Smallpox and Sending Out Laundry

REPORT
OF
THE LANCET SPECIAL COMMISSION
ON THE
SPREAD OF DISEASE THROUGH
LAUNDRIES.

THOUGH cleanliness is the best safeguard against disease, it is nevertheless an undoubted fact that clean linen is often the medium for propagating small-pox and other similar complaints. Under these circumstances, the recklessness and ignorance displayed, not only by common washerwomen, but even by the managers of model laundries, are totally out of keeping with the progress we have achieved in other sanitary matters. The smallest rooms, the most unwholesome back kitchens, still seem good enough for the washing of linen; and the same is dried in passages frequented by the lowest class of persons, and hung between walls on which the dirt of ages has accumulated. The clothes that go nearest to the skin, that are the most likely therefore to introduce through the pores any germs that may fall on them, are thoughtlessly entrusted to a laundress without any inquiry being made as to the suitability of the place where they are to be washed. If they are taken to the suburbs it is simply because rents are cheaper in those districts; but there, as in town, clean and dirty clothes are brought into constant contact, and the washerwoman's family, perhaps also some of her assistants, sleep, eat, sicken, and die, with their customers' linen lying round about them. We have visited innumerable laundries, and what we describe is not the exception, but the rule.

For instance, at Kensal New Town, a district especially favoured by washerwomen, we inspected a row of dilapidated cottages, each containing four rooms, with a little yard behind, and a plot of ground in front, called, by courtesy, a garden. The two central cottages were occupied by washerwomen, each washing for from twenty to thirty families, according to the season. During the month of March last a boy, living in the first of these cottages, was taken ill with small-pox, but, fortunately, the sanitary inspector of the district received timely information, and acted with commendable energy. The linen in the house was all seized and disinfected, and the washing for customers abandoned during the course of the illness. But the inspector had no power to interfere with the neighbours, who still continued washing as usual, hanging up their clothes to dry almost immediately under the window of the room where the patient was lying. In the back-yard also clothes were hung up to dry, and these within two or three feet of the closet used by the patient. The two front rooms of these cottages contain about 1200 cubic feet, the back rooms 600 cubic feet; doors and windows are generally kept open, the neighbours constantly entering each other's houses. But, further, to prove that this case of small-pox was likely to spread, perhaps indefinitely, we should add that the boy's aunt, who assisted at the washing, took the disease home to her husband. The date further helps to demonstrate the origin of this second case, for the washerwoman's husband was ill three weeks after the boy, and this latter was so severe a case that death ensued in a few days. These misfortunes do not seem, however, to have conveyed any useful lesson to the widow and her fellow-washerwomen. We conversed with them for some time, and noted that they were not at all impressed with the necessity of taking sanitary measures to prevent other similar outbreaks.

We visited several other laundries where there had been cases of small-pox or scarlet fever, and in every instance the clothes there washed must in all probability have been contaminated with the germs of disease, and the action of the authorities was not always sufficient to entirely dispel the danger. Innumerable cases are concealed, and washing taken in during the whole time. In other instances the washerwomen are not aware of the nature and danger of the disease from which an inmate of the laundry may be suffering. Thus we discovered, near the Blackfriars-road, a woman who took in washing for several families for a children's school, and dried the clothes in her small cottage, in the passage or in the back yard—the latter barely twelve feet square, and containing the dustbin and the closet. This woman has five children, and some weeks ago one of her boys was severely attacked with small-pox. Two other children were also unwell, but their symptoms were so slight that the mother let them run about as usual, and it was not till they were nearly cured that the attending practitioner saw them and succeeded in persuading her that they also had the small-pox. How far this woman continued washing while the small-pox was raging in her tiny and overcrowded home is a moot question, as sbe, of course, will not give all details. We succeeded, however, in extracting from her the confession that she brought the linen from the school into her house while her son was there sick with smallpox, but she urges that she was not then aware of the character of the disease. Subsequently she sent the clothes to be washed by a friend in the suburbs. She also admits that during the whole course of the illness she did her own washing in the house, and also that of a neighbouring customer, whom, she affirms, did not object to her linen being brought into such close proximity with the small-pox patients. It is questionable, however, whether this neighbour was fully aware of the danger she was incurring, and whether she had any right thus needlessly to expose herself by wearing linen which she knew would probably be infected.

