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

THE TOOTING CASES.

The following is the report of Mr. Grainger on the
state of Mr. Drouet's establishment at Tooting. We
were reluctantly compelled to omit this report on
Monday, from want of space :
Sir,—l beg respectfully to state, for the information
of the General Board of Health, that, in accordance with
the instructions I received, I visited, on Friday, the sth
inst., the establishment of Mr. Drouet for pauper chil-
dren, at Lower Tooting; I made a careful inspection of
the various rooms occupied as cholera wards for the re-
ception of the sick children. It is necessary, however, to
premise that as the powers of the General Board are
limited, under the provisions of the Nuisances Removal
and Diseases Prevention Act, to the issuing of regulations
and to instituting inquiries, no authority existed for en-
forcing any measures which in consequence of this in •
vestigation might appear to the General Board to be
desirable. I first entered those on the female side, when
I was struck by a sense of the extreme closeness, op-
pression, and foulness of the air, far exceeding in of-
fensiveness anything I have ever yet witnessed in apart-
ments in hospitals, or elsewhere, occupied by the sick.
There was especially, in the highest degree, that pecu-
liar and sickening smell familiar to all who are ac-
quainted with close, unventilated, and heated rooms,
overcrowded with children. The rooms were crowded
with beds, utterly disproportioned in number to the space
allotted to them. In a room, for example, 10 feet long,
12 feet wide, and less than eight feet high, there were
five beds occupied by eleven children, all ill with cholera.
In another room of the same dimensions, there were four
beds with 13 cholera patients, of whom four were in one
bed, and three in each of the others. In a third room
18 feet long, 16 feet wide, and eight feet high, there
were nine beds with 16 children in cholera, two of
the beds having three patients in each; a circumstance
which I observed likewise in other wards. The lighting
and ventilation of the whole of these wards was totally
insufficient.

On the boys' side there was a room containing 18 beds
nearly touching each other, in which were 35 boys ill
with cholera; 25 being in bed (two in each bed), and 10
sitting round the fire, being convalescent. One boy had
just died on my entrance. In this ward, which is an
example of the arrangement of all the main buildings of
this establishment, there were windows only on one side
—a construction totally incompatible with a due supply
of light and air.
On the girls' side I found only one regular nurse, who
was passing in and out to attend to the children in
several wards ; and in the boys' side, in the room above
described, containing 35 patients, there was only one
nurse (a man) in attendance.
To those who are acquainted with the nature of cholera,
with the violent and most sudden evacuations both by
vomiting and purging, it is needless to point out the
utter inefficiency of such attendance.
I found that the children were continually vomiting
in the beds and on the floor, and that, consequently, the
sheets, bedding, and floor, were covered with the dis-
charges; that no efficient aid was in a single case afforded
to those suffering children; that some of them were get-
ting oat of bed; and that all needed, not only for de-
cency and comfort, but for actual safety, that careful
and watchful attention which cholera patients in the
stage of collapse so urgently demand.
The various appliances found in all properly regulated
institutions for administering relief to patients suffering
under cholera, and especially for applying continued
heat to the surface of the body—a point deemed by all
authorities to be one of the most essential means for the
treatment of collapse—were either totally wanting or
quite inadequate.
In passing through the girls' cholera rooms I ob-
served some small apartments containing unoccupied
beds; and on inquiring why these were not used; in
order immediately to relieve the over crowded beds. I
was informed that they were unprovided with fire-places,
or other means of heating.
As a medical man it is my duty to state that it is im-
possible to conceive a state of things more entirely un-
suited as to the construction of the buildings and the
overcrowding of the inmates, the absence of all efficient
nursing, and the want of the recognised means of medical
and other treatment, than was presented in this esta-
blishment.

From the evidence of Mr. Popham, one of the paro-
chial surgeons of St. Pancras, who was sent down on
Friday evening by the Board of Guardians of that pa-
rish, it appears the evils described above had become
greatly aggravated, in consequence of the increased and
rapidly increasing number of the sick.
This gentleman says—" Found everything in very
great confusion; found, in the cholera wards for boys,
with two exceptions, four boys in each bed. Some were
dying; others in a state of collapse; some recently
brought in and placed in the beds with others. In
the girls' cholera wards found five patients in
one bed. In the other beds generally four in each.
A foul stench in all the wards. The floors were wet
from the matters vomited, owing to the total insuffi-
ciency of nurses and attendants. In the boys' side
there aro two rooms communicating so as to form one
ward. In this ward there were on his arrival 64 boys,
all suffering with cholera. The number of beds was 28,
of which some were empty, in order to receive, as he
supposes, fresh cases.
As to the arrartgements and attendants, found all
defective and in confusion ; one male nurse only to the
boys' ward, and occasionally a female, who was for the
most part in bed, owing to fatigue and being unwell.
There was only one oandle in this ward, and the buys
were crying out for assistance in all directions. There
were no means of applying heat; only two or three hot
bottles ( to his knowledge) could be procured.
"As to the surgery, there was only one pair of
scales, one spatula, and some of the medicines were not
labelled at all; in consequence of this total insufficiency
little efficient assistance could be afforded to the patients
last night. The great crowding, the noxious atmosphere
of the wards, the impossibility of procuring and putting
up the proper medicines, and of attending to so many
patients with so tew nurses, were most adverse circum-
stances. Am of opinion, as a medical practitioner, that
the mortality has been considerably increased by all
these causes."

