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

NORTH DUBLIN UNION.

The union for the northern half of the city lies close to the Grangegorman Asylum, and near — rather too near — to the terminus of the Midland Great Western Railway. The workhouse is not so favourably situated as the sister union of the south, being in a more crowded part of the city; it is also smaller in area, though not so crowded. The nucleus of the building is the "Bedford Asylum," another of the Foundling Houses, to which has been added from time to time the various blocks that compose the North Dublin Union. This Board has adopted the wise plan of removing its children to schools in the country. We were sorry not to have had an opportunity of seeing them, as we understood that they are very satisfactory. The ground plan of the union is a double square, placed back to back; the connecting portion is the Bedford Asylum, the top floor of which is used as the Protestant Hospital, the lower floors being the female infirm wards. We had the advantage of the guidance of the master and matron, and we received every courtesy at their hands.

The sick, as is usual in the Irish workhouses, are classified according to creed, the hospitals being duplicated and quite distinct. The Roman Catholics are nursed in two blocks, the male portion in a block near the gate, and the female in the buildings that form part of the square near the Protestant Hospital. The opposite side of the square is occupied in part by the male infirm. In both the male and female blocks for the Catholics the arrangement is the same; the staircase in the middle, the wards going off on each side for three storeys. The wards are oblong, having matting or linoleum down the middle; they contain about 36 beds each, tables and benches for those who are up, as there are no dayrooms. The windows, which are small and in heavy frames, face each other; the walls are brick surface painted, the upper walls having pitched roofs. The general appearance of the wards was good, clean, and neat, but they were too crowded, and in winter we were informed that more beds would have to be put in. Each bed had a locker table in which was kept the separate towel, and a bag with brush and comb was hanging at the foot of each bed. The fireplaces are the wide open grates, wasting more heat than they give, and in some of the wards they had been smoking, We noticed some Tobin ventilators, many of which more often served as a shelf. It is evident that the greater part of the ventilation is by means of the windows, the upper part of the frame falling inwards on a toothed bar. There are separate wards for children in both hospitals. The bedding is hair or fibre, on an iron bedstead, with paillasse, with straw ticks for certain cases. The patients are classed as medical, surgical, and phthisical, and included all kinds of disease as in a general hospital.

The Protestant hospital for 194 patients is on the top floor of the old building; the male and female patients are on the one floor, also the children. The classification is the same as in the other hospital. The wards, 3 in all, hold, in the largest ward, 38 beds, and, in the smallest, 23 beds. The quarters of the head nurse are in the: middle, and the whole is self-contained. The wards are in style similar to those in the other blocks, but here also we noticed the difference in the work as done by the trained nurses and the nuns. These wards were not so crowded as those in the other blocks, but they were filled to their capacity.

The nursing in the Roman Catholic Hospital is in the hands of the Sisters of S. Vincent de Paul, and we were pleased to notice that it bore trace of being done in a business like way. It is evident that these nuns, from the variety of the works that they undertake, are well fitted for work in the workhouses, and if to this they would add hospital training as a qualification of the order, they would be invaluable for the work. They are assisted by a large number of inmates, as there are not nearly sufficient nuns for the wards. As far as we could see each sister had charge of a floor, or about 70 patients, and in the male block there were a large number of able-bodied men at work. One was dressing a case of extensive strumous ulceration of the neck, and another was in attendance on a patient recently admitted with delirium tremens. Everywhere we saw them acting as nurses. In the female block very many of the wardswomen are of indifferent character. During the night one trained nurse or a sister is up in each ward with pauper assistance. A trained head nurse is in charge of the Protestant Hospital, and she has 3 nurses working under her for 194 beds. Here also we found the pauper helps, 2 men and 2 women. There is a trained nurse for the night, with a male and female pauper to assist. The sick department is superintended by a resident medical officer, with two visiting doctors from the outside, who are salaried officers. Most of the cases for operation are sent to the general hospital, the surgeon in charge of these cases being of opinion that they stand a better chance of recovery under the more favourable circumstances in which they find themselves.

The maternity department consists of two wards, holding together 20 beds. There is no separate labour bed or ward, and the second ward is used for the waiting pregnant women. It has no separate offices. The women are attended to by a midwife. The nursery for sick children under the nuns is one ward, with a corridor as a playroom. There were no cribs, but only the small bedstead that looked unsuitable for the little things. The playroom was a bright, cheerful room, low chairs and tables, and some toys for the convalescents.

The lunatics are not at all well located in this union. The men are crowded into a small, dark, low-pitched dormitory, off which is a small dayroom, and their yard is an oblong concreted enclosure, with very high walls, in which are a few benches. In this we saw the men lounging about, with no occupation to relieve the tedium of their existence. The ward is furnished with "harrow" or box beds and the straw tick; a few benches were round the large old fireplace. Some of the men were here, and others in the equally dreary day room.

