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

TULLAMORE WORKHOUSE INFIRMARY, KING'S COUNTY.

Dr. George Moorhead, the medical officer to the Union, placed himself at our disposal, and kindly conducted us round the infirmary. Tullamore is a second-class house; there were 273 inmates the night before the visit, of whom 62 were in the infirmary, 78 in the infirm wards, and about 30 in the lunatic division.

The infirmary is a large four-storeyed building, standing to the right of, and detached from the body of the house, differing in this respect from the ground plan of most of the houses we have visited. The men are on the two lower floors, the women on the two upper, and there is a common staircase in the middle of the block. All the wards are painted in two colours and ceiled, the ceiling of the top floor being of stained wood. There are cross lights, but the windows are old. The ventilation is by means of the windows and by apertures in the floors and ceilings. The bedsteads are of all kinds; in the ground-floor ward were spring beds with hair or flock mattresses, and some in the ward above, where also we saw the "harrow" frame bed and straw tick. In the female wards there were some box beds besides the "harrow" bed.

On the ground floor, in addition to the two wards, there are a waiting room, a small oratory, and a very small kitchen. In this kitchen was an old range and no boiler, so that all the water for this large number of patients has to be heated in kettles. The cooking for the infirmary is done in this kitchen by paupers under the direction of the Sisters of Mercy.

In the wards there are about 13 beds in a single ward, or 26 on a floor; the average number occupied is between 80 and 90 altogether. There appeared to be no particular plan of classification, but Dr. Moorhead told us that he preferred to place his female surgical patients on the top floor, where the air was purest. About half the patients were in bed; they were chiefly the chronic cases that form so large a proportion of workhouse infirmary cases in the summer. In winter many acute cases come in for treatment. The beds were covered with heavy red quilts, which appeared to us unsatisfactory from a sanitary point of view. There were two basins on a stand in each ward, small tables between the beds and a larger table at one end with benches for meals, and a very few armchairs. There are two isolation wards in connection with the female division; one was occupied by a woman with severe necrosis of bone; the patient was in charge of an inmate.

Immediately behind the infirmary, and only separated from it by the width of a narrow street, stands the fever hospital, a three-storeyed block, which interferes seriously with the light and air of the infirmary, and, considering its purpose, it is far too close to the general wards. In it was a family with typhoid fever; the four patients were convalescent. These were on the ground floor, where are 2 wards with 6 beds in each. The first floor, generally allotted to scarlet fever, was empty. In this block there are two nurses, one (trained) for day duty, and one for night. We noticed temperature charts and notes of the cases, and the work appeared to be done on hospital lines. Laundries and kitchen are attached to this block. There are no day rooms for the patients in this or in any other division of the sick department. The nursing of the infirmary is in the hands of the Sisters of Mercy, whose convent is attached. The nuns are not trained, still the clean aspect of the wards and of the patients and the attention paid to details of management is a great gain to the infirmary. The pauper attendants are used extensively in the nursing, the nuns' work being chiefly confined to supervision. There is one paid nurse (untrained) on duty during the night in the infirmary.

The infirm form a large class in this house — 46 men and 32 women in these wards on the day of the visit. The men are on the ground floor, in the body of the house, in two wards and a day room; the women in two wards in the opposite wing, one above the other. The walls are bare and rough, colour washed, the rafters unceiled, and there are no comforts. Brick has taken the place of mud as the flooring of the day room, and the change is no doubt an improvement, but it must be cold to the feet. The fireplaces are wasteful, and not sufficient to heat the far ends of the wards in winter. Dr. Moorhead hopes to get windows broken out on the long outside walls, and this will be a great improvement. These wards are in the charge of an inmate. There are no bells, and they are locked on the outside at night. A small round towel, changed once a week, was the allowance for the sixteen patients in each ward. There are the old "harrow" beds, with straw ticks for the aged, and in the day rooms deal tables and benches, but no chairs.

The maternity ward is in the body of the house; it has six beds in a small ward., The confinements are few, which is as well, for there is no midwife.

The nursery for children from 2 to 5 years is in the old infirmary block. It is in charge of an inmate, and consists of day and night nursery. There are 8 box beds, and though not all were full the children were put head to feet, two in a cot, an arrangement presumably due to the laziness of the attendant pauper. There appeared to be no supervision; the air was close, and tainted with the smell of wet napkins. There was a roller towel for common use, but no signs of basins, or other means of bathing. Close to the entrance was a recess under an outside staircase which had become a receptacle for all kinds of refuse.

The infants' nursery is also the day room for the able-bodied women. Here were about eight infants with their mothers, some in the cradles filled with straw, others being nursed. The room was badly ventilated, and both this and the other nursery were entirely devoid of any brightness or attractiveness indicative of child life. We were struck by the number of children we saw about, even with the women at their work.

The lunatics are in the old infirmary block, in wards on two floors. They are classed according to the degrees of their mental disease. The upper ward is open to the pitched roof, and the lower has a brick floor. Both are badly lighted, and have whitewashed walls. There are no day rooms; the airing courts are paved with pebbles. This class is under the care of inmates, and they looked thoroughly neglected. They are at some distance from the infirmary, and appear to have no regular supervision, merely such as the officers can find time for among their multifarious duties. At night, also, they are left to pauper inmates, and their division is at some distance from any of the officers' quarters. The beds are of the old type, with a few box beds for the more helpless. The epileptics are in this class.

There are no baths in the infirmary except one movable one, and, as already mentioned, no means of heating water except in kettles, unless it is brought from the house kitchen. The outside privies are on the waggon system; those that we saw were in a bad condition, in one the floor was broken, and in all the stench was abominable. The infirmary, infirm wards, and lunatic wards use night chairs or soil buckets, and in all cases these are left untouched till the morning, fouling the atmosphere in the badly ventilated quarters of the aged and of the lunatics. The water supply has lately been taken from the town waterworks.

There is no range in the kitchen; the original three boilers are still in possession, each with its furnace, a wasteful mode of cooking, but as we note that the dietary, even for the sick, consists mainly of bread, milk, beef tea, and tea, and that no vegetables are supplied to the infirmary, we conclude that there is but little cooking. Most of the fireplaces throughout the buildings are of the old wasteful pattern, and turf almost the only fuel. The laundry was badly found, no hot water laid on and no mangle. As there are very few able-bodied in this union, labour-saving appliances will soon become an absolute necessity.

RECOMMENDATIONS.

We have before us Dr. Moorhead's report of July 16th, 1895; we can hardly do better than emphasise his points. He draws attention to the insufficient and untrained. nursing; to this we may add that the employment of paupers in responsible work in the wards is in our opinion open to the gravest objections, and we recommend therefore a trained nursing staff, sufficiently numerous to dispense altogether with the pauper helps as nurses. Paid and trained attendants for the unhappy lunatics are also an urgent want, and we would also suggest the provision of day rooms for the infirmary and for the lunatic class. Dr. Moorhead asks for more spring beds and more armchairs for the infirmary, and we would add the suggestion of more comforts for the aged class, wider beds, chairs, and better day rooms. The sanitation should be brought more into harmony with modern requirements and changed conditions, and a service of hot and cold water to all departments would be a great and most desirable improvement. The two nurseries should be brought closer to each other, and a paid nurse placed in charge of them.

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