On inquiring as to the total number of children in the
establishment, I was surprised to find that, after the
continuance of the epidemic for eight days, so few had
been removed; that no efficient means had been taken
to lessen the overcrowding, whereby the danger to those
who had hitherto escaped was greatly increased; whilst
at the same time by furnishing continual accession to
the sick, the latter could not receive the accommodatioe
they needed, nor could the convalescent be removed into
less contaminated rooms.
Although it was no part of my duty to interfere with
the management of the cases, yet common humanity de-
manded that I should make some effort to lessen evils of
such magnitude. I therefore recommended that the services
of three additional legally qualified medical practitioners
should be immediately obtained; that some physician in
whom the public had confidence should be selected to su-
perintend the arrangements; that in each room containing
more than 12 patients four properly qualified nurses should
be appointed, in order to afford assistance day and night;
that in the rooms with less than 12 patients three nurses
should be provided; that means should be taken so to
relieve the overcrowding that there should be only one
child in each bed; and that the recognised means of
affording warmth, &c., should be forthwith supplied.
In connexion with the arrangements for the sick, it
may here be stated that on Sunday, January 7, I again
visited Mr. Drouet's establishment; and on inspecting
the cholera wards, I was much concerned and surprised,
after the explicit recommendations I had made on
Friday, to find that some of the more important
of them had been so imperfectly carried into effect.
In each of the beds there are for the most
part still two patients ; thus, in the room for
the female children of St. Pancras parish, there were
tea beds and nineteen children, many of whom were in
a state of the extremest collapse. As regards the
provision for nurses, I am called upon to express my
strongest disapproval. On Friday evening four addi-
tional nurses were sent down by the authorities
of St. Pancras ; two of these returned on Satur-
day evening—a promise having been given, ac-
cording to the statement of Mr. Popham, that six
additional nurses should be sent to Tooting on
the same evening; which, however, was not realised.
I find on Sunday that the proprietor of the establishment
had not added a single nurse; so that the only addition
made since Friday consisted of the two women who still
remained from it. Pancras; and yet at thin time
there were 178 cholera patients under treatment,
being an increase since Friday of no less than 64! On a
more c •
l examination, the results of this lamentable and
close .
reprehensible neglect were most apparent. I found four
of the female wards under the care of one nurse--a wo-
man belonging
to the establishment, and whom I had seen
on my previous visit. In the ward with the St.
Pancras female patients? 19 in number, there was
but one nurse, who informed me that she had
been up since she came on Friday evening. On
the boys' i
side I found that in a small ward, contain-
/4g, besides several children labouring under ordinary
complaints, one cholera patient and eight with diarrhoea,
vas a nurse of the establishment, who had been up on
Friday night, the greater part of Saturday, all Satur-
day night, and on Sunday till the time of my visit.
In the adjoining larger ward, with nineteen patients,
some of whom were convalescent, was one male nurse;
whilst in a third room, with 32 beds, I found only
one female nurse, sent by St. Pancras parish, who
informed me she had one young woman to help her in
the daytime, but she herself had been up all the time
since her arrival on Friday evening without five minutes'
rest. It is right that the names of these two young
women from St. Pancras, who have thus hazarded their
own lives in the attempt to save that of others, should be
recorded; they are Mary Ann Keith and Sarah Sellers.
An attempt was made to make up for this insufficient
supply of nurses, by employing some of the older pauper
boys and girls still free from attack; in one of the boys'
wards, I found, for example, four boys, of the average
age of thirteen, thus assisting ; even some of the
children recovering from cholera were so employed.
This is a most objectionable procedure, inasmuch
as to bring children, already acted on by the
cholera poison, and perhaps on the very verge of an
attack, into the contaminated atmosphere of such sick
wards as these, was to expose them to imminent danger;,
whilst, as regards those who were recovering, it was
of primary importance that they, instead of being detained
to attend on the sick, should have been removed as early
as possible into properly prepared convalescent wards.
The consequence of all this increased neglect was, that
on Sunday the bed clothes were still soaked with the
evacuations of the suffering children, and that the few
nurses who were in the wards were obliged to run from
one bed to another, and that the patients were most in-
efficiently attended on.
With reference to the medical assistance for the sick,
I found one resident medical officer, 25 years of age,
a member of the College of Surgeons and Apothecaries'.
ball, who had been the medical officer of the establishment
during the last two months, having to take the charge of
1,370 children, at the remuneration of 50/. a year, with
board and lodging. This gentleman states that he had