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

BAILIEBOROUGH UNION, CO. CAVAN.

This house is situated in a remote country district on the outskirts of a town of the same name. It is a medium-sized house, and was more than half empty when we visited it. Dr. Ryan, the medical officer, to whose house we drove, readily accompanied us to the workhouse, and under his escort we found our way into the fever hospital which stands to the left of the body of the house and between it and the infirmary, making with a low building opposite a square enclosure, the body of the house and the infirmary forming the other sides. There is accommodation in this block for twenty-eight patients. but on this day it was empty. The wards are on the first floor, the ground floor being occupied by two large flagged rooms not in use at present, though we thought that one might be advantageously turned into a laundry for this block. The rooms above are two long wards for male and female cases respectively, the nurses' rooms being between, and a slice taken off one ward forms the hospital kitchen. The bed spaces on each side are platforms raised about 6 inches, leaving a sunk path down the middle; this construction represents a period in social history when straw ticks placed on the ground were the beds of the inmates, a custom which still prevails in the dormitories for the able-bodied in the majority of the workhouses. The wards were empty of all furniture but a few wire-wove mattress beds on trial and the harrow bed and ticks. The walls are rough surface whitewashed, and from their appearance we should say that they offered every facility for the lodgment and subsequent dissemination of germs; no care bestowed on their cleansing could ever make them anti• septic; the roof is pitched, the rafters being exposed. The little kitchen looked thoroughly businesslike, having a modern range, one of the best that we have yet seen in our rambles. There is a permanent nurse in charge of this block, experienced but not trained, and she is assisted by her daughter, also untrained, who at this time was taking holiday duty for the nurse in the infirmary.

The infirmary, in style like that of all the other houses, has 32 beds on two floors, 7 beds in each of the two lower wards, and 8 in each ward above, the lying in ward containing 2 We saw patients in all these wards. The structure is quite unsuited for hospital purposes, the roof bare and open to the slates in the top wards, and the rafters unceiled in the ground floor rooms, the walls rough, having some remains of whitewash on the surface, small ill-fitting windows on one side, and slit openings in the opposite wall, dirty floors, dirty beds crowded together, a few tumble-down chairs, an arm missing from one a leg unsteady on another, the inevitable backless bench, old rusty grates, mugs of milk standing by the beds, a hunk of dry bread, sometimes on the floor, sometimes in a dirty handkerchief, made a picture of neglect—or shall we say of ignorance?—that was sad to see. The whole conditions are insanitary the straw ticks and pillows resting against the wall, making a greasy mark, or, as we heard, sometimes collecting blue mould; the continuous rail supporting the bed head enclosing a space between the wall and the uprights, the thorough cleansing of which is a task beyond the intelligence of the average pauper nurse (we saw the cakes of ancient dirt and dust under the beds); the absence of any closets or water supply inside the infirmary, necessitating the use of buckets or pails by day and night, the imperfect ventilation. these conditions fully bear out the statement of the medical officer in his report: "The infirmary is quite unfit for its purpose; no alteration will make it suitable." Ledges, floors, benches, walls, patients, all stood in need of a thorough cleansing. As we only saw the one basin and towel in each ward for the patients, we were not surprised that they looked in want of a good wash. As we entered the male ward an old man, hearing a strange voice, stood up, and saluting in military fashion said, "Can you tell me why I am shut up in prison? I have served my Queen and country well, I have my discharge and pension, but my liberty is taken from me as though I were a felon. Will you please tell me why it is?" The doctor, in explanation, told us that the man is a pensioner, but being friendless and old he has no other refuge than the house; that he pays his pension to the guardians, and he has a few indulgences—extra tobacco, tea, etc.—but since by the general orders he cannot go beyond the small yard attached to the infirmary, he is, in fact, that which he states himself to be—a prisoner. And this is the condition of all the aged, infirm, and sick, who are forced by stress of circumstances into the workhouse; they are worse fed, clothed, and housed, than criminals. We denounce the whole system as inhuman and barbarous, unworthy of a civilised country, and we will not cease to clamour for justice for the poor voiceless paupers and the old soldier seated on his hard wooden bench grieving over his wrongs. The other patients many of whom were in bed, included some serious cases—an abdominal tumour, a man suffering from spinal injury, another with bronchitis, a case of hip-joint disease, anaemia, hemiplegia, and various forms of infirmity. There are no dayrooms, and, to quote again from the medical report, " the wards are too small, and the cubic space insufficient, for the number of patients who have to eat, sit, and sleep in the same apartment." The nurse (at this time absent on her holiday) is untrained; her assistants are the pauper inmates, one to each ward, and there is no night nurse. We are glad to read in the report from which we have quoted that the doctor protests against the pauper assistants, " who levy blackmail on the patients." The blackmailing of the helpless by the pauper placed in authority is known to every Poor law official, but as it is one of those abuses of which ignorance is commonly professed, we hail the fearless courage which notes the custom in a report which is published in the general press.