The females were lodged in equally unsuitable quarters. The greater part were in the yard at the time of our visit, and we were horrified to see amongst them a coffin lying on the ground, where it had been placed until the mortuary was unlocked; worse still, a low opening in the wall protected with wire netting permitted these unhappy creatures to see into the mortuary at all times. The yard was crowded with all kinds of idiots, some of whom were jabbering round the coffin. There is a paid officer for the male lunatics and another for the females; but these officers must be heavily handicapped by the miserable surroundings in any efforts they make for the good of their charges, who appeared to us to be in quarters better fitted for animals than for human beings.

The male infirm wards were another weak part of the establishment. We entered a dark low dormitory where we found 35 men congregated in a ward that would be full with 25 men in it. The windows are small and set high in the wall; the "harrow" beds and straw ticks give no idea of comfort; no armchairs or resting seats, benches forming a square round one of the old grates; the walls with rough surface, coloured, and the rafters unceiled, completed a picture of neglect that was not creditable to the authorities. As a set-off against this dreariness, we found that the Master had turned a waste piece of ground into a nice garden for these old men; trees, shrubs, flowers, grass, and comfortable benches made a pleasant spot for them in the fine weather, and furnished some interest for them in the cultivation of their garden. There being no day-room for the infirm men, this formed a good outlet, but what must be their condition when winter keeps them indoors?

Their attendant is a wardsman taken from the inmates, and they are locked up at night, depending on each other for such assistance as they may need.

The female infirm wards were not so crowded or so dreary. As before said, they are in the two lower floors of the middle block, there is more light, better-sized wards and more cleanliness; but these old women have no officer appointed to attend them, and they are under the charge of an inmate. Considering how nearly some of those we saw are to the stage of helpless infirmity, they can hardly be satisfactorily cared for by inmates, and certainly there is need of more supervision. Another part of the enclosure has been turned into a garden for the old women, where they can sit on comfortable benches and enjoy the sunshine and air. There is no dayroom for these wards.

The sanitary appliances are placed indoors in the hospitals; they are placed either at the ends of the wards or in an annexe built out at the middle of the side wall of the ward. These consist of a watercloset flashed, a slop sink, and a bath with hot and cold supply. We observed that the closet pans were not properly cleansed, in some instances they were quite foul, and the baths were often the receptacle of various odds and ends, as though not in frequent use. In all the places that we saw off the wards there was no intercepting lobby; the convenience was too close to be sanitary, and one, at the end of a ward, appeared to be taken off the ward. The Roman Catholic hospitals have modern kitchens attached to them, where the whole of the food is cooked under the direction of the nuns. The Protestant hospital is served from the main kitchen. The main laundry is much too small for the work that it has to do. We were surprised to see that the Board had not yet adopted the many labour-saving appliances which help the work now that the able-bodied are so scarce in all the unions.

RECOMMENDATIONS.

We would most earnestly draw the attention of the Board to the question of nursing. We were struck by the large number of men employed among the sick — men who appeared to be capable of earning an independent living; how far is this system of pauper nursing responsible for keeping them in the house? We are most anxious to see these large city unions turned into training schools for workhouse nurses, but before this can be done the pauper nursing must be abolished. It demoralises the nurses and is responsible for the lower standard of nursing that is accepted in the workhouse hospitals. We would gladly see more nurses engaged and the places of the paupers taken by probationers, whose cost would certainly not exceed that of the paupers, and who would work more economically and efficiently. Another thing necessary is that all the hospitals should be worked by trained nurses in a business-like way like any other hospital. If these excellent nuns, who are doing such good work in the North Dublin Union, would obtain the necessary knowledge of sick nursing through some of the recognised schools, the value of their work would be enormously increased. It is too much the fashion to think that these hapless poor do not require skilled nursing, but their ailments are the same, whether in the hospital or the workhouse.

The condition of the aged and infirm cannot be regarded as satisfactory, either structurally or from the point of view of attendance. We would suggest that paid officers be appointed with quarters adjacent to the infirm ward. For the wards themselves, on the male side they should be condemned, and the inmates removed to more commodious and healthy surroundings. The same remark applies to the lunatics; we feel certain that more could be done in alleviation of their lot, with better quarters, opportunity of occupation or amusement, suited to their powers, and a means of outdoor exercise in more airy and cheerful grounds. The domestic offices might be improved by the introduction of more modern and suitable appliances, especially in the laundry, and we also suggest the erection of a small kitchen for the Protestant Hospital. The sanitary appliances of the maternity block should be taken into consideration, also those for the infirm and lunatic wards, for which department, proper baths and other conveniences are required. If the Board could only see its way to removing the sick to more commodious and healthy quarters, there would then be ample space for the better housing of the infirm and the lunatics.

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