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

COOTEHILL UNION, CO. CAVAN.

We received a cordial welcome from Dr. Moorhead, the medical officer of the workhouse, who very kindly took us round, giving us every help in his power. The house, a grey stone building, stands close to the railway station, but about a mile from the town, on rising ground, facing south and north. It is what is styled a "second class house," a term describing its capacity (about 800 inmates), but not referring to its efficiency.

Passing through the lodge and the body of the house we came to the infirmary. As we looked at the exterior we were struck by the small slit apertures in the wall which serve as windows; they are a relic of the time when the therapeutic value of light and air was not understood. On the ground floor is the surgery, a small room full of drugs, and intended for the use of the medical officer; to the back is a disused ward holding 8 beds, now used for operations, or for the isolation of any case; opposite is a stone paved room intended for a men's day- room when the infirmary is full; the corresponding room on the female side is used as the infirmary kitchen; its equipment is a wide open grate, over which was suspended a large cauldron, containing water, we believe, a large iron boiler containing the only water at hand for use, a dresser, some tin plates, mugs, a saucepan, and a frying pan. There is a close range in the nurse's kitchen upstairs.

It is almost impossible to convey to the reader the picture of squalor and wretchedness that greeted our eyes as we mounted the stairs to the first floor where the sick are; long narrow rooms, beds on each side, 6 on a side in the first ward, and about 4 on a side in the continuation ward; the beds close together, on one side (the north) square windows in heavy iron frames, and opposite to them the slit-like apertures already commented on, rough colour-washed walls, roof open to the slates, an old-fashioned grate at one end, more chimney than fire, a bench and a few wooden armchairs; a bucket, chair, and a small table at one end completed the furniture. The bedsteads, close together, were many of them of the hospital pattern, but we saw the "harrow" bed in use besides. On the spring beds Dr. Moorhead uses a pad of old blanketing, this being, in his opinion, more sanitary than the hair mattress, as it can be washed, but on the "harrow" beds there was a tick filled with straw, and all the pillows are of straw. On the old bedsteads the tick and pillow are placed against the wall, which is sometimes damp. As the square windows are neither weather-tight nor air-proof, the lower section has been boarded up, as some of the beds are across them; the whole of the ventilation is by means of the windows, the upper section swings on a pivot regulated by a toothed bar, but the frames are so heavy that it is a trial of strength to open them; such other openings as were in the roof or cornice were evidently out of gear. There are four such wards, two on each side, and it must be observed that those at each end are over the lunatics' quarters.

The patients presented all the variety of ailment that is found in a general hospital, though the larger number are chronic cases; the wards were comparatively empty, as it was the summer; there were 22 patients in the wards, and 35 in all on the medical relief book. Several of these were in bed; a man with rheumatic arthritis, a severe case of pneumonia, a case of intestinal obstruction, ulceration of the leg, senile debility. and some good cases of recovery from operation; all surgical cases are dealt with here, as it is practically the hospital for the district. There is no lying-in ward, the women being confined in the general wards.

The nurse, a trained midwife, has acquired her general training under the medical officer; her wards were clean and showed that much can be done for the sick by a zealous nurse, even under such unpromising circumstances. She has the assistance of an inmate in each ward, and on the male side there is a paid wardsman, who works under the nurse, and who has been of much service in inducing habits of order and cleanliness (Dr. Moorhead's report). There is no night nurse. Dr. Moorhead selects the wardswomen from the older women, rejecting, if possible, those who are in the house with infants, the latter being likely to neglect the patients for the sake of their child. The nurse is responsible to the medical officer for the infirmary, and she also is held responsible for the custody of the lunatics. There are bells from the wards to the nurse's room.

The fever hospital, a two-storeyed building, stands at right angles to the main building. It was built later than the infirmary, and exhibits many improvements in its structure and arrangement; the walls have a smooth surface; the wards are larger and more lofty; the windows are of fair size and face each other; the ceilings are plastered; but the fireplaces are of bad construction, and there are no internal sanitary appliances. A nurse — untrained, but experienced — is in charge, with pauper help. At the time of our visit there were two patients, both convalescent, under her care; considering the decline of fever all over the country, the number of patients is never likely to be large, except in the event of an epidemic. Still, as the nurse has entire charge of the laundry and kitchen in the hospital her hands must be more than full when her patients are in the acute stage.

The lunatics were almost a sadder sight than the sick in the wards; they are in the two ends of the infirmary on the ground floor. Their quarters consist of the old cells disused by the medical officer, but not removed by the guardians, and the corridor and dayroom attached. In the corridor were 3 beds head to foot against the wall, and the other beds were in the day-room, no furniture but a bench and a table, rough whitewashed walls, a small window, and an old grate protected by bars. The recreation ground, a stone-walled grass-grown yard, having a deal board as a seat; the woman standing up, herself feeble-minded, is the caretaker, the previous one having been discharged by the doctor for beating the poor creatures. These unhappy wretches are confined to this section, where neither treatment nor alleviation is possible. On the male side the section is the same, but many of the men were employed about the place.

