Chapter I: The Strand (3)

Here let me remark that there is no occupation that can be followed at which so much money can be made as by the system adopted by some speculators of taking houses in poor localities and letting them out in single rooms to the humbler classes. To get therefrom all the benefit possible you must be absolutely heartless and unprincipled. If the wretched tenants do not pay their rent weekly, they must go out--and do go! Having, after their weekly collections, much spare time on their hands, these men often get on to Boards of Guardians and frequently on to the District Boards as well: at the first they are always present when outdoor relief is given, which they strongly advocate as a means whereby the rent may be more readily secured; secondly, on the District Boards, where they are always at hand when the Inspector of Nuisances and of insanitary tenement houses makes his report. They generally try to be on the best of terms with this latter official, their scheme being to minimize the character of their reports, and to minimize what is required to be done, as it saves their pockets. One of these persons, who had some three hundred of these houses, was fined by the magistrate for neglecting to keep his houses in a sanitary condition. I had the honour of his permanent hostility. He was, at the time of being fined, not only a member of the Board, but of the Health Committee also. When I was a member of the Strand Board of Works I carried a resolution that the name of the owner of these tenements should be always included in the Inspector's Report. In my deliberate judgment, all persons of this class should be disqualified from sitting on a Board of Guardians, or on any District Board. The same class of middlemen are to be found in all large towns; they are the most dangerous members of the body politic, and should be rigorously treated as such. The person I have before referred to, was not only a member of the Strand Board of Guardians but a member of the District Board also. He was also on that of St. Giles, and St. Pancras. In all these places, and districts, he had tenement houses.

It having been my habit to go to the Workhouse infirmary for twelve years early each morning, I found my time at first hang somewhat heavily on my hands, but after a short while I made up my mind what to do. I resolved to watch the action of the Department, and to do my best to make the permanent officials do their duty, so far as my observation could aid me. With that object in view, I arranged for an aggregate meeting of the profession, at the Freemason's Tavern, to discuss the composition of the so-called Board at Whitehall, and the grievances of the Poor Law medical officers. Among other things, I told them that the nominal Board never met, and that documents requiring the various members' official signature, were taken round to the residences of the Ministers, and, it was alleged, frequently signed without reading the contents.

This statement had been made in the House by an ex-President.

This meeting was an immense success, for not only was there a very large attendance of medical men, but they came from all parts of the country, and the Department had an opportunity of learning how their permanent officials were watched and criticized throughout the country as permanent officials always should be. Mr. Griffin having retired from further vindicating the claims of his professional brethren owing to an attack of paralysis, to which, unhappily, he ultimately succumbed, the balance of the money in his possession was handed over to me in trust for carrying on the objects of the Association. It was also decided that the Provincial Poor Law Medical Officers Association, of which he was the Chairman, should be merged in the Metropolitan Association, which had been started by me two years before, and I was elected the President, a position I held for some years, and which I resigned only when I recognized that the objects of our Association would be more readily advanced by selecting some medical member of the House of Commons to act in that capacity. So I contented myself with the humbler position of Chairman of Council.

