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

LONDONDERRY WORKHOUSE INFIRMARY.

On arriving in Londonderry we at once sought out the medical officer, Dr. Browne. who kindly promised to show us over the infirmary on the following day. The house, which is of the second class, stands on a hill in the city. The grey stone building, on its platform partly of masonry and partly of natural formation, is a conspicuous object in the landscape, at any rate from the side from which we approached it.

The accommodation for the sick in the infirmary is insufficient for the needs of the union; it was crowded even in the summer. There were 67 patients in the wards, which was a little above the average for the time of year. The infirmary was built sixty years ago. The plastered walls are whitewashed, and the beams supporting the roof are rough and uneven, whilst on the ground floor the rafters are uncoiled. Small windows on one side, with slit openings in the opposite wall, near the cornice, are the only channels of ventilation as well as of light, and there is no superabundance of either. For these 67 patients there is one nurse by day, and she is untrained, so that it is a mere quibble to say that they are not nursed by paupers; there must be pauper nursing, or practically none at all. A night nurse, also untrained, has recently been appointed. The most serious class of cases is not often found among the patients, as some are taken to the County Infirmary in the city; yet our brief glance round showed us a bad case of jaundice, requiring careful feeding; bronchitis, which would be all the better for warmth, regular poulticing, and appropriate nourishment; heart disease in need of watchful nursing and rest; ulcers on the legs after confinement, requiring skilled dressing; and besides spinal disease, paralysis, and senility, patients who need handling and tending like an infant.

The harrow bed is the only bed used in the wards, with straw ticks and pillows; a wide lining of wood is carried round the walls, so as to prevent the bedding touching the plaster; a bucket chair or two are in each ward, a table shelf for two beds, and some chairs. We also saw some box beds for helpless patients; these are filled with straw, which, in the case of a paralytic patient, can only be kept clean by daily renewal, a process costly to the ratepayers, and unhandy for the patient.

The pauper wardswomen are chiefly women with illegitimate children, a special nursery being provided in the infirmary for these infants, that they may not be separated from their mothers. This arrangement deprives the infirmary of some space for sick beds. In this infants' ward were eight beds or cots. The infirmary nurse is lodged in a dark room, crowded with necessary furniture, and suggestive neither of comfort nor health. The surgery, a corresponding room, was equally unsuited to its purpose.

The lunatics, as this class is styled, though it consists mainly of feebleminded and epileptics, are placed in a separate division of the infirmary. We were pleased to note a distinct improvement in the style of the arrangements made for them as contrasted with those of previously visited infirmaries. The cells are disused, and in lieu thereof the Board has provided dormitories, dining and day rooms, partly on the first floor of the infirmary wings. These rooms are light and cheerful; pictures, plants, and mats give some air of comfort, and we were informed that paid attendants had lately been appointed to each side. The condition of the lunatics in the majority. of the workhouses is so scandalous that such slight attempts as these at a more humane and sympathetic treatment deserve favourable comment. We do not, however, mean to convey that the sanitation or the arrangements for the night are as they should be, but the nurse from the infirmary visits these wards during the night. The lunatics themselves looked comparatively clean and happy, and some had some slight occupation such as knitting.

The aged and infirm are in their usual quarters in the end blocks of the body of the house. We noted in our round that there are no conveniences for the old people at night, except pails and buckets; and, furthermore, we ascertained that these wards are locked on the outside at 7 P.M. and not unlocked till 6 A.M. In conversation with one of the officers we were told that if by chance one of these dormitories is visited at night "the stench is very bad," the floor at times being soiled with excreta; as the officer remarked, "the old people cannot be blamed, as there is no light." The appearance of these wards is not inviting. The harrow beds — about twenty in each ward — are close together; the walls are rough surface, colour washed, the rafters unceiled; a window at either end gives only a poor light through the long room; an old-fashioned fireplace added to the desolate look, and some pictures stuck on the wall§ did very little to redeem the general dreariness. There are day rooms leading out of the wards, having a long table and benches. In one of these a male inmate was making his toilet, a basin on the table and a scrap of looking glass being the apparatus. The females were in the dormitory, one old woman rambling in her talk; another with club-foot, whose most comfortable position was crouching on the ground. The old men and women and their wards looked cleaner and better cared for than in many other houses which we had visited. The master said that he wished the people in the neighbourhood would kindly send him old magazines and picture papers for his old people; he had not nearly enough for them.

