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

DONEGAL WORKHOUSE INFIRMARY.

Our visit to the Donegal Workhouse was made in a downpour of rain, such as is common on the west coast, where the hills condense the rainclouds as the air comes laden with moisture from the Atlantic. The house stands on the line of march between Stranorlar and Ballyshannon. The Board has given discretionary power to the master to refuse relief to the tramps, and the relieving officer simply passes them on to the house for the master to deal with. The result of this plan is, so we were told by the master, that the tramps do not apply at the house. Having an introduction to the medical officer, Dr. Pope, we met him by appointment at the workhouse.

The house is a small one, a fourth-class house, and was very empty at the time of our visit; 54 was the number of inmates all told, and of these 30 were on the medical relief book (28 in hospital), not including the lunatics, so that more than half the inmates are disabled paupers. We were not surprised to learn that it is sometimes necessary to obtain labour from outside, the master being empowered to hire when requisite. No ground is cultivated, with the exception of a few flower beds in front of the house.

The lunatic wards on the male side were empty. The cells are used in this house, two females sleeping in one cell; there were two most sad cases in box beds, semi-idiotic semi-paralysed women, entirely helpless. The three patients who were up, epileptics, were seated on a bench against the wall of the corridor into which the cells opened; at one end is a protected fireplace, and at the other the door that opens on to the airing court. These patients are under the care of a pauper; they had an unwashed, untended appearance. The cells are dark and ill-ventilated, the corridor is merely a dreary passage giving access to the cells, yet this is all the accommodation provided for these unhappy creatures. Only last year the Inspector of Lunacy commented in the severest manner on this disgraceful state of things. We quote from the report [43rd Report, 1894]:

"We are compelled to reiterate the opinion that the condition of the lunatic inmates is far from satisfactory. The most helpless are frequently found ill attended to, the only persons to look after them being to a large extent pauper inmates; the apartments allocated to their use are often dark, ill-ventilated, and badly furnished, whilst the means of securing personal cleanliness are very inadequate.... Unfortunately in nearly all the Irish workhouses the inmates of the lunatic wards are found to be the most helpless imbeciles and dements, who, quite incapable of caring for themselves, unable to wash, feed, or dress themselves, and requiring the most constant and careful supervision, are left to the mercy of a pauper inmate, or, where a paid attendant is attached to the ward, to the care of an official usually ignorant and untrained, and very often negligent of his duty."

These strong words of an official qualified to speak are not too strong to represent the condition of the unhappy pauper lunatics at Donegal.

The poor idiots made such an impression on us that we have spoken of them first, but we must not forget the sick, who are in wards on the two floors of the hospital building. These wards, two on each side of the middle block, hold seven and eight beds respectively; in the lower a wooden screen acts as a draught protector between the beds and the door. The structure exhibits the usual characteristics of these primitive hospitals—the whitewashed walls, which are so wearying to the eyes; pitched roof with bare rafters, where the dust gathers and forms a soil for the germs of disease; small, ill-fitting windows on one side, faced by slit openings in the opposite wall, admitting the weather but not ventilating the ward; old fireplaces which waste fuel and are niggardly of heat; these are the conditions which surround the patients.

There was one bad case of paralysis — a woman with entire loss of power. She was in a box bed on straw, and we noted that the poor thing was in a most uncomfortable and insanitary condition. A young woman with synovitis was waiting for a leather splint; a man, who appeared to be in an advanced stage of phthisis, was seated by the fire; he had been a soldier, but had not served long enough to earn a pension. The other patients were chronic or old age cases. One case in especial roused our compassion : a respectable-looking woman, who had been in good service in London, was, by the Act of Settlement, returned with her child to face the horrors of an Irish workhouse. The infant was ruptured, and this fact detained her in the sick ward. The look of utter hopelessness in her face will not soon fade from our recollection.

