BMJ Reports on the Nursing and Administration of Provincial Workhouses and Infirmaries, 1894-5.

MITFORD AND LAUNDITCH, NORFOLK.

The Chairman (Mr. T. H. Hubbard) and his colleagues on the Board of Guardians of the Mitford and Launditch Union had kindly agreed to show us over this workhouse, situated in the small village of Gresenhall, about three miles from East Dereham, the last home and burying-place of the poet Cowper. The union comprises sixty parishes, all agricultural; it is the largest in Norfolk. The house was built about 1840, round three sides of a square, in which is a garden. The infirmary, which is a separate building, stands at one end of the workhouse proper, beyond the square.

On entering the hospital garden we face an open arcade, roofed by the upper story, which overhangs the ground-floor rooms. A portion of the arcade, at either end, is enclosed, forming a short passage, containing a bath, a copper for heating the water, and a wash-up sink. The doors giving access to the day rooms and to the staircase open on to this arcade. There is no bath room on the first floor, only some fixed basins, which were being. altered at the time of our visit. There is a watercloset for each floor on both male and female sides.

The wards hold 72 beds, of which 61 were occupied at the time of our visit. They are on two floors, and contain each 12 or 13 beds. Both male and female wards are in the same block of buildings, communicating by a door on the first floor, and on the ground floor by a passage, off which is the nurse's room. The arcade is divided by the party wall, and there is also a wall which divides the garden into two halves, corresponding to the two divisions of the infirmary.

On the female side we found a patient with cancer of the breast; there was no open wound, but the poor creature was in a state of helpless suffering. The rest were cases of decay, paralysis, and infirmity. The nurse told us that she had 33 women in the wards as helpless as children. The walls are painted brick, giving an uneven and insanitary wall surface, the day-rooms, staircases, and passages are colour washed. There is no attempt to relieve the monotony of the day-rooms by any decoration. The bedding is principally straw, on a cocoanut mat; the nurse said that the latter were not being replaced, since they served as a hiding place for unlawful possessions, and it was also suspected that they might harbour vermin. There are a few spring mattresses. The beds are of good width, and most of them of modern pattern. The wards are not very cheerful; the windows are set high in the walls, and are small; there are few open fireplaces. The nurses, however, by the aid of plants and pictures, had done the best they could to improve their aspect. The method of heating most in favour is the tortoise stove, with a length of stovepipe chimney. In one ward where the stove was alight the air was stifling, and most unsuitable for sick people; this was in a ward of which the occupants were in the day-room, but it served as an object lesson as to the effect of wards heated by these stoves. The wards are square, or nearly so; the principal means of ventilation is by the. windows, and the lighting is by oil lamps.

The lying-in ward is on the first floor, opening off the landing at right angles to the door of the watercloset; it holds three beds. This ward is now disused, the medical officer, Dr. Vincent, having noticed a rise of temperature in successive patients, beginning in the first week and lasting for about ten days, then subsiding and leaving no ill-effects. For this reason the lying-in women are now treated in an attic room above this, and make an uninterrupted recovery. The watercloset, which may be in fault, has a good flush, and is quite sweet; it has, however, no intercepting lobby. The guardians are careful to keep the lying-in ward whitewashed, and the bedding is changed after each confinement.

The male wards are on the same plan as the female, but there were fewer patients in bed. There was one case of far advanced senile decay, another patient recently admitted, the diagnosis not yet given; a third had an ulceration of the leg. The nurse informed us that six of the men were quite helpless. The more serious and helpless cases are placed on the ground floor. The old men were in the day-room, seated on benches round the fire, watching it, a monotonous occupation in a dreary room. Does it never enter the heads of the authorities that a hard wooden upright seat affords very little rest to old bones?

The boys' ward, which is a small crowded room holding six beds, was occupied by two boys with whooping cough. We found these boys in the men's day room, so that the ward only imperfectly provides for the separation of the lads from the adults. It is much too small for its purpose. We saw no ward for the girls.

There is practically no classification. We saw two imbeciles in the wards, and on asking the Chairman what arrangements were made for the care of these patients, he said that they kept the idiots for the most part out of the house by their system of outdoor relief. This bore out the doctor's statement that he had no ward for the imbeciles. We saw one small ward holding two beds available for the isolation of any case; it was really a passage room, and, of course, could only be used for temporary nursing.

The dinners were being served whilst we were in the house; they were well cooked, and were sent up hot. The able bodied paupers were having pea soup and rice pudding. For the infirmary the excellent custom obtains of sending the food over in bulk in jacketed tins, the nurses being responsible for its distribution. The nurse told us that the old man with decay had milk, broth, or beef tea in small quantities at frequent intervals; the other diets were pudding, broth, roast meat, and vegetables. The food at this workhouse and the method of serving it are alike to be commended.

There are two trained nurses and a probationer; the former are obtained through the Workhouse Infirmary Nursing Association, and the latter is generally a probationer in training for the Fakenham Rural Nursing Association. The head nurse is a certificated midwife, and either the second nurse or the probationer is on night duty. Pauper help is used to a certain extent, but the nurses make the beds of such patients as are confined to bed, and are responsible for the nursing; and we must bear in mind that thirty-nine patients, more than half of the total number on the medical relief book, are quite helpless. The infirmary is not a separate department. We ascertained that the supply of linen does not admit of each individual having his own towel; the plan seemed to be to issue a certain number of towels, which are shared as far as they will go, and changed thrice a week or oftener. It seems a pity that in apportioning the linen for the sick department the estimate is not calculated at so many articles per bed, and the nurse then held responsible for the care of the linen under the usual method of inventory and stocktaking. This would conduce to the smooth working of the machine.

The nursery is in the main building; in it were five infants under the charge of a pauper. We learned from the Chairman that the pauper is often changed according to the exigencies of the work in the house. Once more we noticed the absence of anything calculated to develop the child life; there were a few cradles, a low bench, a chair or two, in a whitewashed room. We were not surprised to learn from the doctor that these infants often came under his care for excoriations about the body, for under such circumstances the babes only receive the same haphazard nursing as is the lot of the little ones in their cottage homes. The Chairman said that the management held the mothers responsible for their infants, and that they were reluctant to relieve them of that responsibility. The theory may be good; but the result in practice is the raising of a permanent crop of paupers.

The drainage was entirely overhauled and improved about five years ago, and is pronounced in good order; the water is pumped up every day from wells into tanks and cisterns; there appeared to be an ample supply. The closets have a good flush, and there is water for the baths.

The medical officer lives about two miles and a-half from the house; he is fetched by messenger. Considering this distance, it is fortunate that he can rely upon the services of trained nurses, whose skilled observation can tell them when it is necessary to send for him. There are bells from the wards to the nurses' room.

RECOMMENDATIONS.

It appeared to us that, considering the size and situation of the infirmary, it might with advantage be made into a separate department under its superintendent nurse; that the wards wanted more light and air and a better system of heating. More wards are required for isolation and for the treatment of the fit and imbecile cases, a children's ward (with which the nursery might well be combined and put under the control of the nurse), and increased accommodation for the nurses. We would also suggest an intercepting lobby to cut off the closets, and that another place be chosen for the lying-in ward. More comforts for the patients might be added to this list.

We trust that these suggestions will be met in the spirit in which they are offered, as we are fully sensible of the courtesy with which the board allowed the inspection of the house. We look forward to the day when this infirmary shall take its right place as the hospital for the district, the ambulance bringing patients from the remote villages to be nursed within its walls, and a visiting staff of nurses setting forth on their errand of healing to the cottage homes.