BMJ Reports on the Nursing and Administration of Provincial Workhouses and Infirmaries, 1894-5.

BLOFIELD UNION, LINGWOOD, NORFOLK.

This infirmary is attached to a workhouse which represents the union of several sparsely populated agricultural parishes; though licensed for 200, it is rarely, so we were told when visiting the house, that half that number of inmates seek its shelter. It stands in the flat country between Norwich and Blofield. which is populated to a great extent by the descendants of immigrants from Flanders and Holland; the dykes, canals, and windmills give to the landscape a very Dutch aspect.

The infirmary itself occupies only a small part of the buildings; it accommodates eighteen patients, exclusive of the lying-in beds. The female ward is on the first floor, consisting of two rooms leading out of each other; there are five beds in the first room, in the second also five, but the nurse informed us that the fifth in that room was an extra bed and not in use. The nurse's room opened out of this ward, and beyond again is the labour ward, containing three beds. These wards form part of the workhouse buildings.

The male infirmary stands quite apart, forming a separate building. To reach it the nurse has to cross a court into a garden, out of which opens the yard which gives access to the building. There is no covered way of communication. We have here a single ward of eight beds, out of which opens a day room, in which the wardsman sleeps. This ward contrasts most unfavourably with the female ward: it is dreary, comfortless, and crowded; its size would be about twenty feet square; the walls are colour washed, the windows, semicircular openings, are placed high; there is a fireplace, commodes, and a chair or two; in the day-room there are arm chairs and a table, and a few pictures on the walls. These rooms are on the ground floor, and the door from the yard opens immediately into the day-room. In this ward we saw two old men lying on narrow beds, about two feet six inches wide, not wide enough to permit a full grown man to turn round in, without risk of falling out; one man was crippled with rheumatism, and the other had complete paralysis and was unable to articulate, but there was no trouble with the sphincters. The other occupants of the beds, cases of old age, were at the time in the day-room. The bedding on which these men were lying was long straw beds over matting, and they appeared quite clean in person. We saw a mineral oil lamp against the chimney breast, which the nurse told us was kept alight during the night. The only convenience attached to this ward was a privy on the far side of the yard. An inmate was pointed out to us as the wardsman responsible for these old men.

Certainly in this house the guardians give all honour to the women in their infirmary appointments. The wards are cheerful; there are windows out of which the patients can look, flowers, and pictures, little bits of carpet, and curtains for the more delicate ones. The wards are small, each room having only one window, but there are shutter ventilators in the wall. The bedsteads are a little wider than those in the male infirmary, the bedding is the same. It seemed to us on feeling the beds that the mattress was over full. A long straw bed may afford a comfortable rest, but there is an art in filling the ticking. In the first ward there were two patients in bed, one of whom had a wasted, anxious face; the nurse said it was a case of phthisis, but the matron afterwards disagreed with this diagnosis and said she had paralysis. As no temperatures are taken in this infirmary we cannot side either with the matron or with the nurse, though from the woman's aspect we incline to think the nurse was right. She lay near the window, in the bed opposite to her was a rheumatic cripple who had been in bed a year. The other patients were sitting about in armchairs. To get to the second ward we pass through a small lobby used as a scullery, out of which opens the convenience; it was quite clean, and had a good flush of water, In the further ward was an old woman suffering from senile debility; she was lying on a half-water mattress, as there was a threatening of a bedsore. Her bed was quite close to the nurse's door, so that the nurse might give her such help as she required in the night.

The labour ward is beyond the nurse's room: there was a woman in it with a baby a week old. The ward is small, and we should say that in the winter the small fire, which is all the grate allows, would hardly warm it. The ward looked as if part of its use were to serve as a lumber room.

There are no baths except small hip baths, and no hot water is obtainable except from the main kitchen at some little distance from the wards. There is a cold water tap on the matron's landing, otherwise all water. hot and cold, must be carried by the inmates; this applies to the female wards; in the male infirmary we saw no arrangements for any bathing, nor any supply of water, hot or cold.

The isolation hospital stands at some little distance in the grounds. It has accommodation for four male patients, and presumably for the same number of female cases. The male side is at present occupied by a family isolated for ringworm, a mother and four children; the mother looks after the children. The wards look as if they would require many a day's work to place them in fit condition for the nursing of strictly infectious cases; they were dirty and uncared for, just four walls and a roof, a small fireplace, and four beds of all sizes and conditions, with scullery attached. There is an earth closet in a lobby which would be wholesome if it were kept supplied with earth, but when we saw it the receiver was empty. A supplementary supply of earth, in a box with a shovel, is so much more satisfactory. As this building is quite apart from the house, with no means of communication, it is essential that it should be provided with all the necessaries for nursing.

The nurse is untrained, and is not a midwife. She was formerly in a lunatic asylum, and is therefore accustomed to institution work; but, as the medical officer lives at Blofield, four miles from the infirmary, it surely would be better to have a trained nurse on the spot to take the responsibility of the attendance on the sick, and to relieve, the doctor of some of the anxiety of the care of patients at that distance. In the male wards the wardsman, an inmate, is practically the nurse, and at night, there being no bell of communication with the nurse's room, he is alone responsible. In the female ward there was no wardswoman, the one who had been employed in that work being the patient in the labour ward.

The airing courts are the small gardens above referred to, and we were informed that the patients were allowed in these courts at certain times during the day. We should like to see seats placed outside for the use of the infirm patients, and generally a more liberal use of the extensive grounds around the workhouse for those old folks who have no other home, and for whom these places exist.

The diets for the sick are under the control of the medical officer, and he orders such extras as he thinks requisite, but the bulk of the food is meat, suet pudding, vegetables, and broth. We wonder, as we see the food served out, whether the guardians are aware of the waste that is consequent on this scheme of dietary. Those toothless old jaws cannot masticate the junks of meat that are put on the plates. Until the rates are chargeable with artificial teeth for the paupers, could not the Board supply a mincing machine for use in the infirmary? We fear that the whole question of the sick dietary requires careful revision.

Married couples are allowed to live together in this union. We came across an old man and woman in a room off one of the courts who were ending their days together in the precincts of the workhouse. The old woman had some plants which she tended with much care, and they had decorated their room with some coloured prints.

RECOMMENDATIONS.

We were struck with the inconvenience of the distance between the male and female infirmaries, and by the squalid air of the former. We suggest a rearrangement of the wards, adapting some of the unused parts of the building to infirmary work, and placing all the patients within reach of the nurse; that bath rooms be provided for the use of the sick, and also suitable conveniences, easy of access for the night; that the isolation block be cleaned and made into a complete hospital for infectious nursing, provided with separate offices for male and female side, and with nurse's quarters; that the nursing of the sick be in the hands of a trained nurse, and that a night nurse be on duty during the night, thus superseding pauper help.