adequate to support ordinary nutrition, it
will not bear any serious diminution (from the
rejection of a portion) without becoming
entirely insufficient; and it is certain that such
diminution will happen in the case of all persons
who from any cause are at all delicate. It is
true that the surgeon has the power to order
for all such persons a proper special diet; but
the labour of carrying this out in large
workhouses is very great, and the temptation is
consequently strong to adopt the laissez-faire
system, and allow these poor folks to struggle
with their nutritive difficulties as best they
may."

"An objection has been raised, in our hearing,
to the idea that the infirm are at all
frequently underfed, on the score of the very great
age to which many of them attain in
workhouses. The fact of the frequent longevity of
the infirm is undeniable, but the inference
drawn therefrom is a mistaken one. True,
these persons live long, but they live a life of a
most low grade, with the minimum of mental
and bodily activity; in fact, they subside more
and more into a vegetative existence; and a
part of this change is distinctly traceable to the
persistent under-nutrition which they
experience. An intelligent workhouse master has
described to us a most interesting phenomena,
which we have ourselves subsequently
recognised, and which he calls the 'ward fever.'
This is neither more nor less than a low febrile
excitement which marks the transition from
their old habits of occasional plenty and
occasional starvation to the grim monotony of a
diet which is, for the reasons above given,
uniformly insufficient."

The first of the above-cited paragraphs
contains an allusion to one great cause of dietetic
mismanagement; namely, the trouble that all
alterations or extras entail upon the medical
officer.

The Poor Law Board is not sparing in the
amount of book-keeping and form-filling exacted
from all its officials; but, in very many cases, the
books required answer some useful purpose, and
are essential to the framing of some necessary or
desirable account. The Workhouse Medical
Relief Book is, however, little more than an
ingenious contrivance for wasting the time of the
surgeon. It professes to contain the name of
every sick person, with the days on which he has
been visited, and with the diet ordered for him;
and it is so arranged that one entry of the name
suffices for visits and diets for a week. It is
supposed to be kept by the surgeon himself; and he
is, at all events, required to initial every separate
entry in it. In a workhouse where there are
nine hundred sick the surgeon has to sign his
initials in this book nine hundred times every
week; and as the smallest change of diet would
render it necessary to put the name of the:
pauper upon this dreadful list, there will seldom
be any disposition to make the nine hundred into
nine hundred and one, so long as even that small
increase can be prevented. The ordinary plan
is for the book to be kept by a clerk in the
master's office, or by one of the inmates, the
surgeon paying some gratuity to this irregular
assistant. When the book-keeper hears that the
doctor has "been round the house," he puts
down a visit against the name of every sick
inmate (although perhaps not one-fourth of them
have been spoken to), and he also records all
changes of diet, of which information is sent to
him from the wards. Then, before the " board
day," he waylays the doctor with, " Please, sir,
to initial the book before you go." To " initial"
nine hundred entries takes some time, and that
time is deducted from the period allotted to the
patients.

So much is the augmentation of the list
dreaded, that it is the practice in many
workhouses to provide the master with a big bottle
of " house medicine," of " cough mixture," of
"chalk mixture," and of other abominations,
and to make every one who aspires to the dignity
of being ill submit to a sort of probationary
physicking from one or other of these bottles
before he is admitted as a bonâ fide patient,
and permitted to appear upon "the book."
Common sense suggests that if a register of
medical visits be required, it should not be kept
by the doctor himself, and that the master is the
person upon whom the registry of diets should
devolve. If an authoritative medical order were
required, it might be written (as in voluntary
hospitals) upon a card at the bed-head of each
patient.

A writer in the Lancet affirms that at St.
Leonard's, Shoreditch, "Medicines are
administered with shameful irregularity. 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 medicines for three days, because,
as the male " nurse" said, his mouth had been
sore. The doctor had not been made
acquainted 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 by the nurse to fulfil
this duty, had been too completely bedridden
for the last few days to rise and give it to her.
Other patients had not had their medicines
because they had diarrhœa; but the suspension
had not been made known to the doctor, nor
had medicine been given to them for their
diarrhœa. The nurses generally had the most
imperfect idea of their duties in this respect.
One nurse plainly avowed that she gave
medicine three times a day to those who were very
ill, and twice or once a day as they improved.
The medicines were given all down a ward in a
cup; elsewhere in a gallipot. The nurse said
she ' poured out the medicine, and judged
according.'

"In other respects," continues the report,
"the nursing was equally deficient;" and we
regret that the details of the deficiencies are too
graphic to be reproduced. In a general review