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BMJ Reports on the Nursing and Administration of Irish Workhouses and Infirmaries, 1895-6.

ATHY WORKHOUSE INFIRMARY, CO. KILDARE.

Athy is an important market town, and the workhouse, which is on its outskirts, draws its inmates from a large b agricultural district. The medical officer, Dr. O'Neill, lives at distance from the house, and we were unable to time our visit to coincide with his. The matron, however, kindly placed herself at our disposal.

In this workhouse the sick have overflowed into the body of the house. The infirmary, originally planned for 30 patients, has at the present time to accommodate 42, and there are besides over 80 beds for cases of chronic infirmity requiring nursing, which are placed in the infirm wards in the body of the house. There is an average of 95 inmates under treatment, exclusive of the lunatics, and this out of a total of 200, the number booked as being in the house on the night preceding our visit.

The infirmary, consisting of a middle block and two wings, is given up to the cases which require most attention; in the middle portion is the operating room, on the first floor; below, the surgery, and on the male side the kitchen, which occupies the space of two rooms. The wards throughout are whitewashed, the wall surface being smooth and the ceilings plastered. A match-board lining is carried round the walls at the height of the head of the beds. The windows are diamond paned, in heavy metal frames; the upper half falls inwards, the lower turns on a pivot; there is no other ventilation. The bedsteads are principally the old harrow frame, with fibre mattresses, but on the male side there are some spring beds. Between the beds were tables with a drawer on each side; there was a long table with benches for meals, and a few arm chairs. The ward crockery was kept in cupboards, and the linen store in a cupboard on the landing. In the operating room we were shown the instruments, which were creditably kept; this room contains a table, desk, and bed.

On the female side the wards were not very full; an empty ward was in use as a dayroom; in the second ward, of ten beds, was a child with acute chorea — we have seldom seen a worse case; another with phthisis; a case of fractured thigh; anaemia; ulceration of the legs; a strumous child; and two women who were dressed. One of these told us that she "had her chest bad," and the other had some internal trouble. On this side there are ten more beds than on the men's side. The lower ward was used as a sleeping room for any inmates whose services were required at night in the wards.

The male patients also were few in number. In the first ward, of six beds, they were all up; in the second, containing ten beds, three were in bed — one with bronchitis, another with an ulcerated leg, and the third was a case of senility. As the visit was paid in the summer we found the sick department at its lowest. The wards were being scrubbed, which gave them a disorderly appearance. The lunatics in this union are kept in cells. There is accommodation for six on each side, in three cells. The so-called dayroom is the corridor outside the cells. These cells are bolted at night, and there is no spyhole. On the male side were five patients; they were out in the exercise yard. On the female side were two patients, seated on a bench in the corridor. An infant belonging to the wards-woman was in a cot in one of the cells. These divisions were clean, but unspeakably dreary and cheerless. The airing court on the female side, in which we were pleased to notice benches, is spacious and had growing flowers; it is used in common by hospital patients and by the idiots. The epileptics are in this class.

The infirmary nursing is in the hands of three nuns who are not trained; they have the usual pauper helps, one to each ward. The nuns are also responsible for the lunatics, though on both sides an inmate was in charge. There is no night nurse; if necessary inmates are placed on duty at night, and if more nurses are required by day a larger number of inmates is sent from the house; quantity is not stinted if the quality be more than doubtful.

The maternity ward is in the body of the house, close to the infirm wards. It is a large room, having, however, only four beds, one of which was occupied; there is no labour bed. The ward is not good — dark, badly ventilated, and difficult to warm in winter; the windows are placed high in the wall, and on one side only. The beds are straw on the "harrow" frames. A door leads to the nursery, a small room, and beyond is a small garden in which is an open shed with bath and cold water tap, a privy and a receptacle for foul linen; the shed was much blocked with pails and odds and ends of lumber, making it practically useless for its original purpose.

As previously mentioned, a large number of hospital patients are treated in the infirm wards, where 42 beds in two wards are assigned to them in each wing. These wards are fitted up as sick wards, and here we saw helpless cases — paralysis, old age, etc. On the male side there were 20 in bed, on the female side only 8. The matron is responsible for the nursing of these patients, and has a wardsman or woman in each ward. These wards are locked at night on the outside; there are no bells to the officers' quarters, and though they are termed convalescent wards, most of the patients treated in them will never reach the convalescent stage. Nor are there any appliances for nursing, no water supply, no offices, no proper ventilation, the only light and air coming through a large window at either end of the ward. More serious still is the great distance between these wards and the infirmary proper, and the absence of all supervision at night. The guardians have placed good stoves in the wards, and also, by the provision of small tables, chairs, etc., have endeavoured to overcome some of the difficulties of nursing, but the structural defects remain. The sunk portion of the floor has been levelled, so as to provide space for the iron-framed bedstead with fibre mattress. In some wards we saw a few "hairow" beds in use.

The fever hospital is a separate building, standing on a higher level than the workhouse. It is better planned for the requirements of the sick, and as there is no fever, we were told that the doctor sends thither such patients as in his opinion require better air. It is nursed by two trained nurses, and has its separate kitchen and laundry.

In the girls' and boys' dormitories we were pleased to notice that the guardians had superseded the straw ticks on the floor by spring bedsteads, that they had levelled the floor, and on the girls' side had removed the partition, thus improving the light and increasing the cubic space. The fireplaces throughout are the old grates, except in the infirm wards.

The kitchen is still in its primitive condition &mdashh; huge boilers, with their separate furnaces, and no range. The water for house use is heated in the laundry. This laundry serves all departments, except the fever hospital. We were informed that the feeding-troughs are still in use in the dining-hall for serving the stir-about to the able-bodied.

In sanitary matters, this house is on a level with others of its class. The privies are on the trough system; they were not in a cleanly state, and in some cases we noticed great carelessness in placing the trough. There is one bath in the infirmary, with hot and cold water supply. There are no indoor conveniences. Soil buckets are used in the infirmary and infirm wards, and remain unemptied at night. The water supply is ample, and is pumped up daily.

RECOMMENDATIONS.

We observed in this house a strange mixture of enlightened administration in certain directions, and in others an unreasoning adherence to bad old customs, in curious contrast with some of the reforms introduced. It is evident that the problem of providing for the overflow of the sick has been a perplexing one, but we cannot regard the solution arrived at as satisfactory, and would suggest that all hospital patients (we mean those who require nursing and attention at night) should be placed under one roof. A new infirmary to accommodate 100 patients is the counsel of perfection, and this will have to be done in the future. The body of the house might be converted into the infirmary, but it would be necessary then to provide for the children elsewhere, and there would be a large outlay for alteration and adaptation. A sanitary system in accordance with modern standards would be part of the new works. In the meantime, we must advocate the employment of trained nurses by day and night, and if this qualification can be added to those already possessed by the nuns, we know of no body of women so fit to undertake the control of the workhouse, bringing as they do devotion and discipline into the work; but anything short of nursing throughout the twenty-four hours is neglect of duty to the sick.

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