To show the prevalence of such cases, we may mention that at the same time, and in the same street, another case of small-pox occurred in a house where washing is also taken in. The back room on the ground floor in this house was used as the laundry. It measures 8 ft. 2 in. by 9 ft. 6 in., including therein a staircase rising along the wall, with a coal-cellar under it. At the top of this staircase, which is a little more than 2 ft. broad, there is a bedroom, where the small-pox patient slept, and which is separated from the laundry by a mere wooden panelling and a door, generally left ajar. The ceiling of this upper room slants, and when it reaches the outer wall is only 5 ft. high, while the window is only 2 ft. 6 in. high and 3 ft. 6 in. broad. Close under this window, in a yard measuring 10 ft. by 11 ft., the clothes are hung up to dry, by the closet, and over the dustbin, and lumber of all descriptions. Fortunately, in this case, the small-pox patient was removed to the hospital ; but how often do similar cases escape detection? Some of the sanitary inspectors with whom we have conversed on this matter assure us that they have entered rooms where the linen was hanging to dry from strings drawn across the ceiling and a fever or small-pox patient lying on the floor under the damp clothes. The inspector, for instance, of St. Martin's parish, recently discovered a case of this description in Bedfordbury. Here a woman, occupying a single room, with children sick with small-pox lying in the corner, had collected some of her neighbours' linen to wash, and was about to carry them away to the public baths when the inspector entered just in time to seize the bundle. The Broadwall case,' already mentioned in these columns, and which caused so much sensation at the time, was not so bad as this, for the patient was not in the same room as the linen. The Broadwall case has, however, a sequel which should not escape notice. In the next house there is another laundry, and in the third house there were two other cases of small-pox, and one resulted in death. These were not removed to the hospital, but were kept in the back rooms. As there was no illness in the middle house, the washing continued there as usual, and the clothes were hung up in the back yard to dry, though on both sides, and at a distance of only a few feet, there were windows whence the germs of small-pox must have escaped and fallen on the damp linen.

Near the Queen's-road, Peckham, there are great numbers of both large and small laundries, and here the small-pox epidemic has been more than usually severe. We were shown one street, consisting of about seventy small cottages, where some thirty cases of small-pox occurred. At one house in this street a man died of the disease, and his room was fumigated; but as there were fourteen persons living in the house at the time, who could not be easily disturbed, we may be permitted to doubt whether the disinfection was effective. In one case, a woman who earned her living by working a mangle caught the disease, and was removed to the hospital. Her daughters, however, still continued to mangle for some days before the doctor discovered them at work and stopped them. A poor washerwoman lived next door, and, on learning that the small-pox was raging on. both sides of the street, a gentleman who had given this woman his clothes to wash, chiefly in the hope of helping her, called and suggested that, for the moment, it was scarcely safe for her to take in linen. She, however, warmly rejoined that the worst of the danger was now over, and that the small-pox had not been in her house, though it had done so much mischief among her neighbours. It happened, however, that this gentleman met, the same evening, a local practitioner, from whom he accidentally discovered that a man suffering from small-pox had been removed from his laundress's house ten days prior to his visit. Further, this woman had actually washed nearly all his blankets while the small-pox patient was still in her house, and delivered them back to her customer the day after the sick man had been removed—that is to say, long before any disinfection had been attempted. Thus, every bed in this gentleman's house might have harboured the germs of disease. But, further, this woman was washing for a lady who had been confined at the same time as the small-pox broke out in her laundry, and she also washed a large number of table-napkins for a West-end restaurant. Thus, even at our meals, if we escape being poisoned by our cook, we may catch small-pox from our table-linen. Let us add, that this woman was not prosecuted, is still washing for a number of customers, that small-pox is still prevalent in her street, and that should it again visit her household, emboldened by her past impunity, she will doubtless again hang her customer's linen up to dry in the tainted atmosphere of her home.

Evidently, and notwithstanding the occasional interference of sanitary inspectors, the clothes sent to be washed in small cottages and the crowded dwellings of the poor must come into constant contact with persons suffering from contagious diseases. After washing at home, which at present is the safest of all methods, laundries managed on a large scale evidently offer the greatest security. But even here the dirty linen is not generally kept thoroughly apart from the clean. At the Metropolitan and Suburban Steam-power Laundry Works, where nearly all the table-linen of the great West-end clubs is washed, the dirty linen is certainly sorted in a separate room, boiled and washed in the next compartment, mangled in the third, and ironed in the fourth room. But the clothes hung up to dry in the yard are sometimes too near to the sorting-rooms. The Great Western and Parisian Laundry Company, a remarkable society, governed by a board composed exclusively of lady directors, who hold high positions in the world of art, music, and letters, purpose making a special feature of their sanitary arrangements. Apart from commendable cleanliness and excellent open-air drying-grounds, the chief sanitary advantage of this establishment is due to the fact that the washerwomen sleep on the premises, instead of coming in every day from the worst streets of London and bringing with them the seeds of disease.