At this representative meeting of the profession, I alluded, _inter alia_, to my evidence before the Select Committee, and to my advocacy of the supply of all medicines. I also mentioned the action of one of the Inspectors, a Mr. Gulson, when Mr. Fleming's letter containing the recommendation of that committee was read out by the clerk of the Weymouth Board of Guardians at their weekly meeting. The Chairman having appealed to this official, who was present, as to what should be done, he stated that the resolution was only carried in committee by one vote, and that the Chairman of the Committee, had voted against it. Thereupon the Guardians of the Weymouth Union directed that the official letter should lie on the table, and no expensive medicines were found. I took care that a report of this meeting should be sent to every Poor Law medical officer, and to the Department, as well as to every influential Member of Parliament I could reach. One of the reports having fallen into the hands of Mr. C. P. Villiers, the ex-President and Chairman of the Select Committee on Poor Relief, that gentleman wrote to me protesting against the statement which had been made, and assuring me that it was in direct opposition to what had really taken place, as he had warmly supported my suggestion, and that he should at once call on Mr. Gulson for an explanation of his statement. He also stated that he had been much annoyed at the long delay that had occurred ere the Chief Secretary, Mr. H. Fleming, had drawn up and forwarded to the various Boards of Guardians the letter containing the recommendation of the Select Committee. From other sources, I subsequently learned that for a very long period of time prior to the resignation of Mr. Villiers as President of the Board, he held hardly any communication with his Permanent Secretary. It will be well understood, that if it took some fifteen months for the Permanent Secretary to draw up and issue the letter containing the Committee's suggestion as regards expensive medicines, that no hurry would occur in the establishment of Poor Law dispensaries in the Metropolis, which was only an amplification of my original suggestion. And that actually happened; and it was only by our constantly pegging away, that at last the Board commenced to establish them. But whilst no _bona fide_ effort was made to carry out this portion of the Metropolitan Poor Act, an absolute epidemic took place as regards the building of asylum hospitals, district hospitals for fever and infectious diseases, asylums for epileptics, idiots and imbeciles, district schools, &c. This arose partly from indifference on the part of the permanent officials, but to a greater degree from their complete ignorance of the necessary details required for economic building. It was never my desire, in striving to amend the system--that is, to substitute for the absence of all system of medical relief to the poorer classes the reverse policy--that architects, surveyors, and builders, should be at liberty to extract all the money they could get from the pockets of the metropolitan ratepayers. As it was, finding that the absence of all efficient control was leading to an enormous outlay, and that the public was naturally getting not only alarmed, but indignant, at the profligate expenditure of their money, I put myself in communication with Mr. Torrens, then M.P. for Finsbury, and asked him to question the President of the Poor Law Board on the subject, and to move for a return of what had been already spent and what was proposed to be spent in such buildings. I also requested him to inquire to what cause the delay in establishing Poor Law dispensaries under Mr. Hardy's Act was due. This action considerably alarmed the permanent officials. More important still, it led to a very considerable curtailment in the amount of contemplated expenditure on buildings, and, with this, an approximation to some control. Soon afterwards the establishment of Poor Law dispensaries was commenced, which was an important feature of the Act.

I cannot but relate the close of Mr. George Catch's career.

I have already stated that after the enforced resignation of his appointment at Newington, this model master was selected by the Guardians of Lambeth, as the master of their Workhouse, notwithstanding that he had as opponents some respectable persons who had creditably filled similar appointments elsewhere. His election was due to the assistance he received from the clerk of the Strand Union, and his old friends at that Board. His appointment was challenged at the time, but in spite of the serious evidence afforded by the Newington inquiry, it was confirmed by the Department, but with this proviso--that a special report as to his conduct should be sent by the Guardians to the Poor Law Board at the end of six months.

