The Sun.
London, England, 1849-01-17 00:00:00

THE SUN,

visited the hulks at Woolwich, where he had seen some
cases of cholera; and also that he had, in two previous
situations, had the charge of pauper patients.
It appears that a significant warning of the approach-
ing outbreak was given 14 days before a single case of
cholera had occurred. Three girls were on Friday, De-
cember 15, attacked with vomiting, diarrhces, and col-
lapse; but this warning was not understood by the resi-
dent medical officer, who supposed the cases were
dependent on cold and dampness; and thus, no suspicion
being awakened of the true character of the attack, none
of those preventive measures which experience has
proved to be most effective were adopted; no inquiry
was instituted as to the prevalence of diarrhoea among
the children; no alteration was made in their diet, and
no means were adopted to guard them from the noxious
effect of overcrowded and unventilated rooms. If at
this time, 14 days before the fatal outbreak, due and
proper measures had been carried into effect, a large
part of the evil that has since occurred, it is certain,
would hare been averted.

It further appears from the evidence, tbat after the
attack of cholera no efficient means were adopted either
to discover the existence of the premonitory diarrhcea,
or for its treatment, when it was brought under the no-
tice of the resident medical officer. Thus, the mistress
of the girls says, " she had received no direction to
question the children whether they have diarrhoea," and
a similar statement is made by the master and one of
the under-masters, tee only officials of this class ques-
tioned by me: whilst, as regards the medical officer, he
could not undertake this duty if it had ever been con-
templated, being overcharged with attendance ou the
sick. With respect to the treatment of the premonitory
diarrhoea, although all the medical authorities connected
with the Board of Health in England, Ireland, and
Scotland, have, in their published instructions, advised
the use of some preparation of opium, that medicine
has not been administered in a single case of diarrhoea
up to my visit on Friday, the medical officer relying on
astringents.
That there has been, as in all similar circumstances, a
large amount of diarrhoea prevailing among the children
at this establishment, both previous to and since the out-
break of cholera, is abundantly proved. One of the
assistant-masters stated to me, " he had observed that
the boys had been purged during the last fortnight, and
especially since yesterday week."*
The schoolmistress also states, that " many of the
children have been taken with pain in the bowels." The
resident medical officer says, many of the children at-
tacked by cholera had informed him that they had
suffered from diarrhoea before the attack, some for a day
or two, and others longer. The inquiry instituted at
my suggestion by the several medical gentlemen now in
attendance, led to the discovery of 38 cases of diarrhoea
on Saturday and a part of Sunday, although the number
of children had then been diminished one-half by re-
movals ; among these cases only one child bad on Sun-
day passed into cholera.
On examining the buildings and premises appropriated
to the children in general, I found that the boys' dor•
mitories had only windows on one side—a most unfavour-
able arrangement both as regards light and air; the
same observations also apply to the schoolrooms. The
dormitories are greatly overcrowded, and in those for the
younger children the arrangement was that three chil-
dren should sleep in ono bed. In the schoolroom for
boys the master informed me there were, when all were
present, 500; the length of this room being 94 feet, the
width 21 feet, and the height 11 feet.
The ventilation is most defective, and entirely incom-
patible with the maintenance of health, even in the case
of a much smaller number of boys than that above speci-
fied. The girls' schoolroom is used for 260 children, it
is lighter than that of the boys, but the ventilation is
equally defective as in the preceding case.

