong light. I then passed on to state that this condition was sometimes found in man, where again the winking and blinking was noticeable as well as the whiteness of the skin and hair, from the absence of this dark pigment, hence the name of "albinos" applied to those thus afflicted. I then went on to state that recently we had a notable example of this in the Chancellor of the Exchequer, who suffered from this infirmity, and that his dread of light was so extreme that he had attempted actually to put a tax on matches. This joke was followed by a positive scream of delight from visitors and inmates--showing that Mr. Lowe's fiscal effort to increase the revenue was known to them all. At the conclusion of the night's proceedings, Miss Augusta Clifford, who was present, came up and said she should repeat my story of Mr. Lowe and the match tax wherever she went. At the next meeting of the Board, several of the Guardians having been present on the occasion referred to, it was moved and seconded and carried unanimously, that a vote of thanks should be given to Dr. Rogers for the entertainment provided by him, and for the highly interesting and instructive lecture which he had delivered.

I found in the sick and infirm wards several of my old acquaintances of the Strand, who were chargeable to St. Anne's, and had been transferred to this House when the Union was formed, among them a woman by the name of Maria Hall. She had gone into the Strand several years before I left; her friends at first paid for her maintenance. She was an epileptic--and something beside. When I knew her in the Strand she professed an inability to talk, except unintelligible gibberish. She was very artful; she claimed to be a deeply religious character, and contrived to take in the benevolent lady visitors to a considerable extent. She continually showed me letters she had received, and books that had been given her by ladies, and would ask me to share with her the grapes, cakes, and sweetmeats sent her by her dupes. This went on for several years, altogether about twenty. She always posed and was spoken of as "poor Maria"--in fact, she was the pet of the nurse and of the ward. At last it came to my knowledge that she presumed on her condition to be exacting and troublesome. Finding that remonstrance was unavailing, I reluctantly ordered her removal to the insane ward. It was attended with the best result, for, finding that she was at last sternly dealt with, she threw off the mask she had worn for twenty years and talked as distinctly and clearly as any healthy person. She had traded for years on her alleged infirmity. It was true she was an epileptic, and eventually died from that form of disease; but she had been the most persistent cheat I had ever met with.

On the male side I found a poor fellow who had also been transferred from the Strand, where I had known him when he was first admitted there. He was paralyzed all down on one side. He was the most patient, honest fellow I had ever seen. After I had been in office some years Sir Charles Trevelyan came to call on me respecting a public movement that we were both engaged in. Finding I was at the infirmary, he came round to the House and was shown into my room. I asked him to go over the wards with me. He did so. I introduced the poor paralytic to him as an honest, patient, and grateful poor man. Sir Charles asked him how long he had been afflicted, and he answered, "Some twenty years." Then I said, "This poor fellow cannot get downstairs; he has not seen the streets for all these years, but he is always happy and cheerful." Sir Charles kindly left with me L1 to pay his cab fare, so that he might have the chance of seeing them once again. As I had to send two people with him each time the L1 soon went. His enjoyment of this treat in his daily dull, routine life was, I was informed, most pleasing to witness.

There were several other very interesting persons I found on both sides of the ward. One was an old man who was said to be eighty-eight years old. On my morning visit he was always standing on the staircase smoking. He had lived many years in Australia, and his long white hair and beard, which reached to his waist, conjoined with a florid complexion and bright blue eyes, caused me to consider him one of the handsomest old men I had ever seen. One day I took two young ladies over the infirmary. We found the old man in his usual place. I jocularly introduced him to them as the Adonis of the House. The old man was terribly offended. As we walked away I heard him muttering aloud, "That's a pretty name to call a man--'Donis indeed!" He did not forgive me for a long while. I wonder what he thought the epithet really was intended to signify.

