is below low-water mark, and with an average
space per bed of four hundred and fifty feet.
Many of the wards are low and hot, some have
no water-service, none are suited to their
purpose. Further, we are assured by Mr. Hart that
besides the workhouses already named, those of
Islington, St. Giles, and West Smithfield, have
irredeemable defects, which render them unfit for
hospital purposes; while those of St. James's,
Westminster, Chelsea, St. Luke's, Lambeth,
Lewisham, Camberwell, Bermondsey, Holborn,
and London East, may be made suitable for
chronic cases only, if certain important alterations
be carried out. It is noteworthy, moreover,
that even where new workhouses are
being built, a wretchedly insufficient amount of
space is allotted to each sick bed. At St.
Leonard's, Shoreditch, for example, where a
really magnificent pile of buildings has been
erected, only five hundred cubic feet are allowed: a
little more than a third of the number declared
by competent authorities to be essential.

Passing from the workhouses to their
discipline and internal arrangements, the results
are even more painfully unsatisfactory. Let
us compare the medical attendance at the
hospitals supported by private charity, with
that of the parochial infirmaries representing
the hospitals of the state. For the three hundred
and fifty patients at St. George's Hospital there
are four surgeons and four physicians, who each
pay an average of three visits a week, besides
two resident apothecaries, three resident house-
surgeons, and a dresser for each surgeon; St.
Mary's Hospital, with one hundred and fifty
patients, has three physicians in ordinary, three
surgeons, four resident medical officers, and
three dressers. At the Strand Union, on the
other hand, with a floating population of nearly
two hundred persons acutely sick, and four
hundred who are chronically infirm, there is no
resident medical officer. The one gentleman engaged
to visit and prescribe for as many invalids as St.
George's and St. Mary's Hospitals hold together,
receives the munificent salary of one hundred and
five pounds a year, out of which he is expected
to find most of the drugs required. At Greenwich,
where out of a thousand inmates nine
hundred are more or less disabled, and where an
average of four hundred are constantly under
medical care, the only doctor is non-resident,
has no dispenser to assist him, and is wretchedly
underpaid. At Shoreditch, where out of a
population of seven hundred, two hundred and
twenty are sick, one hundred and forty insane,
epileptic, and imbecile, besides the usual
proportion of infirm, there is neither dispenser
nor assistant; and the non-resident medical
officer is supposed to see to the needs of those
in his charge, in a hurried morning visit of a
couple of hours. These facts and figures are
unanswerable. We need draw no comparison
between the relative acuteness of the disorders
under which the patients in the two kinds of
hospitals suffer. It is sufficient to know that
under existing circumstances it is as impossible
that the sick paupers of our workhouses can
be otherwise than neglected, as it is that the
occupants of our regular hospital beds can be
otherwise than well cared for. In not more
than a fourth of the workhouses in the
metropolitan district is there a resident medical
officer, and in every case the doctor's interest is
made to be in direct opposition to that of his
patient. The rule in the majority of cases is that he
shall find medicine out of his inadequate stipend,
and even where drugs are provided he has to
act as his own dispenser. Thus he saves
money by withholding remedies, and labour by
avoiding change of prescription. Add to the
temptation implied, that he is always poorly
paid, and that the workhouse is often looked
upon as a mere insignificant supplement to his
private practice; and, that our sick paupers do
not die off even more rapidly and unnecessarily
than they do, becomes a mere testimony to their
tenacity of life.

The nurses employed in workhouse infirmaries
are generally paupers, to whom a full meat diet,
with, perhaps, an allowance of beer and gin, is
made the substitute for salary, and who
mismanage their duties and neglect their patients
in a way incredible to those unacquainted with
the bitter cruelties of workhouse rule. Mr.
Hart, who is corroborated by Doctor Anstie, of
the Westminster Hospital, who accompanied
him on his inspection, draws this picture of the
state of affairs in the externally palatial establishment
of St. Leonard's, Shoreditch:

"To make matters as bad as possible, the
nurses, with one exception, are pauper nurses,
having improved rations and different dress,
but no pecuniary encouragements. They are
mostly a very inferior set of women; and the
males, who are 'nursed' by male paupers, are
yet worse off. The nursing organisation at this
establishment is as bad as can be. The male
nurses especially struck us as a peculiarly rough,
ignorant, and uncouth set. There are no night-
nurses. Desirous to ascertain what was the
condition of the patients under such an
administration, we became a little curious as to
details.  .  .  . The outer surface of the beds is
clean, and the linen generally, through the
able-bodied wards, tolerably so; but as to the
lying-in wards, they were frequently filthy with
crusted blood and discharges, and in the sick
wards also they were far from being well kept.

"The next part of inquiry was as to the
regularity of the administration of food and
medicines. Medicines are administered in this
house with shameful irregularity. The result
of our inquiries showed that of nine consecutive
patients, only four were receiving their medicines
regularly. A poor fellow lying very dangerously
ill with gangrene of the leg had had no medicine
for three days, because, as the male 'nurse'
said, his mouth had been sore. The doctor had
not been made acquainted either with the fact
that the man's mouth was sore, or that he had
not had the medicines ordered for him. A
female, also very ill, had not had her medicine
for two days, because the very infirm old lady
in the next bed, who, it seemed, was appointed