In Connexion with these schoolrooms, it is necessary
to state that Mr. Hall, the Assistant Poor.law Commis-
sioner, informed me that in the beginning of the month
of November last he and Mr. Tufnell gavel Mr. Drouet
a written order, limiting the number to be received in the
boys' schoolroom to 400, and in the girls' schoolroom to
160. This order, which ought, under the ordinary cir-
cumstances of health, to have been immediately carried
into operation, was neglected, and, as it must be pre-
sumed, to the injury of the children's health.
The yard or playground was damp and wet, owing, as
it appeared, to its limited size, and to the buildings by
which it is more or less surrounded. Mr. Semple, one
of the medical officers of Islington, stated to me that he
had complained of the wet and damp condition of the
premises. All this is most unfavourable to the health of
, young children, for, as there are no day rooms, the
children must either go into this damp yard or remain in
the schoolrooms or dormitories, which, on other grounds,
is equally objectionable.
One part of the buildings requires a special notice.
About five or six months ago, according to the evidence
of Mr. Walter Chapman, one of the late medical atten-
dants of this establishment, a low range of buildings,
constituting one long room, was erected in the imme-
diate vicinity of a yard, in which a large number of
animals, pigs, cows, horses, and poultry are kept. These
premises are, moreover, in a most objectionable situation,
as they are placed very near to the two foul open
ditches or drains described in the evidence of Mr. Lovick,
of the Sewers Commission. When this building was
erected, and before any children had been placed in it,
Mr. Walter Chapman, then the professional medical ad-
viser of Mr. Drouet, " expressed his opinion that the
Commissioners of the Poor or of the Board of Health
would insist on the removal of the pigstyes and animals
if the children were to live there." Notwithstanding
this representation, 150 children were placed in this
room. The present medical officer has also expressed
to the proprietor his opinion that the locality was
not suitable. In consequence, as it is believed, of these
representations, some of the animals have been removed,
but I saw a large number of poultry still in the yard, and
some pigs also remain. One of the ditches was also
cleaned out about a fortnight ago, but in so ignorant a
manner, the offensive mud being thrown upon the banks,
as to increase the evil by extending the evaporating sur-
face. (See Report of Mr. Lovick.)
In the immediate neighbourhood of this establishment,
and intersecting the land in all directions, are numerous
open ditches, canals, and pieces of water, of the most
offensive character. The condition of these foul streams,
and their relation to the premises of Mr. Drouet, are
very clearly and correctly described in the report of Mr.
Lorick. It is only requisite, therefore, in this place, to
state that no locality more unfit for the lodgment of a
large number of children could possibly have been se-
lected, and the fact that the inmates of this establish-
ment have heretofore escaped violent epidemic disease,
can only be attributed to the dilution, by the pure air of
the country, of the poisonous effluvia constantly poured
forth by the vast extent of exhaling surface described in
Mr. Lovick's report.
In considering the causes of this awful visitation, the
more important circumstances requiring notice are—
firstly, the locality; secondly, the diet and clothing of
the children; and lastly, the number of children in
the establishment. As regards the locality, there can
be no doubt that it has exerted a most injurious in-
fluence on the children; for, although, according to
the evidence of Mr. Walter Chapman, the amount of
actual sickness in the establishment has not been high,
yet the experience of the present epidemic has plainly
demonstrated that the constitution and health, in a large
number of instances, must have been seriously deterio-
rated. Thus far I have no hesitation in stating my
opinion that the foul waters surrounding Mr. Drouet's
premises hare, by their exhalations, acted most delete-
riously, and by thus inducing a high degree of suscepti-
bility to disease, have greatly aggravated the intensity
of the attack and augmented the mortality.
But it is certain that the injurious locality has only
played a secondary and indirect part in this epidemic,
and for this obvious reason—that whilst a large number
of ;persons inhabitants of Tooting and of the poorer
classes, have been exposed to the same noxious effluvia,
though probably not in the same degree, not one of them,
either adult or child, has hitherto given any indications
of being affected by the cholera poison. Under such
perilous circumstances, it was, of course, my duty to in-
stitute a searching inquiry into the present state of
health of this populous village ; and I therefore re-
quested the medical officer of the district to ascertain
if any of the inhabitants, and especially the children
of the poor, were labouring under diarrhma or other
affection indicative of cholera. The result of this inves-
tigation, I am rejoiced to say, has been most satisfac-
tory, by showing in a conclusive manner that up to the
present date there has been no excess of disease above
the average. This being the case, the essential causes
of the outbreak must be sought in the establishment it-
self ; and, first, as regards the diet—
This consists of meat three times a week, pudding
once, and pea-soup three times a week. On inquiry,
and questioning a considerable number of children, I am
bound to state that in many instances the food has been
defective in quality: the kind and quality of the diet also
ehsapveeciall
beeyn of an objectionable character, and liable,
in a season like the present, to have exerted
an injurious influence on the system.
Underctuh.onam utmet
htehen he
the use
tautsieos
noe
proprietor
sf
as
vs eugdeedidt a bnb circumstancesyloet, it i
tdihni
diet.
General
selnt
fo,erbael
accordance mB
insteaduowcaih regretted
Board,
feeding
ehireseedet
discon-
tinue
these children so often on a kind of food, pea soup
(known to exertinnar a diet yeasescoanrseisltaixngingmionrfleueofcesoloind
the alimentary ca
and dry and farinaceous food, had been substituted for
green vegetables when the cholera approached the me-
tropolis, there are sufficient grounds for inferring that
the stamina of the children would have been better
maintained, and that consequently more resistance
would have been offered to the attack of the epidemic
influence of cholera.
With respect to the clothing, this is insufficient, parti-
cularly as concerns the provision of flannel next the skin,
a point in primary importance in maintaining the health
of all young children.
After maturely considering all the circumstances con.
nected with the painful occurrence, I am induced to
essentialex-
ove rcr
wcdai
nu
gs e
of
ff t
hailsl
pethsrtel'asbmsliimsshcyhmifieefhrrath.apcsobanenvegincetrtiohouensitnahoiarltdictn(hianetceetve
the
effluvia
from
the foul sewers and stagnant ditches to be, yet, diluted
as they are by the winds, they might not alone have been
sufficient to produce this outbreak, as may be presumed
by the immunity up to this time of the inmates of other
houses near these moats and ponds. But the state of
overcrowding was such as must have lowered the health
of the inmates in ordinary times, and was almost certain
to produce disease under the depressing influence of an
1 epidemic condition of the atmosphere. Without doubt,
both the noxious effluvia and the overcrowding contri-
buted to the calamitous result; but of these two causes I
attach,
othh ea h uyt ms
toes importance
carried tot theo
such
h overcrowding,extent
as
will be immediately shown to have prevailed in this
establishment, must have lowered the health of the in-
mates and predisposed them to disease.
It appears from information derived from the Poor-
law Commission, that on the 23d of December, the
total number of children under Mr. Drouet's charges
amounted to 1,372. The original premises were totally
• This evidence was taken on Friday, Jan. 5.