It was not very long before the opponents of this man's appointment were fully justified in the course they took, as he speedily renewed his old course of cruelty to the inmates, and of quarrelling with the other officers. One of these acts was inquired into, and reported on by Dr. Markham. Although it was clear that the master was in the wrong, yet Dr. Markham, in his official report, managed to throw a doubt on the evidence of the medical officer, evidently to screen the master; but he was not saved for long, for shortly afterwards a young woman, who had been subjected to much harshness by Catch, ran away and hid herself, as it was supposed, in the chimney of one of the women's infirm wards, when the master, with the view of forcing her to come down, induced the junior resident medical officer, to bring from the surgery some substance, on which he poured some hydrochloric acid, whereby some extremely pungent gases were evolved, thinking thereby to compel her to come down; but as the young woman was not there (fortunately for Catch, for if she had been she would have been suffocated), the only effect was that all the old women in the ward, were set sneezing and coughing. This atrocious proceeding, having been reported to the Poor Law Board, Catch was called upon to resign. It will hardly be believed that certain of the Guardians memorialized the Poor Law Board to let him retain his office, when Mr. Shaen, the eminent solicitor, on the urgent representation of his wife, who was a lady visitor at the Workhouse, and knew a great deal of Catch's doings, took the matter up. Mr. Shaen saw me, and asked me whether I could tell him anything about Catch. I narrated the incident of the false charge which he, in connection with the clerk, had made against me when I was away in Scotland, and also told him the story of his behaviour in reference to the sick woman in the lying-in ward of the Strand Union which had led to his leaving that Workhouse. Mr. Shaen took down my statement, and subsequently he sent me a pamphlet of some two hundred pages, in which I found not only my own statement, but sundry others of a highly damaging character, but unfortunately these were so recklessly drawn, that it gave Catch the opportunity of bringing an action for libel. Its publication had induced Mr. Goschen to peremptorily call upon him to resign his office. Catch sent out an appeal to all the masters of workhouses to support him in his action, and a sufficient sum having been collected, the Attorney-General of the day, now Lord Chief Justice Coleridge, acted as his counsel. Having been asked by Mr. Shaen to support my statement in the Court of Queen's Bench, I attended. When called on, I went into the witness-box, and after giving my evidence-in-chief, was cross-examined by the Attorney-General in such a manner that three times during the cross-examination Lord Chief Justice Cockburn interfered to stop it, giving as his opinion that the Attorney-General was pressing me unfairly. As I was leaving the witness-box I turned round and thanked the Lord Chief Justice for his kindness in screening me. I was followed by the late porter of the Strand Workhouse, who was there to substantiate my evidence. A similar attempt to browbeat this witness afforded fine fun. The witness was an Irishman, and at every effort made by the counsel to confuse him, Pat was too much for the Attorney, and feeling that he could make nothing of him, he told him peremptorily to stand down, which he did in such a comical way as convulsed the court with laughter. Unfortunately Mr. Shaen failed to justify several of the libels, and the jury, after twelve days' trial, gave a verdict in favour of Catch for L600--an amount which the judge said was excessive, and for which he refused to certify, thereby affording Mr. Shaen the opportunity for asking for a fresh trial. Subsequently a compromise was effected at the instance of the Lord Chief Justice. In summing up the case to the jury, the judge said that my evidence, if it stood alone, was sufficient to stamp Catch as an improper person to hold the office of a Workhouse master. Mr. Goschen would not allow Catch to resume his office, and, having no resources whatever, he drifted downwards until ultimately, being without means and having tired out all his friends, he in a fit of despair threw himself in front of a Great Western train and was cut to pieces.

I was so much annoyed by the action of the Attorney-General in cross-examining me that on my return home I wrote to the Lord Chief Justice again thanking him, and enclosing for his perusal a pamphlet I had just written on the administration of the Poor Laws. To my great surprise he sent me by hand the next morning a letter, in which he acknowledged its receipt, and informed me that he should read my pamphlet with the greatest pleasure. There is no doubt that my labours up to that time were very well known to his Lordship, as, when at the Bar, he was the standing counsel of _The Lancet_ newspaper, in which my name had frequently appeared. When he became a judge he kept up his interest in that journal. This was told me by the late Dr. Wakley, to whom I related Catch's story and the account of my cross-examination and of the courtesy and support afforded to me by Lord Chief Justice Cockburn whilst under cross-examination. The Lord Chief Justice was a man of scrupulous integrity and honour. I remember a solicitor of good position in Soho, whose brother was then the Treasurer of the County of Middlesex, and whose son now holds the position, saying to me, "Although I am opposed to him politically, yet I have the highest opinion of his conscientiousness, and of his extraordinary ability--we are all proud of him." I esteem it a high honour to have received a letter from such a man written under such circumstances. I have this letter still.

An illustration of profligate expenditure, and the absence of all efficient control at the Poor Law Board, was at this time supplied by my old friends, the Strand Union Board. Shortly after I resigned the Board decided to build a new Workhouse at Edmonton, and plans of the contemplated building were issued to builders, &c. Tenders from sundry large firms for its erection were sent to the Guardians, the lowest tender being from an eminent firm that had acquired a great reputation for the buildings it had put up in various parts of town, as well as in the country. Their tender was rejected, and the contract given to a small builder, resident in St. Paul's, Covent Garden, whose estimate was some L2,000 higher. It was stated at the time that after the contract had been signed the members of the Board were invited to a dinner given by the lucky contractor. The large firm that competed for it, feeling that they had been improperly treated, got the question raised, and the new President, Mr. Goschen, investigated the transaction, but it was too late, as the builder had already set to work, and had a considerable amount of his plant on the ground. Although Mr. Goschen felt that he could not interfere to stop this disreputable transaction, he did not fail to give this party of jobbers a most severe lecture, probably the most severe that ever emanated from the Poor Law Board, in connection with the doings of a Board of Guardians. The issue of it to this Board must have brought about a change of policy among the permanent officials who had not remonstrated against it. I know not whether it was this transaction, or Mr. Goschen's general knowledge of the laxity of the staff, certain it is that during his Presidentship he kept the Secretary in his place, and did not permit him or Sir John Lambert (then plain Mr. Lambert) to obtrude themselves upon him when he received deputations from public bodies and from societies. But I am anticipating.

