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

BALLYVAUGHAN WORKHOUSE INFIRMARY, CO. CLARE.

As we crossed the stormy Bay of Galway we caught sight of the tall four-square building, standing at the foot of the Burren Mountains and dominating the small town from which the union takes its name. This workhouse, unlike those so often described in the British Medical Journal, is not built in sections; with the exception of a low erection, containing the lodge, school rooms, probationary wards, and offices, it is all compressed in a large block of grey stone three storeys high. It was an unusual sight to come across this large prisonlike structure in this wild and remote part of the country. The plan of the house places the sick and the infirm at each end of the block, the able-bodied quarters being in the middle. The dining hall is the link between the entrance and the main portion, and divides the male from the female departments. There are, we believe, only two other houses in Ireland built on this plan.

We were quite unprepared for the sight of wretchedness, misery, and squalor that greeted our eyes as, following our guide the "nurse," we entered the part called the female infirmary. The ground floor is paved with brick, from which a wooden staircase gives access to the two floors above. An unhappy idiot was crouched in the corner of the lower stair, with a shawl thrown over the head, and some dirty garment wrapped round her. In the ward to the front there were about 8 beds, and in the ward behind about 12; the walls are smooth, and have probably been whitewashed at some remote date; at present they are of all colours — the rafters black with smoke and age, the fireplace a rusty grate with some smouldering turf, two iron-framed windows, neither large nor clean enough to admit much light. Such are the surroundings of the inmates. The ward was apparently quite full of patients, some of whom were seated on benches round the fire, and others were in bed. They clustered round us, stroking our hands and clothing as though we were some strange animal, and called for blessings on our head after the manner of the country, when told that we had come to see them. When we could somewhat discern our surroundings, we noticed that all the patients were very dirty; there was vermin in abundance; the clothing, both of those up and of those in bed, was most miscellaneous and bore no resemblance to the workhouse garb, it appeared to consist of any garment on which the inmate could lay her hand; on some of the beds the covering was a horse rug, or would have been so-called in a stable; those in bed might have had bedgowns on, but they were not distinguishable from the shawls or capes that they had thrown around them. The bedsteads are the "harrow" frame, the bedding was either straw, or fibre matted into lumps and balls, the bedsteads stood on a raised platform which often served as a seat, for chairs there were none worthy of the name, and the middle of the ward was at a lower level than these platforms. Among this miserable group there was a barefooted woman who was called the nurse; she pathetically remarked "I do the best I can for them, but it's not much I can do." The only apparatus that we saw for washing was two pails on a board supported between two beds, underneath it were the saucepans; but we should judge from appearances that washing is the last thing thought of for the patients, and that a change of clothing for either bed or patient does not form part of the routine of the wards. There are six wards on the female side all resembling each other; we did not see any empty beds. It was difficult to arrive at any accurate statement of the nature of the diseases for which the inmates were on the sick books; it appeared to us that the aged and infirm were among the sick; but we certainly saw some faces on which illness and suffering had left their mark. There was one old woman who was dabbing her chest with a piece of wet rag, for what she called "the heart complaint;" another woman had dislocated her leg, there were some cases of phthisis; a young girl suffering with the last mentioned complaint was in one ward, her fresh, youthful face, made more refined by her complaint, looking quite out of harmony with the horrors around her. The most serious cases appeared to be on the first floor; one woman in a corner bed attracted our attention, she was very emaciated. and extremely weak, and apparently near her end, but there was no notification that she was the object of any special care or nursing.

The upper wards have pitched roofs and small windows. In one there was a man in very dirty clothing, seated on a bed wherein was an old woman, his mother. He came every day, bringing his food with him, some bread in a dirty handkerchief, so that he might eat his tea with his mother; his devotion was touching, but we felt that a little cleanliness would not have hindered this feeling, and it would have been better for the ward. In one corner was an old woman crouched in a corner praying at the top of her voice; she was feeble-minded. In this ward most of the patients were up. We observed dirty clothes lying about, in the beds, on the beds, under the beds, unemptied vessels of all kinds, bread anywhere, on the shelves, on the floor, in dirty handkerchiefs, and some mugs of tea. Comforts there were none, nor any appearance to indicate order or method, we should hazard a guess that these poor creatures were in want of every attention and care.