insufficient to accommodate this large number, and
consequently, as successive additions were contributed
by various parishes, new buildings were erected. In
the construction of these buildings none of the sani-
tary precautions so urgently demanded by the circum-
stances were observed ; no effective ventilation was
provided; and especially it must be pointed out that the
space allowed, both in the dormitories and school-
rooms, was altogether inadequate to the number of
inmates they subsequently received. It is one of the best
ascertained facts in the construction of hospitals, that
wards containing a large number of patients in
each, as seen so often in continental cities,
exert a most prejudicial influence over the pa-
tients lodged within them, and never can be ren-
dered so healthy as smaller wards. The same principle
strictly applies to the case of apartments designed for
children, especially those of tender age. In the present
instance this injurious system has been carried to the
utmost extreme, and has, by inducing a highly sus-
ceptible state of the system, enabled the efficient cause
of cholera, at a time when that epidemic gave so many
plain indications of its existence, to operate with intense
energy among the crowded inmates of this establish-
ment. It may be affirmed that in no public institution
in the kingdom, however well contrived and regulated,
could so large a number of children, with the existing
detective sanitary arrangements, be received without an
injurious influence being excited on their state of health.
This being so, what but the most evil results could be
anticipated by the collection of nearly 1,400 children
in an establishment formed upo❑ no plan, expand( d
hastily to receive the repeated influx pouring in
from so many parishes, supervised by uo compe-
tent authorities, and freed from the wholesome
control deemed essential to the safety and well-being
of every parochial establishment in the kingdom?
If there be any one part of the pauper population re-
quiring, more than another, watchful and solicitous
care, it is assuredly that large part of it comprised of
children of tender age. To these, much more than to
adults, whose vital powers are fully developed, a free
supply of pure air, a provision of spacious and well-
warmed rooms, and of dry and airy premises, are, in
addition to a suitable diet and proper clothing, indispen-
sable to the maintenance of health. If any of these con-
ditions be violated, not only will the general stamina of
the childien be in many instances permanently
lowered, but the danger of violent and destructive epi-
demics will be ever impending.
As indicative of the evil and pernicious influence of
the overcrowding and improper diet, it is important and
interesting to state that out of 56 adults employed in
various capacities in the establishment, only one case of
cholera had occurred up to Sunday, Jan. 7.
In concluding the report it is my duty to call the at-
tention of the General Board of Health to some facts
connected with this distressing case. It is, in the first
place, certain, that if the various instructions contained
in the several notifications of the board had been duly
observed and efficiently carried into execution, a large
part, if not all, the evils that have occurred would have
been avoided.