In the autumn of 1868 a general election took place, with the result of replacing the Liberal party in power. With the concurrence of the Council of the Poor Law Medical Officers Association, I had issued a circular letter to the various candidates for Parliamentary honours, in which I drew attention to the imperfect character of the Poor Law Board, and the usurpation by the permanent officials of powers they were not entitled to, and asked whether the candidate would assist us in our efforts to reconstruct the Board, and to improve the system of medical relief. The replies I obtained were not only very numerous, but they held out the prospect of an alteration for the better. Looking back at the various changes that were made subsequently, I have no hesitation in asserting that many of these improvements were brought about by the action our Council took at this general election. These will be briefly referred to.

I will here relate an incident that gave me the cue as to the line to be taken in the introduction and establishment of a Public Health Act. I was desirous of visiting an aged relative who lived in a village in Hampshire. The local medical gentleman kindly volunteered to fetch me from the station, some seven miles distant, and to put me up for the night, &c. As I neared his house my sense of smell was assailed by one of the most awful odours I had ever encountered. To my inquiry from whence it originated, my host said, "That is from the farmyard over there. Young Green, the son of the corn dealer, has taken Miss Smith's farm, and has commenced to breed pigs. He has at least 300." "Well," I replied, "if I lived here I should make short work of Mr. Green and his pigs; I would at once indict him." "Ah," he said, "you can afford to be independent, you live in London. I dare not; for if I complained, or took any action in the matter, old Green would go to all the markets round about, and would denounce me for attempting to interfere with his son's business, and I should make enemies by the score." Some three or four years after Mr. Stansfeld brought in his Public Health Bill, one of the essential features of which was that every district medical officer should be the health officer in his district. I opposed the proposition with all my might. I knew the Act would be absolutely abortive if Poor Law medical officers were placed in this utterly false position which Mr. Stansfeld proposed. In taking this course I encountered much opposition, and became for a time very unpopular, though at last my views prevailed, and gentlemen wholly independent of local influences were appointed to large areas. Among the remonstrants was the medical man who was the neighbour of the pig breeder, when I silenced him by reminding him of Mr. Green and his pigs, and of the fear that he had that if he complained that his business as a country medical gentleman might be damaged. He said no more.

Having come to the conclusion that the course followed by my poor friend, Richard Griffin, of Weymouth, in continually calling attention to the grievances of Poor Law medical officers, would never eventuate in an improvement of their position, for the general public have never cared for our class in any way, I cast about to ascertain whether there could be any course adopted by which the attention of the public could be drawn to the shortcomings of the system, and decided that the only chance that existed, whereby an improvement could be effected, was by proving that an amended system of medical relief would eventuate in the diminution of the duration of sickness, and consequently of its cost to the ratepayers; and having at this time a copy of the annual report of the Irish Poor Law Commissioners placed in my hands, I studied its pages, and saw that under the Irish Medical Charities Acts the poorer classes of that country had secured to them the most complete system of Poor Law medical relief. I resolved to go over to Ireland, and study its administration on the spot. I carried out my intention, and during my stay in Ireland obtained a complete insight into the way in which the Irish dispensary system was carried out. I also brought back with me all the papers and documents that enabled me to popularize the subject here. I also spent much time in examining the annual returns of the English Poor Law Board, with the result that I was enabled to prove conclusively that efficient medical relief was followed by diminished poor relief expenditure, not only by shortening the duration of sickness, but by the actual saving of human life: this latter was shown also by a return I got Mr. W. H. Smith to move for, which was as follows--

"A return of the population at the last census in England and Wales, in Scotland and in Ireland.