The airing courts attached to the infirmary are small grass-grown courts at the back of the building. In this house Dr. Moorhead has endeavoured to redeem the waste of desolation by laying them out somewhat like a garden, and placing a few seats for the old people, an act of kindness that has been much appreciated, the old people finding some relief to the monotony of their existence by the cultivation of the garden. The law of classification is so rigid that these poor people are practically imprisoned in the part of the house to which they are assigned. The rank grass that we saw in the lunatics' yard is anything but wholesome for the inmates.

We now turned our steps to the body of the house, where are the quarters for the aged men and women. These consist of long wards, low-pitched and unceiled, rough, whitewashed walls, windows at either end, and three at the side, a stove, harrow beds down each side, a few benches without backs, and a table at one end. The rooms were dirty, the patients were unkempt and unwashed, and as the only materials that we saw for the toilet were a tin basin and a dirty round towel this was not to be wondered at. This ward is approached through a concrete floored apartment called the dayroom, equally dirty and uninviting; most of the men were here, seated on a cross-bench in front of the comfortless grate; a long deal table, almost as black as the floor, was the only other furniture. On the female side most of the women were in the dormitory, many of them at needlework ; their appearance was not quite so bad as that of the men, though the conditions in which they lived were the same. Both the men and women are in charge of an inmate, these caretakers themselves being old and infirm. In fine weather this class can sit under the sheds in the yard, but in the winter they are confined to their quarters. Before passing to the nursery we will describe the sanitary arrangements in these and the sick wards. It must be understood that there are no indoor conveniences, and that the privies are at some distance from the wards, and therefore unavailable in bad weather or at night; to meet this difficulty the old people are provided with open pails or buckets; in the sick wards these buckets are enclosed in a wooden chair. It must also be observed that the infirm wards are locked on the outside from 7 P.M. until 6.30 A.M. The greater part of that time the ward is in darkness, and the only assistance available is such as the inmates can render to each other. The pails remain unemptied until the morning in both the sick and the infirm wards. We pictured to ourselves these wards locked up, the windows closed to husband the feeble warmth of the stove; the inmates on their narrow beds, from which they may slip to the floor in their weakness and there remain until the morning; the filthy-smelling buckets, some doubtless upset in the dark; no water to be had, no help available except in case of dire need; we turned away sick at heart that such things should be. In the sick wards the nurse is at hand, but there is no night nurse, and the excreta of the sick poison the air in those crowded wards. In the lunatic wards the same unsavoury method prevails, and the well-known dirty habits of the feeble-minded add to the foulness of the surroundings. The privies in this house are on the waggon system; a movable trough receives the soil, and when full is drawn out of a door at the back and wheeled on to the land. We noticed that the trough was neither cleansed or purified before being returned to the privy.

The nursery is close to the women's dayroom. It is a small room, having one window, rough walls, raftered ceiling, and an old grate set in the angle of the wall. We saw three infants in this nursery; one asleep in a wooden chair by the fire, its vomited food on its clothing and on the floor; another in a wooden cradle asleep; and the third sitting up, and roaring lustily for the attendant, who was not in the nursery. These infants were not clean or sweet; we were informed that their mothers were supposed to take care of them. We saw nothing suggestive of a nursery — no toys, amusements, or pictures. The room opens on to a yard.

There are no baths either in the infirmary, the fever hospital, or the infirm wards, nor is any water laid on to these departments, except to the laundry. The water for the infirmary is obtained from a tank in the body of the house, and that for the body of the house from a large well, from which it is pumped up by the inmates into the tank. The movable bath, having to be filled and emptied by hand, is now practically disused from lack of labour. The kitchen and the laundry remain as they were constructed when the house was built; in the former, three large boilers each, with its separate fire — one for the stirabout, one for potatoes, and one for holding cold water; in the laundry two old wash-tubs, a copper, and a box filled with stones on rollers serves as a mangle. Both these offices were very dirty — a dirty pauper was head cook, and two women were splashing dirty clothes about in dirty water in the laundry. The sole cooking utensils that we saw were two saucepans and a frying pan. It is no wonder that Dr. Moorhead pathetically remarks in his report that it is no use his ordering meat, for he has no one to cook it. Under these circumstances we were not surprised to find that the dietary was as elementary as the appliances, consisting principally of porridge, milk and bread for the able-bodied and old people, and for the sick such food as could be cooked in the small ill-found kitchen in the infirmary.

RECOMMENDATIONS.

It has been our custom in concluding these reports to focus the results of the inspection; thus, we hope, giving some aid to the guardians in the work of reform; but in this case we find ourselves confronted with a building in all ways unsuitable for the work required of it, and, when the question of adaptation is considered, the cost of fitting it for the use of a modern hospital will be so large and the result so unsatisfactory that we hesitate to suggest it. As we considered the circumstances of the district and the proximity of workhouses quite in excess of the population, we saw a prospect of amalgamation leading to better classification and the more efficient treatment of the sick and infirm. The alternative is a new infirmary, which would be cheaper in the end than the attempt to patch and adapt an unadaptable building.

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