It has been shown, for example, by the evidence of
Mr. Lovick, that a fortnight before the outbreak one of
the foul ditches near the premises was emptied and the
filthy mud thrown on the banks, in contravention of the
following clear directions contained in the second noti-
fication of the General Board, bearing date October 31,
I848:--

" With reference to the larger works of cleansing, such
as the cleansing out of long lines of ditches, or the re-
moval of large masses of decomposing refuse, much mis•
chief has sometimes been occasioned when the ope-
ration has been so ignorantly and unskilfully con-
ducted as to increase the extent of the eva-
porating surface ; as, when the contents of foul
ditches have been spread out on the banks and allowed to
remain there, and when cesspools have been emptied
into drains or sewers having no proper fall, or no run
for the discharge of the contents from beneath inhabited
houses. Works of this kind should be conducted under
the superintendence of a person who possesses some
knowledge of the nature of the gases evolved, the atmo-
spheric and other conditions that promote their copious
evolution; their probable effects on susceptible persons
and the mode of diminishing or averting them, either by
the proper use of deodorising fluids, or by other means.
The medieal officer who may be expected to be the best
informed in these respects, should, therefore, as before
stated, be required to take the general superintendence
of such operations."
Again, with respect to the premonitory diarrlicei, not
only was no attention paid to the purging, which it had
been shown became so prevalent a week before the de-
cided attack of cholera as to attract the notice of the
school• master, but even the occurrence of three well-
marked cases of ♦omiting, purging, and collapse,
occurring fourteen days before the outbreak,
awakened no suspicion of the approaching evil.
Upon this point the General Board has been most so-
licitous to diffuse correct information. In the first noti-
fication, dated October 5, 1848, in addition to other
cautions of a similar kind, occurs the following pas-
sage :
•• It must be repeated, however, that whenever Asiatic
cholera is epidemic, the slightest degree of looseness of
the bowels ought to be regarded and treated as the com-
mencement of the disease, which at this stage is capable
of being arrested by simple means, but if neglected
only for a few hours, may suddenly assume a fatal
form,"

These notifications were widely diffused, and ought
to have come to the knowledge both of Mr. Drouet, and
of the various boards of guardians that had children in
the Tooting establishment ; they were inserted in the
Gazette, copied into the newspapers, and moreover, were
expressly sent to each board of guardians throughout the
kingdom, and also to the medical officers of the various
unions and parishes.
These facts relate to the circumstances antecedent
to the fatal outbreak. On its actual occurrence there
appears from the evidence to have been even more
reprehensible neglect. No means of separating the
healthy from the sick were taken for seven days after
the first cases.