"A return of the mortality from general causes in the three portions of the United Kingdom, and of preventable mortality."

That return exhibited the following: That whilst one in every 43 died yearly in England, one in 44 in Scotland, only one in every 60 died in Ireland; and whilst in England zymotic, or preventable diseases, constituted one-fourth of the total mortality, or one in 190 of the population, Scotland one-fourth, or one in 194 of the population, in Ireland it was one-fifth of the total mortality, and one in 308 of the population; the fact being this, that in England and Scotland there existed the same miserable system of medical relief, whilst in Ireland, after the potato famine and the fever which followed it, calamities which swept away a large portion of the inhabitants, the Medical Charities Act was introduced, and led, by its efficient working, to the beneficial changes which had taken place in the health of the country.

The views I advanced met with much favour, and were commented on and approved by many general, as well as by all the medical journals. Having sent a copy of the paper I read at a meeting of our Association to Mr. C. P. Villiers, that gentleman wrote to me stating that he had derived much pleasure from its perusal, and that I had thrown more light on the causes of pauperism, and devised better measures for its diminution, than any previous writer on the subject. Subsequently, through the influence of Mr. Corrance, then M.P. for East Suffolk, I was invited to address the Central Chamber of Agriculture, which I did, when a resolution, couched in very flattering terms, was adopted, and further it was moved that a copy of the Chamber's approval of my address, and the principles contained in it, should be sent to the Poor Law Board, coupled with the request that the attention of all the provincial Chambers should be called to the subject. Subsequently I was invited to address the Worcester Chamber on the same subject, as well as that of Suffolk.

At a very early period of the presidency of Mr. Goschen, several of the provincial Poor Law Inspectors were directed to make inquiry into the question of medical relief to the poor, and the desirability, or otherwise, of establishing dispensaries, modelled on the principles contained in the Irish Medical Charities Act. One of the most able and exhaustive reports was sent in, as might have been expected, by Mr. Farnall, who thus proved true to the views he held in his interview with me some ten years before; whilst the very feeblest of these was that preferred by Mr. R. B. Caine, who manifested the same lack of heartiness here as he exhibited earnestness some years before in upsetting poor Richard Griffin's statistics, of which he boasted to me during his conduct of the inquiry at the Strand Union in 1866.

One of the results that sprang from my visit to Ireland was the establishment of a good understanding between our Association and that of the Irish Dispensary Medical Officers, of which the late Dr. Toler Maunsall was the honorary secretary. Dr. Maunsall was the most indefatigable secretary I ever knew. His appetite for work, and his skill in getting up statistics was remarkable. He was most valuable to me, as he assisted in getting out dry figures for my use, which would have given me infinite trouble. Poor fellow! like many others of my fellow-workers, he was destined to die early, and I sustained a great loss by his premature death. Unfortunately, too, he died badly off. I started a subscription in England for the benefit of his widow and children, which helped to swell the sum that his friends got together in Ireland.

During my stay in Ireland it was arranged between us that we should mutually help each other, and consequent on that, when the Irish Association strove, under the leadership of the late Dr. Brady, M.P. for Leitrim, to obtain superannuation allowance for dispensary and workhouse medical officers, I called attention to the subject in the medical journals, and induced the members of our Association not only to petition, but to interview members in their respective localities, in favour of the Bill. Dr. Brady, having succeeded in carrying this measure, essayed the next year to do the same for England and Wales. The success of the appeal we had made to members in the general election of 1868, facilitated the passing of the measure most materially, as we had promises of support from upwards of eighty gentlemen who were subsequently elected. Prior to the second reading of our Bill, I interviewed several members, and got promises to attend the second reading and vote for the measure. Some of these gentlemen, having intimated their desire to speak in its support, and having asked to be supplied with information on the subject, I coached them up. To one of the ablest of our supporters, who asked me to provide him with facts, I said that I was opposed to superannuation on principle, as I held that every one should be able during the working days of his life to provide for the exigencies of his old age--but then it was necessary if he held an office that the pay should be such as would enable him to do so. Now it was notorious that the pay of the medical officer was based on such a starvation principle as to render it impossible for him to save anything. This argument, reproduced very much as I have written it, in the House assisted a great deal in the success of the Bill. At the time this occurred I was out of office, and had not the most distant idea I should ever again be a workhouse medical officer. I did not know what was again in store for me, nor that I was destined to have another fourteen years of it; that I should be again suspended, restored to office, and eventually, through broken health, compelled peaceably to resign and to be myself a pensioner.