As the poor, however, are more susceptible of epidemics than the wealthy patrons of such establishments as those above mentioned, we were more anxious to inspect the public baths built in accordance with the Baths and Washhouses Act of 1846. These institutions, though in many respects so admirable and useful, are, we fear, often the means of propagating disease. It would take too much space to describe how public laundries are disposed. They are for the most part built on the same model. The chief point we have to consider is the fact that no precautions whatsoever are taken to prevent the admission of infected linen. Indeed, the managers of these establishments were surprised when we suggested that this should constitute a portion of their duties. They certainly protested that if they were aware that a woman had brought in infected linen, she would be forthwith compelled to quit the premises; but the idea of prosecuting such a delinquent for having endangered the lives of all the persons in the laundry and the health of all their customers does not seem to have occurred to them. Practically speaking, no control is exercised; with a few rare exceptions, infected clothes have been brought into public laundries without any let or hindrance. Nor are the laundries so disposed as to minimise the chance of contagion. On the contrary, the clean linen is ironed and mangled side by side with piles of dirty clothes, so that the germs may fall from the latter on to the former. We would suggest that in future the clothes should be washed and boiled in one room and ironed and mangled in another. The drying horses should occupy the intervening space between the two compartments, and be heated with a view of not merely drying, but, if practicable, of disinfecting the linen. As it is, we found that the heat varied from only 90° to 120°.

Other cases, besides the one mentioned above as occurring in Bedfordbury, conclusively prove how often infected clothes are taken to public baths. A woman, who washes for several families in Soho, related to us that she had two or three times taken and washed clothes at the Leicester-square public laundry which emitted so peculiar an odour that her suspicions were excited, and, on making inquiries, she ultimately discovered that there had been fever or small-pox among her customers. Yet the manager of this laundry declared that, though he had occupied the post five years, he never knew when these or any other infected clothes had been brought in. At the Endell-street public laundry, where 180 to 200 people wash their linen on Saturdays, the manager in the course of eight years only discovered one woman bringing in clothes from a small-pox bed. Last year 30,000 washing tickets were sold at this laundry. Is it likely that in eight years there should have been only one bundle of infected clothes brought? But the Westminster public laundry affords the most startling illustration of this description. Here the manager has been in office since 1851. An average of 1000 washings are done per week, so that, if this average has been the same throughout, something like 1,352,000 separate bundles of linen must have been brought into this laundry since his tenure of office, and yet, out of the entire number, he only detected one lot that came from an infected house! This, too, only occurred a few weeks ago. We visited the case, and it was certainly the most appalling one we have ever seen. A man, who kept a cat's-meat shop, died of small-pox, and we inspected the premises. On the ground floor there is the shop where cat's-meat in every stage of decomposition poisons the air. The man died in a room upstairs, and next to him lives and works a woman (with children), who washes linen for several families, carrying it backwards and forwards from her bedroom and the public laundry; this, too, after nursing her landlord, the cat's-meat dealer, whose attack of small-pox presented symptoms of more than usual severity. Underneath, in the cellar, a woman and her two daughters t (and sometimes her two sons), live, cook, sleep, and, worse than all, mangle the linen belonging to several neighbouring  families. The stench and the filth accumulated in this cellar were perfectly appalling. There were no beds, but some heaps of black rags. The walls were black, the floor slippery and oozing with grease and dirt; a feeble light d twinkled through a small aperture near the ceiling, but a there was nothing we could call a window, and not even a gleam of sunshine has ever entered this awful abode. Here the woman, apparently unconscious of her misery, and not in the least ashamed of her filthy home, was actually congratulating herself that, notwithstanding the death of her a landlord, she had still been able to do some mangling during the whole time. Nor is this all. She sometimes washes and hangs the clothes out in the back yard, close to a closet, without a trap, and a dustbin which has never been emptied, and is entirely hidden by the dust and refuse a strewn over it. To add to this confusion, a few planks roughly joined together constitute a stable for the pony that fetches the cat's-meat; thus there is manure, as well as general dirt and rotting meat, ready at band to absorb the germs of disease, to retain them for months, so that the two washerwomen, who are to continue living and working in this house, may have ample opportunities of carrying thesmall-pox to their customers. The room in which the man died will, of course, be disinfected ; but zymotic germs cannot be isolated in a house of this description.

At the St. George's Laundry, Buckingham Palace-road, the same indifference as to the admission of infected linen is displayed, though it is stated that here a woman lost her husband through her carelessness. Instead of emptying the copper used by her predecessor she boiled her linen in the same water, and as her husband died of small-pox a few weeks afterwards, and her child was very ill with the same disease. The widow made some inquiries, and found out that the woman who washed before her had small-pox in her house. Probably, however, the disease was not caught from the copper where the water boiled, but from the germs left on the floor, &c.; but in every case stringent means should be employed to keep infected linen out of laundries, especially public laundries. Printed notices should be hung on the walls warning all of the danger incurred, and threatening to prosecute anyone who knowingly brings infected clothes. A few severe sentences would soon spread knowledge on this question, while women who take washing in at home should be under the constant supervision of competent sanitary inspectors, who would compel them to cease washing whenever any danger was present, giving, if necessary, some compensation for the time lost, Even with all these precautions linen should be disinfected by washing, and not allowed to be near the clean linen till it has been washed, as we do not always know when clothes are infected, and must sometimes unwittingly send them to the laundry when they should be sent to the disinfecting oven.