The directions of the General Board, of the date of
November 6, 1848, upon this point are to the following
effect :

" And we'also authorise and require the said guardians,
where it shall appear needful, to provide rooms or places
of refuge, to which may be removed the families of such
necessitous persons as have been attacked with cholera,
and also such necessitous persons living under the same
roof with, or in the vicinity of, persons so attacked, as
the medical officers acting under the authority of the
said guardians may deem it necessary to remove ; and
the houses, room, or dwellings from which persons may
have been so removed to the houses of refuge, shall be
cleansed and purified by the owners or persons having
the care or ordering thereof, or, in their default, by the
said guardians."
If under the ordinary circumstances attending an out-
break in a town or city this measure is, as it is recog-
nised to be, of primary importance to break the force of
the epidemic, how infinitely more imperative was it in
the case of this establishment, overcrowded to excess,
and with few or none of the appliances demanded for
the treatment of the sick ! That the sudden removal of
nearly one thousand for hundred children under such
circumstances was a difficult procedure, and one which
could only be justified by the urgency of the occasion, is
self-evident; but with children falling into collapse every
minute, with such an awful and rapid mortality, and
with such a state of things as that described in the
cholera wards, there was but one step to •be adopted by
the guardians—the instant removal, under medical ad-
vice, of all the children not yet seized, to properly-pre-
pared and sufficiently spacious premises unconnected
with any other building. This was the recommendation
made by me to the general board, and by it communi-
cated to the local authorities of the parishes interested.
Seeing the distinct evidences of a general poisoning
among the children, and knowing that they were all
still subjected to the same pernicious agencies, which
had caused all the mischief, my conviction is that if they
had not been taken out of the establishment and re-
moved to a purer atmosphere, and uncrowded rooms, the
epidemic would have continued to rage among them until
hundreds had been destroyed. That many must, not-
withstanding this measure, still be attacked and perish,
was foreseen and explained to the parochial authorities,
for the children were already poisoned, and whether they
remained, or whether they were removed, the result
must have been the same, except that in the latter case
a larger number, passing into a more favourable atmos-
phere, would be enable to resist the noxious influences
and escape.
The interests both of truth and humanity compel me
to affirm that no effort or attempt was made on the part
of the proprietor to carry into execution some of the
most essential of my recommendations given on Friday,
the sth of January, and which were capable of speedy
execution. Among the foremost of these, next to ob-
taining further medical aid, was the provision of a suf-
ficient number of competent nurses. I expressly stated
to Mr. Drouet and to his medical attendant, Mr. Kite,
that to each of the wards containing more than 12 cholera
patients four nurses should be allotted, and in wards
with less than 12 patients three nurses. On Sunday,
January 7, as already stated, I found in all only two ad-
ditional nurses, and yet, if my reccommendation had been
carried into effect, as there are eight wards, there would
have been in attendance on the poor sufferers at least 32
nurses. On my remonstrating with Mr. Drouet upon
this gross neglect, he replied that he had understood me
to say that I recommended four new nurses for all the
wards, and in this he was supported by his medical
officer. Fortunately, in addition to my own distinct
and certain conviction, there is the testimony of Mr.
Hall, the Poor-law Commissioner, who, in hisl report
addressed to the Poor-law Commissioners dated January
6, 1849, states:—

" Mr. Grainger required that he should at once en-
gage three additional medical officers to remain on his
premises, and arrange with a physician of eminence
conversant with cholera to visit his establishment daily;
he also required him to appoint four nurses to every
ward in which there were as many as 12 sick children."
To attempt to remedy the evil caused by inattention
to my directions, children still unattacked, as already
mentioned, were brought into the cholera wards to act as
nurses, thus periling their lives by greatly increasing
the danger of an attack, affected as they must already
have been by the poison. Another consequence of this
neglect was, that the few nurses in attendance were ex-
hausted by fatigue; two of them from St. Pancras had
been in attendance on the sick from Friday night, and
were thus placed in a most dangerous condition, perilous
to their lives, by being exposed to the epidemic with the
vital powers debilitated by long watching and incessant
fatigue.l also urged the vast importance of placing each
in a separate bed,
by two children.
bed, but on Sunday I found
u
cholera
almost p
everyti patient
ted still occupied
It cannot escape the noticel_kon
eof the board that in other
important respects Mr. t
has e
a
evinced great ne-
glect. Notwithstanding the warning
from his former and present medical attendant, he per-
sisted in introdpcing 150 childreninto the new building
he received both
yard
alluded to abotO whilst the air in its immediate vicinity
contain.
was poisoned by, the exhalations from the