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

BALLYSHANNON WORKHOUSE INFIRMARY.

Our visit to this house was the first cheerful experience since the beginning of our commission in Ireland; it was a revelation of the possibilities of an Irish workhouse under humane and enlightened management. The town is beautifully situated on the Erne; the falls, up which we saw the salmon leaping, are near the fine bridge which, spanning the river, connects the two halves of the town. The workhouse stands on the southern side, on a hill overlooking town and river. Dr. Condon introduced us to the Mother Superior, whose keen enthusiasm in the cause of the poor, forgotten workhouse inmates was indeed refreshing.

We were conducted first to the fever hospital, which stands apart on the other side of the road from the rest of the house. Structurally it differs in no respect from other buildings of the same class; it has two storeys, with two small wards on each side of the middle staircase on the ground floor, holding four beds each; on the top storey there is but one long ward on either side of the landing. The nurse's rooms are built out behind at right angles to the block, this annexe containing also the kitchen and laundry. The whole building was quite clean and ready for possible patients. The ground floor wards are flagged, which always seems to us unsuitable for sick wards; the stones strike cold to the feet of the attendants, and make the wards more difficult to heat. Straw ticks on iron bedsteads are used in this division. The nurse is trained, and she has paupers for the service of the building, but they do not act as nurses. There are no baths in the block, nor waterclosets; commodes are not kept in the wards, the vessels being emptied outside as they are used. The walls are smooth, whitewashed, locker tables stand between the beds, and we noticed armchairs. Spacious grass courts both to the back and front of the hospital form cheerful recreation grounds for the patients.

Crossing the road we returned to the workhouse, of which the whole administration is entrusted to the nuns, the head of the community acting as matron, and working with the master, so that the infirm wards were under her supervision as well as the hospital. The infirm wards were the same in position and structure as in any other house, but their whole aspect was different. The walls were smooth, colour washed, and decorated with pictures; the floor was clean, the patients were washed, armchairs took the place of benches. Both men and women looked like human beings. Each bed had its separate towel, and at the foot a little bag with soap and brush and comb. We informed the Superior that we had been told that the old people objected to be washed; was it so? "We found," she said, "a little difficulty at first, and the men were rather shy, but by the exercise of' a little tact and consideration the objection was overcome, and now they prefer being clean; we have also got rid of the vermin to a great extent." We were told by some of the few visitors who penetrated into the house in the old days that it was necessary for a woman to take care that her skirts should not touch floor or beds if she would avoid carrying away with her lively evidence of her venturesomeness. Iron bedsteads are used in this division, and also in the able-bodied quarters, and in the boys' and girls' dormitories. This is the first house we have seen in which these inmates did not sleep on the floor. The old people were mostly out of doors, in the yards, seated about on benches. The day rooms in each wing are flagged, and are used by the able bodied. The infirm class have no attendant at night. There are commodes in the wards, and bells communicating with the master's rooms and the porter's lodge.

The nursery, upstairs in the body of the house, is the one department which resists the civilising influence of the Sisters, and is a source of grief to the Superior; it was untidy, the atmosphere close, and the infants dirty. The mothers are here with their infants, and as long as this system prevails, so long will the infants be as we found them, brought up in squalor, for the ignorant women resent and resist any interference with their treatment or neglect of the infants. All that the Sisters can do is to watch the children being fed, and thus secure to each child its proper quantity of food. There were five children in the nursery in cradles, one of them being a little friendless waif.

The hospital exhibits the same style of construction as that of other workhouses throughout the country; it is a long two-storeyed building, of which part is reserved to the use of the nuns. There are two small wards for isolation purposes on the ground floor in the male or female divisions, holding 3 or 4 beds. Here the floors are flagged, a locker table is between the beds, and we saw wooden armchairs in addition to the benches. The straw beds which are used in these wards are destroyed on the termination of the case. On the male side was a lad suffering from erysipelas. Above in the long ward, with 17 beds, only two men were in bed, about five were up and about in the ward, and others were in the garden, for the Sisters have contrived a garden for their patients.

