space, and the guardians think they can save
a few pounds by keeping a little below this very
humble standard. We have heard somewhere
that the whole workhouse space of the
metropolis gives an average of only three hundred
cubic feet to each inmate. According to the
Lancet, which medical authority has been doing
vast service in this matter of late, there are
many wards in which the space does not exceed
four hundred and fifty feet per bed; and some
in which it falls to four hundred and twenty-
nine; and, in such places as these, cases of
contagious fever are scattered about among the
other patients.

In the voluntary hospitals of London, the
number of surgeons and physicians, for the in-
patients alone, ranges from eight to ten for each
institution, and these find their duties to be no
sinecure, although assisted in their performance
by an army of house-surgeons, dressers, clinical
clerks, and pupil-assistants of various kinds.
A workhouse hospital, containing, perhaps,
one hundred and fifty or two hundred beds,
will be under the sole charge of a " medical
officer," who is sometimes a general practitioner
in the vicinity, sometimes a young man debarred
from private practice and holding his appointment
only until something more eligible offers
itself. In the former case, the medical officer
cannot have the time, and in the latter case
he can scarcely ever have the knowledge,
necessary for the proper management of the
various and numerous forms of sickness that
fall under his care. Medical officers of workhouses
are only human; and, when human
creatures are placed in such a position that
their duties altogether transcend their powers,
they invariably fall as much below the standard
of what is possible, as their ideal or nominal
standard is placed above it. No man can
undertake a hospital with two hundred inmates,
and really exercise his mind about them all,
watch the changes in their conditions, and trace
out the causes of their sufferings. If he begin
by an honest attempt to achieve this utter
impossibility, he will soon break down; and will
in most cases speedily reconcile himself to a
merely formal discharge of his duties in outward
show; going among his people and asking
them trivial or customary questions, without
bringing his faculties to bear upon the
significance of their replies, and giving them only the
deceptive seeming of attendance, in lieu of the
living reality.

In all cases of serious illness, the best efforts
of the medical practitioner will be of no avail,
unless seconded by proper and careful nursing;
and the necessity for such nursing will be
greater, the less the doctor is able to superintend
the manner in which his orders are carried
out. In voluntary hospitals, where such
superintendence may be constant and unremitting, it
has been found necessary or useful to supersede
the paid nurses of a few years ago by a higher
class of persons, specially trained to the right
discharge of their respective duties, and fitted,
by intelligence and moral character, to exercise
authority and maintain discipline in their
wards. In the majority of cases, the so-called
(and sadly mis-called) " nurses" of a workhouse
hospital are simply some of the able-bodied
paupers who happen to be inmates at the time.
As a rule, able-bodied paupers, male or female,
are persons who, by some kind of misconduct,
have ceased to be able to maintain themselves
honestly. Either they are too stupid, or too
lazy, or too immoral, to earn a living at the
business to which they have been brought up.
And on this account they are employed by
guardians on a business which requires a special
training, a trustworthy character, and an
aptitude for obtaining a moral ascendancy over
others. It appears, however, that a system of
paid nursing is gradually creeping in and gaining
ground at several workhouses, and that it
must in time supersede the present arrangement.
The chief fear is lest the paid nurses, like the
paid doctors, should be numerically insufficient
for the discharge of their onerous duties.

With regard to the question of proper food
there is no difficulty with the actually sick, if
the doctor will assert and use the power which
the law gives him. It not unfrequently happens
that very great difficulties are thrown in
his way by officials whose primary object is to
"keep down the rates," and who are not
sufficiently far-sighted to discover the eventual loss
entailed by the careful saving of the present
sixpence. The master of a workhouse has much
power to thwart and annoy a medical officer,
and the guardians have still more. Any
contests with these officials on the question of diet
or extras seldom fails to impair the efficiency
of the medical service of the institution, and
to recoil at last upon the sick. Where the
medical officer possesses tact and firmness to
use his authority without giving offence, he
may in most cases succeed in obtaining any
diet he pleases for cases actually in the
hospital; but, where he is wanting in these
important qualities, it is not at all uncommon to
find a considerable official pressure brought to
bear upon " sick diets."

The diet of the so-called " infirm" is, in most
cases, very unsuitable. " At present," says the
Lancet, " the mischievous anomaly remains of
allowing the guardians to pretend to feed aged
and feeble persons upon the tough boiled beef
and the indigestible pea-soup and suet-pudding
of the house diet."

And again:

"Having carefully observed the infirm
patients of many workhouses at their dinners, we
are confident that the charge against the
ordinary house dinners——that, from one cause or
another, a very considerable portion of the
materials is rejected by infirm persons——is
correct. In one workhouse we were very much
struck with a perfect heap of leavings which
the nurse of an infirm ward was collecting at
the end of dinner-time; and we have heard many
bitter complaints of the pea-soup as causing
pain and spasm in the stomach. Now clearly,
whether the house diet be or be not theoretically