The fever hospital was built at a later date than the workhouse, but structurally is on the same lines. It is a self-contained building of two storeys. Four cases of scarlet fever were being nursed in the ground-floor wards; the long wards above were empty. Hair mattresses are in use on a few of the beds in this division; here, also, we saw a bath, and a closet with flush. The nurse (not trained) served for many years in the infirmary wards before she was transferred to this section.

The infants are placed in a low building, forming one side of the square. The nursery is a long room with a boarded floor, a fixed bench running round the walls, and a staircase leading to the mothers' dormitory above. The room was tenanted by a solitary little mite crouching close to the fireplace, a true workhouse infant. There were a few wooden cradles at one side. From these insufficient data we were unable to form our own idea of the care bestowed on the infants, but the officer who accompanied us said that as the mothers would tell of one another if the infants' milk were taken, there was no fear of their not being properly fed. The room was clean, but very bare; the rough walls, raftered roof, small windows, and fireplace insufficient for heating the room in cold weather, were not suggestive of a nursery in the proper sense of the word.

The sanitary arrangements are primitive; for indoor service, pails, buckets, or bucket chairs; these remain unemptied during the night. Though in the infirmary the nurse may put the vessels outside on the landing, there is no closet indoors for the emptying of them. Outside are privies on the waggon system, the waggons being emptied daily on to the land. These places were kept clean as far as they could be. There is a service of cold water on the landings and a small sink for the rinsing of mugs, but there is no slop sink nor wash-up sink nor any bath. A basin and jug is provided for each ward, over which is hung a small roller towel, changed, we were told, "as often as necessary." The same provision for personal cleanliness is also made in the wards for the aged and for the lunatics. The water is drawn from the town supply; the sewage flows partly into cesspools and partly into the town supply.

The laundry is in many respects an improvement on others we have seen; there are drying closets heated by steam, the washing troughs are all provided with service taps, there is a copper in good repair, and the ironing room is over the washhouse. We were surprised at the absence of mangle and wringer; but these machines are evidently not much in favour in this country. In the kitchen all the cooking is done in jacketted boilers heated by steam, hence there can be no roasting or baking of the food. Soup was being prepared for the day's meal. The diets for the infirmary are cooked in the main kitchen, whence the food is distributed to the various sections on wooden trays.

RECOMMENDATIONS.

In accordance with our usual practice, we would gather together the points wherein there is urgent need of alteration, and it occurred to us that if the guardians could provide a separate building for the lunatic class, it would set free wards which might be utilised for the sick, and so relieve the congestion in the infirmary. But the crying need is a staff of trained nurses in sufficient numbers to supplant the paupers, who might be far more usefully employed in the domestic service of the house than in attendance on the sick. One nurse, and she untrained, cannot attend to 67 sick or helpless patients. Baths, closets, and a good hot and cold water service all over the place would lessen the labour and add to the efficiency of the nursing. Day rooms, by providing a place for the patients who are able to sit up, where they could have their meals, where the men might smoke, read, or play games, would diminish the crowding of the wards, and also keep them quieter for the more acutely ill. We would make the same suggestions for the improvement of the infirm wards, improved sanitation, and the brightening of the day rooms, the only home of the old people until they die. Considering the prison-like arrangement at night, there should be bells or telephones from every part to the master's house. Finally, the modern bed and bedding should supersede the harrow bed and straw tick, these latter being most unsuitable for the use of the sick, and being, moreover, liable to harbour vermin.

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