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

MULLINGAR WORKHOUSE INFIRMARY, CO. WESTMEATH.

We were somewhat amused when we reached this infirmary to find that the medical officer, Dr. Dillon Kelly, finding that the infirmary quarters were neither commodious nor suitable for all his patients, had taken the bull by the horns, and settled the male patients in the empty fever hospital; and a very pretty settlement it is.

Entering by the lodge, and passing through the dining hall, we came first to the infirmary, which we found quite in accordance with the medical officer's report as laid before his Board: "The infirmary is primitive in its arrangements for light, air, space, and sanitary arrangements, totally unfit for the treatment of medical or surgical cases, and positively injurious to asthma." These wards have rough surface walls, whitewashed; the roof is pitched and plastered, the floors are uneven and none too clean, the fireplaces are old, the windows small and draughty, the ventilation, by means of the upper part of the windows and small apertures in the opposite wall, neither sufficient nor easy to regulate. The beds are the old wooden frames with straw ticks, and are crowded together. The six wards hold 8 or 10 beds each, and are all appropriated to the women. There are no dayrooms.

These wards are over the lunatic wards, which are unceiled and admit of the free transmission of sound, and are within earshot of the yards used by the idiot class. These sick wards are locked at night, there is no night nurse, and no bells to the officers' quarters. We saw several serious cases in this division, two patients in advanced phthisis, one with eczema on the legs, paralysis (the patient lacked the power of retention), dropsy, a severe case of rheumatism, senile decay in all stages, etc.

There were but few comforts, the crowded and limited space does not admit of tables or armchairs. In the ward on the ground floor some attempt has been made to relieve the monotony of the whitewash by pasting some pictures on the walls. The airing courts are equally desolate, and would be improved by the addition of shelters and benches.

As we mentioned above, Dr. Dillon Kelly has placed his male patients in the "fever" hospital. Outside this hospital the doctor has laid out and stocked a small garden, and contrived a greenhouse, and here we saw the old men happily employed in gardening, and one of them showed us the greenhouse with much pride. They felt a proprietorship in the garden and an interest which it was refreshing to see. The "fever" hospital here, as in every other case, is better built and more adaptable than the infirmary, and we do not wonder that the doctor coveted these wards for his patients. The wards, four in all, are on the two floors, the administration block occupying the middle portion of the structure. On entering we found ourselves in a clean commodious hall, where there is a table with writing and other materials for the doctor's use; the nurse's room and the kitchen open out of the hall on the further side, and the wards on either hand, a wide staircase communicating with those above. There are 40 beds in all. The patients were not very numerous, and the trained nurse was away for her holiday, her place being supplied by another nurse. Such cases as we saw were in much better condition than those in the infirmary; the wards are wider, the beds not so crowded; there is cross ventilation, and more light and sunshine. There was a case of abdominal disease, advanced phthisis, some cases of chronic asthma, etc. Several of the patients were able to be up, and they were seated in armchairs or round the tables. The smooth surface of the walls was coloured in two shades; the fireplaces were more capable of warming the wards, though we could not feel that the heat would be sufficient in the winter, especially if turf were used.

The lunatics are placed on the ground-floor of the infirmary, underneath the sick wards, their apartments being unceiled. There are no cells, but the wards are dark, dreary, and uninviting, with rough walls, small windows; the inmates are dirty and neglected in appearance, have no attendants but paupers, and no outlet but the confined yard. There was nothing that indicated kindliness or consideration for these unhappy creatures. There are no baths or conveniences in this division. The hospital nurse is responsible for the lunatics, who are locked in at night under the charge of a pauper, the nurse being over in the "fever" hospital. There were five men and seven women in these wards.

There is one trained nurse who has 120 beds under her charge; there is no night nurse, the result being that the nurse's rest is frequently broken, and if not actually called up, she must often be very anxious about her charges. Her assistants in the wards are the paupers, on whom no reliance can be placed. But we have so often in these reports described the pauper "nurse," that our readers will not need any further insistence on this point.

The lying-in ward is a small ward in the body of the house holding three beds; it was empty when we went over the house. The room had rough whitewashed walls, unceiled rafters, a poor fireplace, and bad ventilation. The number of confinements averages about fifty in the year, and the patients are attended to by a midwife from the town, the hospital nurse being responsible for them during their recovery, though their actual attendant is a pauper woman.

The infirm wards, to quote again from Dr. Dillon Kelly's report, "are long, low, cold, uninviting apartments, badly lighted and heated, unceiled; they are locked on the outside at night, leaving the inmates without means of communication, even in case of illness or fire." These wards are in two-storeyed buildings, which stand at right angles to the infirmary and body of the house, forming one side of the two large yards; they answer in every respect to the above description. Both men and women are on the ground floor, the wards containing 22 beds respectively; there are no day rooms. We saw no seats for the old people other than benches. A table at the end of the wards was set out with mugs and plates; a few old women were in bed, and one old lady was washing out her cap by the stove. The ward did not look tidy.

In the yard in front of these wards were some unsavoury heaps of refuse awaiting removal, and some of the ward slops were being rinsed away, as was quite evident by the smell. This yard is much encumbered with laundry poles. On the male side the conditions were a little better; the yard was tidy and well swept, and the ward trimmer, though we could not see that in the matter of comforts the men were better off than the women. The system of pails and buckets is in force in this division, as there are no indoor conveniences.

Outside the hospital we found the usual privies, quite 25 yards away from the building, a distance which makes them practically useless in bad weather or at night. The waggon receptacles are frequently emptied. The outdoor conveniences for the infirm wards can also only be used in the daytime, as these wards are locked at night. No water is laid on except in the "fever" hospital, where is a separate laundry, and more efficient means of supplying hot water.

The sick diets are cooked in the two hospital kitchens under the supervision of the nurse; in both we found cooking ranges of modern construction. The kitchen and laundry in the body of the house remain as they were built fifty years ago; they have the large coppers of the famine period, unwieldy and difficult to keep clean, and each with its separate furnace.

RECOMMENDATIONS.

In the "fever" hospital, where the medical officer has placed his male patients, the guardians may see what are the structural requirements of a place where the sick are tended; sufficient floor space, air and light, smooth wall surface, and good ventilation; under such conditions it is more possible to keep the patients clean and to nurse them efficiently. It is evident that the sick are overflowing the space assigned them, and the demand for hospital space will increase, as the district is a populous one. As things are the men are better off than the women, and we trust that the guardians will see their way to improving the female hospital; modern bedsteads and fewer of them, armchairs and modern fireplaces, walls plastered and coloured would be no small alleviation to the lot of the sick women, but entire reconstruction of the block would be by far the most satisfactory course. The sanitary appliances require to be brought up to date, and baths with hot and cold water supply are urgently needed. But in the front of all stands the nursing question; the medical officer has no opportunity of treating the patients with one nurse to 120 patients by day and none at all by night; until pauper nursing is superseded by a trained paid staff the sick department is a hospital only in name. Trained nursing will be found the truest economy in the end.