The lying-in ward was occupied by a woman with her sickly child, placed here apart because its fretting disturbed the older patients. We judged from appearances that the ease was marasmus; the little thing was much wasted, it was in a wooden cradle filled with straw; mother, infant, ward, all dirty, a mug of milk standing on a bench, and a piece of bread on the floor, were not suggestive of scientific feeding. Apropos of milk, we may mention here that it is served out once a day, and stands uncovered in the wards for the use of the sick. The circumstances surrounding this infant were not conducive to recovery. The confinements average ten in the year.

The epileptics and idiots are placed in the cells, which form the blocks at each end of the infirmary. These cells differ in no respect from those used for prisoners, except that they are unlocked during the day; a square flagged cell. whitewashed walls, slit in the wall for air, light and ventilation; a heavy door with ponderous bolt, crib beds filled with straw for the "dirty cases," and harrow beds for the less helpless two patients in each cell, no means of warming these cells in the winter, but the borrowed heat from the fire in the corridor. We asked ourselves whether a trick of time had carried us back to the eighteenth century. The pathetic look of the hapless creatures, as they stared at us out of the cribs, haunted us for a long time; the darkness, the confinement, the want of employment, the stone yard for exercise, all seemed cunningly contrived to send them out of their minds. The attendants are pauper inmates, and this department is locked at 7 P.M. Here, again, we found the pails and buckets in the cells; one most offensive case gave quite sufficient proof that this class did not receive skilled nursing.

We found the aged and infirm in their usual locality in the wings of the body of the house. We hesitate to repeat the same tale of dreary wards, dark and ill-lighted, destitute of comfort, noting the same listless group of aged inmates, the same want of cleanliness or of means for personal washing, lest our readers should think that we are filling up blanks from our imagination; but in this case we must even put in the shadows in darker colours, for it is hard to picture a more comfortless place than these wards for the old people. They are approached through day-rooms having mud floors, a long table at one end and a bench being all the furniture in these rooms. The whole ward was dirty, and smelt so, and the patients showed -in their persons negligence and untidiness, but who could blame them when they had one basin and a towel to go round, no bath or lavatory, or decently clean clothing? There are 15 beds in these dormitories.

The only bath we saw was one in the male probationary ward; this answers to the tramps' wards in England, but from its appearance and odour we should say that it was put to other purposes to that for which it was intended. In all sanitary apparatus this workhouse is quite behind the times; pails and buckets are used all over the place, and outside there are privies. which being at some little distance would not be available for the aged or infirm in bad weather. The privies are in a highly insanitary condition; no water is laid on inside the infirmary or the house. The water supply is taken -from the lake; there is also a well in the precincts; the drinking water is drawn from the well. The drainage is into the lake and also into cesspools.

The nursery occupies a portion of the low building facing the fever hospital. It is a very dark stone-paved room, lit by small windows; it was more like a shed than a room, having rough stone walls, roof open to the rafters and slates, and a rusty grate. We saw about eight infants with their mothers; there was no evidence of nursing or supervision, and the condition of the infants appeared in no respect better than that of the children in the wayside cabin. To say that they were dirty and neglected is to use a mild term; a few wooden cribs filled with straw, infants in them; slatternly untidy mothers, with babies in their arms; some half-rinsed cloths on a string. At the other end of the room the beds used by the mothers at night. Needless to say, nothing to amuse the children. No bath or sanitary arrangement for this department, so that it is no wonder that neither infants nor nursery looked as though they were washed.

We turned into the dining hall. As the dinners were being served a few old men came in at one door, a few old women and children at another; they stood around the feeding troughs out of which they took the food, presumably porridge. Our illustration shows the feeding troughs, but in this case the inmates were standing to take their meal. No grace was said, no officer appeared to be present; it was like the feeding of animals, and not of human beings. The kitchen at the end of the hall was indescribably filthy; refuse, dirty straw, and cats were in the corners, the table was black with grease and dirt, the few utensils lying about were in the same condition; the walls and pitched roof black with grime and smoke, and the presiding genius of the kitchen, a male pauper, was in harmony with his surroundings. The laundry opposite was in the same condition—a broken sloppy floor, tubs of dirty water, a copper of which the brickwork was breaking down, no mangle or wringer; we could hardly believe that it would be possible to do any work in such a place.

RECOMMENDATIONS.

It is difficult to make any suggestion. Our readers will agree with the medical officer that the "infirmary is quite unfit for its purpose;" hence to suggest alterations of structure which will involve expenditure is only recommending a course that would be wasteful of the ratepayers' money. It seems to us that the best plan would be to make use of the fever hospital temporarily as an infirmary, making such improvements in the way of water supply and closets as would make it serviceable, and that a temporary building be erected for the infectious cases. With regard to the management, very much might be done to improve the cleanliness both of structure and inmates by efficient, energetic officers, who should be determined to do their duty in the face of almost superhuman difficulties. It would be possible if a larger staff were employed, both in the infirmary and the body of the house. The lunatics' condition requires the attention of the central authority, but until other and more humane arrangements are made for them there is nothing to prevent the guardians doing away with the cells and appointing paid attendants to take care of them. In the name of humanity we trust that the matter will have their immediate attention.

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