The wards had many neat little arrangements which gave them a comfortable aspect. Spring beds and hair mattresses are used for the chronic and sick cases; scarlet and white quilts, small squares of dimity on the lockers, short curtains to the windows, pictures on the walls, flower pots in the windows, wooden armchairs with cushions, slow combustion grates, strips of linoleum down the middle of the ward — all these details were evidence of humane and considerate management. Each patient had his or her separate towel hung on a nail at the side of the bed, and here also the little bag at the foot contained soap, flannel. and comb. The women had clean caps, bedgowns, and shawls over their shoulders. On the female side there were many more patients, and the wards looked somewhat overcrowded. The ground-floor wards were occupied by some of the chronic cases, as there was no case requiring isolation. In the wards the beds are of straw; the head rail beneath the beds has been removed, the Superior condemning it as unclean, insanitary, and very much in the way. Wooden screens (too heavy to be of much use) with chintz covers were in use in the wards.

The lying in ward is a small room on the first floor containing two beds. The midwifery cases are about six in the year. When we visited the hospital a little patient with rickets was being nursed there. He was an orphan, and an old woman was in charge of him.

The lunatic ward was empty, the imbeciles and epileptics being nursed in the hospital wards.

The nursing is under the control of the nuns, the Superior being the responsible head; a trained nurse is on duty at night, and she works from written instructions left by the nuns. There are bells from the wards to the convent, to the master's room, and to the porter's lodge. The nurse undertakes the maternity cases under Dr. Condon. The nursing staff consists of the Superior, three nuns, and the night nurse, the Superior being also matron of the workhouse. There are no pauper nurses.

We were interested to see the method by which in the absence of modern sanitary conveniences the wards are kept clean and sweet. Dr. Condon told us that the question of supplying baths and waterclosets was now under the consideration of the Board, and that they would shortly be added. In the meantime there are no commodes in the wards; the vessels are kept in the garden in a screened recess, brought in when required, emptied and rinsed; when we saw them they were quite clean, and so also were the privies. There is a tap with cold water on the hospital landings, over a basin. All the hot water is heated in the hospital kitchen, where also the cooking for the patients is carried on, under the supervision of the Superior.

The domestic offices are all under the same management; they were clean and serviceable, the appliances kept in a state of repair, even the tin mugs and plates were well scoured and walls and floors, swept. The kitchen still retains the unwieldy boilers, each. with its separate fire, and we hope that the guardians will soon see their way to remove these to make way for a cooking range. In the laundry the hospital washing is kept quite, apart from that of the house, and each department has its own linen. The fever hospital has its own laundry. The water supply comes from the town, but the service is not constant and is supplemented by the wells on the premises.

In conversation with the superior we learned that this house had until lately been quite as bad as others on which we have already commented; pauper nursing prevailed, and with it the attendant evil of blackmailing, the demoralised creatures preying on the helpless inmates, robbing them of their tea, tobacco, money, or any marketable article on which they can lay their hands before they will render them even such services as they are told off to do, and for which they receive extra rations from the guardians. Rather than go back on that oft-told tale, let us record onr admiration of the work done in the short eighteen months which had elapsed between the date of our visit and the day when the nuns took possession. The Superior, by filling the matron's post, has been able to make her influence felt in almost every department, and it is clear that the Board has been ready to second her efforts.

RECOMMENDATIONS.

Our concluding paragraph of suggestions is hardly needed in the case of this house, where the work of reform is being carried out by clear heads and able hands. We hope the ratepayers will give full authority to the guardians to expend what is necessary to construct baths and other sanitary appliances. We also wish that the nursery department could, be reformed, and would suggest the appointment of a trustworthy attendant, who should have the entire charge of the infants, the mothers being allowed access to them only at stated times. Light screens to supersede the heavy ones now in use in the wards, a modern range and fittings in the kitchen, and more labour-saving appliances in the laundry are also desirable, and when they are added we may point to this house as a model of what may be done by guardians who worthily fulfil the task delegated to them by the community.