I also found in the male infirm ward an old French physician whom I had known by sight for a great many years when he was practising his profession in Soho. He was a tall, fine man when I first knew him. He always used to wear a very singular-looking broad-brimmed hat. He was in all externals a very gentlemanly-looking person. I had missed him for a long time, and was surprised and hurt to think that he should have drifted to a workhouse infirmary. On inquiring into the cause of his becoming an inmate of the House, for I always thought he was well-to-do, as he dressed exceedingly well, I learned that he had lived with a lady who was an _employe_ at a French milliner's in Regent Street, that she was much younger than he was, and that he had given to her all his money, which she, in preparation for possible consequences, had put in the Funds, but in her own name only. Unfortunately for him she was taken suddenly ill, and being ignorant of English courts made no disposition of the property, simply telling him, on her deathbed, where it was. When she was dead, he found to his dismay that the money could not be obtained, as he could not establish any legal claim of ownership. Grief at the loss of his mistress and of all his money caused the complete break-down of the poor fellow, and he had come into the House utterly crushed. He was a very interesting old man, being the only son of a French noble family. His mother and father were both executed during the Reign of Terror, and when the family property was confiscated he was but a youth. When he grew up he studied medicine, and in the year 1802 entered Napoleon's army as a regimental surgeon. After serving with his regiment in Germany, Italy, and Austria, he was attached to the Army of England, as it was called, which was stationed on the heights of Boulogne. He was there some time. Suddenly an announcement came that the encampment would be broken up, and that the army would go to Russia. He traversed the whole of Europe, taking part in the various engagements on the road to Moscow, which he saw in flames. He was in the memorable retreat, and returned to France without a scratch. On the return from Elba he rejoined his old regiment, and, as its surgeon, fought against the English at Waterloo. After the peace his regiment was disbanded, and as the old soldiers of the empire were very much at a discount he elected to come to England, where he lived since 1816. He died at the age of ninety-five, retaining his faculties to the last. After his death I raised a fund to bury him, by writing a letter to _The Times_, in which I gave his history, heading my letter, "A Relic of the Grand Armee," and asking any friends of the first Napoleon to help me in burying him in some other place than a pauper's grave. My appeal having brought me L25, the Empress Eugenie being one of the subscribers, he was buried at the Catholic Cemetery at Kensal Green. There were two seamstresses who lived in Gilbert Street, Oxford Street, who were his countrywomen and his sole visitors, with the exception of the Catholic priest of the French chapel in Leicester Square. I asked them and the priest to accompany me to the funeral, which I attended as chief mourner. On our arrival at the mortuary chapel, the coffin was placed on a raised bier with three others. Presently two lads, wearing long black cloaks which reached to the ground, came from the altar. When they arrived at the spot where the coffin was resting, one lad suddenly produced from under his cloak a censer containing fire and proceeded to incense the quartette. How he ever carried the fiery thing without setting fire to himself was to me a wonder. He was immediately followed by the other lad, who, taking just as rapidly from under his cloak a vessel like a whitewash-pot, proceeded with a brush to throw holy water on the coffins. This being completed, the coffin was put on a truck and we hurried away as fast as we could go through the miry ground for a long distance to the grave. On reaching it, down went my two lady companions on their knees in the clay. My respect for the deceased did not carry me so far as that, especially as it was raining hard and the ground was a mere bog. Presently the acolyte produced his whitewash-pot and brush, and I was courteously asked to sprinkle the poor fellow's coffin with holy water, which I did. This having been also done by my companions, I was amused by a little girl about fourteen, who, suddenly taking the brush and pot from one of the young women, went to work sprinkling in grand style, and, what was rather alarming, let me in for more than I had expected. On our return journey the priest asked me to attend service in the Catholic Chapel, in Leicester Square, on the next Sunday. This I did. He was a very gentlemanly person. He thanked me very much for the little service I was enabled to render to the poor old French doctor, whom I missed very much, as it was my habit to sit beside the old man's bed and hear him fight his battles o'er again.

The opposition to the removal of the sick to the Asylum Hospital at Highgate continuing, and plausible ground for some action having been shown in the fact of that establishment being so far away, a move on the part of the Department became necessary. The old Workhouse in Cleveland Street being no longer wanted by the Strand Board (as they had built a new House at Edmonton), it was proposed to pull down and rebuild an additional Asylum Hospital upon the site. The vestry of St. James's, instigated by the Chairman of the Board, gave a determined opposition to the proposition. But for once the Department was firm and the hospital was built. At first the four Unions were associated in its use and management, but after a time its use for the reception of acute cases was limited to the St. Giles's, and St. George's, Bloomsbury, the Strand, and Westminster Unions. The Chairman having for a time retired from the Board, his place was filled by a fresh Chairman, and no obstacle being made to my utilization of Cleveland Street Asylum, suitable cases were transferred there, to the relief of the Westminster House, which, through the resistance of the Board, had become inconveniently full. The new Chairman was a very weak man, who was neither by his financial position or general intelligence justified in aspiring to hold such an office. It is possible that if he had devoted the time he spent at the Board and at the Sick Asylum to his private business he might have delayed, and possibly have staved off, his eventual bankruptcy and ultimate death in the Asylum Hospital in Cleveland Street, to the building of which he gave the most determined opposition. His successor as Chairman was a surgeon in Soho, who was a man of very fair attainments, and during the time he occupied the chair the business of the Board was carried on with remarkable success. I received from him the most generous support, and during his tenure of office my official life was hardly chequered by a single cloud.