After the Bill had become law Dr. Brady most generously bore tribute to my efforts, and stated that he never could have carried the Bill without my help. _The Lancet_ published this statement of Dr. Brady's, and I for the time gained from my Poor Law medical brethren credit for what was, at that period, absolutely disinterested labour.

About this time I was invited by a leading physician in Edinburgh to visit that city and address a meeting at the College of Physicians on the subject of Poor Law medical relief in Scotland. Although I was aware that the condition of things in that country was worse even than it was in England, yet I had not studied the subject so completely as to justify me in asserting it. Consequently I declined what was a very great compliment. Some years afterwards I went and delivered an address. It took place at the time when the annual meeting of the British Medical Association was last held there, when a highly complimentary resolution was adopted at that meeting in reference to that visit and address of mine. After occupying the position of president for a brief period only, during which time the Department was administered most vigorously and successfully, Mr. Goschen was transferred to another office in the Government, and Mr. Stansfeld was appointed President, the effect of which became immediately apparent, for the leading permanent officials, whose influence had been checked during Mr. Goschen's presidency, came directly to the front again.

One of the first measures introduced by Mr. Stansfeld was the conversion of the Poor Law into the Local Government Board. This was carried out by the absorption of the Public Health Department of the Privy Council in the destitution element of the Poor Law Board--a most disastrous act of policy, as it subordinated the Health Department, which had done its work so well to the discredited section of the Poor Law Board as exhibited in the permanent officials of the Board, who had always been obstructive, and had neither carried out, nor permitted any one else to carry out, any reform whatever.

This was early made apparent, for at the first deputation to the President, at which I was present, after his appointment, I saw Mr. H. Fleming and Mr. Lambert sitting together with the President, whilst Mr. (only just recently made Sir), John Simon and his staff, who were the only intellectual element of the new Board, were relegated to distant seats in the corner of the room.

That a Public Health Bill started under such circumstances should be framed absurdly, seeing that those who understood the subject were ignored, and those were consulted who had never done anything well, was nothing but what might have been expected.

One of the provisions of the Bill was, as I have before stated, that every district Poor Law medical officer should be the health officer of his district, and that his reports of insanitary conditions should be sent to the Board of Guardians, many members of which Board would be found to be the principal offenders against sanitary requirements.

This scheme speedily evoked an opposition, and a deputation, representing the British Medical Association, the Social Science Association, and the Poor Law Medical Officers Association, had an interview with Mr. Stansfeld at the Local Government Board. The speakers from the two first Associations having addressed the President, Mr. Stansfeld announced that he had just received a summons to attend a meeting of the Cabinet, but he would leave Mr. Fleming to hear any further remarks that might be made, which would in due course be communicated to him and meet with attention. Being the sole remaining speaker, I said to Mr. Fleming that when I first heard of the proposed utilization of the Poor Law medical officers in the Public Health measures of the Government, I hailed it as a tardy recognition of the valuable services that class of official might render. But when I came to look into the details I saw it would not work, as medical officers would hesitate in affronting their Board of Guardians, many members of which would be found to be the principal offenders against the contemplated Act, and that in the few cases where the parish officers would faithfully carry out the requirements, and thereby offend their respective Boards, they would be sacrificed to the resentment of their members, and if appeal was made for support to the Central Department, such honest men would be called on to resign for not exhibiting sufficient courtesy, &c., and working with their Boards. It was very evident that my observations went home to this Permanent Secretary, but whether they were ever communicated to Mr. Stansfeld is open to much doubt, for his Bill was eventually brought in on the lines he had originally indicated, only to turn out on trial a disastrous and ludicrous failure.