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28
What seems to me to be needed is a number of institutions
scattered over the metropolitan area, in such numbers and at such
a distance from one another, as that no patient sick of typhus
should need to be carried a dangerous distance to reach one of
them; institutions to be maintained, not by the subscriptions of
the charitable, but by rates equably levied from the public at large
institutions, which in the absence of epidemics, might be
used for other purposes. Such institutions we possess in our
workhouse infirmaries; these are already acknowledged to be
the hospitals for paupers and those whom sickness pauperizes,
these conveniently stud the surface of the metropolis, these
alone (among hospitals) are supported by funds provided for by
law, and capable through the rates of increasing their income
to meet any extraordinary demands which may be made upon
them. I allow that at the present time the greater number of
these institutions are quite unfit to receive cases of infectious
diseases. But this unfitness is remediable. To enable them to
treat typhus patients with propriety within their own walls,
instead of sending them, as under the directions of the Poor
Law Board they do now, for treatment elsewhere, it would be
necessary for each workhouse to have in connection with it a
detached ward or wards; to have these wards arranged and
conducted on sound hygienic principles; to entrust the nursing
duties to experienced and seasoned nurses only; and to have at
all events during the height of an epidemic a resident medical
officer. Further, all needless communication should be interdicted
between the inmates of these wards and those of other
wards in the infirmary. I have only sketched very generally
the arrangement and management of fever wards; but it will
be seen that these are very different from what are usually met
with in workhouse infirmaries; and I may add, that if they
were carried out thoroughly and well, there would be no