The beds in the infirmary are almost all wire wove, with hair mattresses; easy chairs do not exist; we saw a wooden chair on which was what appeared to be an old car cushion, and there was of curse the usual bench. The bedsteads are too close together, and there was no room for tables in the wards. As there are no day rooms the patients live all day in the wards, as well as sleep in them, and the cubic space was quite insufficient.

There is a trained nurse in the hospital, but no night nurse; in each ward there is the pauper wardsman or woman, the only assistants that the nurse has. The nurse is also held responsible for the care of the lunatic class, whose quarters are in her division. She is sorely handicapped by the conditions of her work; she has, no separate linen store, no water laid on, either hot or cold; the only means of heating water is in a kettle. The water comes from the river, and is pumped into tanks by the inmates. The fireplace in the infirmary kitchen is a wide-mouthed wasteful grate, which makes almost all cooking extremely difficult.

At night in the sick wards the vessels are left unemptied, and the patients have no help but such as they can render each other. It is therefore more than probable that the poor paralysed woman is left uncleansed all night. Both Dr. Pope and the nurse said that the atmosphere in these wards is very foul in the night. When we think of the fate of these unhappy sick, left all night without nursing of any kind, in the dark and foetid ward, we cannot but condemn the system which allows so much preventable suffering. This is no sensational picture; its worst features can be verified by any inhabitant of Donegal for himself.

The infirm class is a small one in this house: the men's dormitory was empty, the few men being engaged in the house; in the female ward there were thirteen beds, all filled. The harrow beds are used in both wings, with straw ticks and pillows. (We confess to a desire to condemn every Irish Board of Guardians to spend a night or two in the infirm ward of their own workhouse, the door being locked as usual on the outside, at 7 in the evening.) It is always a matter of surprise to us that these straw-filled ticks have found favour for so long with the authorities; they are neither economical nor suitable; the substitution of mattresses would soon be paid for in the lessened amount of the straw bill. The women were all in the dormitory, the dayroom not being in use. The ward was comfortless and dreary; a window at either end gave but a poor light and insufficient ventilation to the long, low-pitched room; an old fireplace, for either turf or coal, in the middle of the long wall, was the only means of heating the dormitory. The benches (the only furniture) gave no suggestion of rest or comfort; many of the inmates sat on the foot of the bed. A basin or towel for the whole ward is the sole means of cleanliness provided.

The nursery has been closed for some time; the confinements (about one a year) take place in a small ground-floor room in the infirmary.

The diets consist of potatoes five days in the week, and soup on the other two days, in the body of the house; in the infirmary, meat, milk, soup, and extras, as ordered by the doctor. Corn flour is the diet of the infants, so that it is as well that the nursery is empty — at all events till a more flesh-forming food is ordered for those under 2 years of age. The food is cooked in a kitchen fitted with three coppers, each having a separate furnace, a plan which is wasteful alike of fuel and labour. These kitchens are relics of famine days, when porridge or soup was cooked in gallons to feed the starving population. But this is half a century ago, and perhaps it might be well to remove them now to make way for something more suited to the requirements of the house. The laundry is of the same date, and has the same old-world aspect; no hot water is laid on; there is no mangle or other labour-saving appliances except a wringer, of which one roller is practically useless.

RECOMMENDATIONS.

We would call the attention of the Board to the words which we have quoted from the report of the Inspectors of Lunacy, and urge them to remove this disgrace as far as Donegal is concerned, by making the quarters of the idiots less cruelly unsuitable, and providing them with proper attendance. If it is right to retain this class in the workhouses at all, the guardians are bound to do all that is possible for their treatment. Further, we suggest the appointment of a trained night nurse for the wards, to remove the scandal of the present untended condition of the sick through the night. Lastly, it seems to us that a well-devised scheme of amalgamation would solve many of the difficulties which beset the guardians. We trust that this matter will soon receive the attention of the central authority, for the guardians require all the advice and assistance possible in this difficult task of bringing the houses up to date.

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