On the male side the arrangement of the wards is the same; but there were fewer patients, the wards on the top floor being unoccupied. Most of the cases we saw were those of old age and infirmity, very few were in bed. The total number, we were informed, in the infirmary was 72, and the total number in the house 101. Among those in bed we noticed a few cases of phthisis, and the others were bedridden old age. The aspect of the wards was perhaps a shade less squalid than on the female side, they were a little tidier, but they bore not the least resemblance to places for the treatment of the sick; they were bare of all comforts or appliances for sanitary purposes, and the bedding was equally dirty and uninviting. When we inquired about the nursing, we were informed that a woman from the female infirmary came over to the men by the day, and that there were the usual wardsmen; those we saw were old and feeble. The wardswomen are the mothers with their infants, and we concluded that there was no nursery, as we saw these infants all over the wards. Our guide was the nurse (untrained). She has been recently appointed, and informed us that she was to go to Dublin for a short time to learn her work. Her idea of responsibility was vague, as she mentioned in the course of conversation that "she had nothing to do with the wards, the women saw to that." Her quarters are in the male block, from whence the master fetches her if her services are required in the night, for there is no night nurse, and there are no bells for communioation with the officers quarters. We inquired what happened if a death occurred, and we were told that the corpse remained in the wards, or was laid out in the dayroom, and this statement was verified, for as we stood at the door leading to the female airing court we saw immediately opposite a door on which was painted in large letters "Dead-house." Perhaps those words were painted when the peasantry could not read, but we were shocked to think that the authorities were so deficient of all right feeling as not to take a brush across the words. The men with a fine scorn of the situation have turned the dead-house into a dayroom, where we saw them smoking and lounging on the shelves intended for their outstretched corpse.

The fever hospital is a detached building two storeys high; it was empty when we visited the workhouse, but it is not kept in a state of readiness for patients. Going along the yard we entered a dark, mudfloor room, the females' dayroom, it was lighted by one small window and the door. There were two benches in it, and on these in front of a rusty grate and smoking turf fire were two women, mother and daughter; the former had been in the house for twenty years, and from the age of the girl it was possible that she had been born in the house. Here were these two able-bodied women living in idleness at the expense of the ratepayers. A few hens and chickens shared the room with them.

The sanitary appliances, or to speak more correctly the insanitary appliances, shared in the prevailing neglect; the privies are unemptied and in a foul condition; inside there are no conveniences, and the pails and buckets are used in all departments during the night. There is an ample supply of water from the mountains, but it has not been brought inside the infirmary, and it seems needless to add that there are no baths for the inmates, nor any supply of hot water. The main kitchen was the only one that we observed, with its three formidable boilers, now only used for boiling the water and preparing the tea. The only implements in the kitchen were a few mugs, but as the patients' diet consists of bread, tea, or milk, an extensive culinary apparatus is not necessary. The laundry was in the same state of poverty, but our readers will gather that the laundry department is not subjected to any great strain.

RECOMMENDATIONS.

We have none to make. To the guardians our words would seem as idle tales; a public body that has shown itself so deficient in the sense of responsibility will not be aroused by comments or suggestions in the columns of a journal, even though the materials for criticism are furnished from the report of an eyewitness; but we trust that this report will direct public attention to the existence of an institution so misconducted by the responsible authorities that the absence of discipline or of control endangers the morals of the inmates, and offers opportunities for any licence that the authorities may choose to connive at. If we offer any suggestion, it is addressed to the Local Government Board; our suggestion is to shut up the house, dissolve the Board, and place the inmates where at least they will have humane treatment and the ordinary decencies of life.