I have spoken of the clerk of the Board as having expressed a favourable opinion of the economy I had effected on my first entrance on my duties. The clerk had occupied a similar position at St. Martin's prior to its amalgamation with the Strand Union. As I never went near the clerk of that Union after the discovery of his perfidy in making, in conjunction with Catch, a false charge against me, I was often at a loss to know to whom I could go when any difficulty cropped up. Having had an introduction to this clerk, I frequently called and consulted him; consequently I was not surprised when, through the loss of his office, as the result of St. Martin's being joined to the remaining parishes of the old Strand Union, he was without employment, that he should call on me and invoke my good offices in favour of his being appointed to a similar position in the Westminster Union--the gentleman who had filled the office and that of vestry clerk for St. James's having elected to continue in the latter office only, and not to combine therewith any appointment under the Poor Law. Having some influence in St. Anne's at that time, and being also known in St. James's, I gave him my support, with the result that he was elected clerk to the Board. He never exhibited gratitude for my doing this; indeed, on the contrary, he was distinctly hostile to me during the first few years after my appointment, more especially in all matters relating to lunatics, the truth being that he had a sympathy with all those who were alleged to be of unsound mind, arising, I consider, from the fact that he had a consciousness of not being quite right himself. During the two-and-twenty years I knew him I never saw him half-a-dozen times with a shirt on. I do not state that he never wore one, it was simply never visible; what did duty for it was a sheet of more or less crumpled whitey-brown paper. His clothes were as torn and ragged as those of the most poverty-stricken casual--his shoes down at heel, and the legs of his seedy-looking black trousers hanging in rags. He always complained of being so very poor through the strain put upon him in having to support some needy relatives. His condition and poverty-stricken appearance were often the subject of conversation and commiseration: "Poor fellow," it used to be said, "he has had a great deal of trouble, and is very poor." It was therefore a matter of great astonishment to find, after his death, which took place somewhat suddenly, that he was possessed of several thousand pounds. He died without making any will, and there was a legal struggle among distant relations as to who should secure his very considerable belongings. I have frequently noticed on the part of eccentric people this disbelief in and morbid sympathy with lunatics, and believe it to arise from a species of innate consciousness of mental deficiency, and a fear lest they also should be incarcerated.

One morning, some time before his death, he came to me in my room and showed me a letter he had received from the military Commandant of Devonport Barracks Hospital, which was to the effect that they had a young soldier under treatment for lunacy, who, in his attestation when enlisting, had stated that he belonged to St. James's, London, and that the authorities determined to send him up to us. The clerk said to me, "That does not show that he belongs here, as there are several St. James's in London; I shall write and refuse to take him until his settlement has been determined." But he reckoned without his host, for when did the military ever recognize the civil power? The same evening I was requested to go to the insane ward, where I found the young soldier, and the attendant informed me that he had been brought by a corporal and left in the ward, and that the corporal said that he should call the next day for the hospital clothes. The attendant also stated that when brought in the man's hands were tied together behind his back. I could make nothing of the poor fellow, as no history was brought with him, and he would not speak. As he appeared to be very exhausted I ordered him some milk, beef-tea, and wine, and desired that when the corporal called the next day he should be detained, so that I might learn something about the patient, but when asked to stay and explain, the corporal would not stop.

On visiting the man on the next morning I found that he had taken nothing, and as he would not open his mouth, speak to me, nor do anything, I sent for the stomach-pump and some of the strongest of the pauper inmates, that he might be fed by artificial means. It took four to take him out of bed, secure him in a chair, and to assist me to get his mouth open, when I made the dreadful discovery that all his teeth had recently been broken away in the forcible efforts that had been made to feed him. After a most desperate struggle I administered some beef-tea, arrowroot, and wine. This had to be repeated for two or three days, until the necessary certificates were ready, which enabled me to send him away to Hanwell. I was so disgusted with the barbarous manner in which the young man had been treated, that I wrote an indignant letter to the military authorities at Devonport, complaining of his treatment, and their neglect in sending the poor fellow to the Workhouse without affording any history of his case. The reply was a cool denial of the truth of my statement, and an assertion that he took his food readily and without artificial feeding. I sent this letter to the medical superintendent of Hanwell, and asked for his opinion, when he replied that the man had been forcibly fed for some time, and that his teeth had been destroyed in doing so. I then wrote an account of the case and sent it to Dr. Lush, M.P. for Salisbury, and asked him to see the Minister for War on the subject, and in the House to ask the question I had drafted.