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

DARLINGTON.

The workhouse stands on the edge of the busy town, tall chimneys and whirling mills all around it. It draws its inmates principally from the town, with a small sprinkling from the country. The operatives are employed in weaving, which is the chief industry of the place; and also in the coal pits of the locality. The operative or skilled artisan is a very different inmate to the agricultural labourer, and the work that he does in the house is that of a skilled workman. In going round the workhouse we were struck with the greater intelligence of the faces of the inmates, especially of the men; among the women, the type of face, while indicating a higher order of intellect, betrayed coarseness and hardness of character. Having an introduction from the vice-chairman of the board, our request to see the infirmary department was readily acceded to by the master. We were sorry that the absence of the matron deprived us of the advantage of her escort.

The infirmary is a detached block, standing only the width of a roadway from the main building; this entails the loss of a certain amount of light and air. The distribution of the wards is two long wards, holding 18 beds each, male and female, with smaller wards for four or six beds; the wards are on the ground and first floor. They have windows on each side, and the beds are ranged facing each other between the windows; the wards had a bright and cheerful appearance, with pictures, flowers, and other ornaments, the work, as we were informed, of the Ladies' Committee. At the time of our visit, which was in the afternoon, we found the wards rather empty, this being the slack time of the year in workhouse life. In the large female ward there were four patients in bed; one a child in a cot in the centre, suffering with gangrene of both legs, an offensive case for which iodoform was used; a pauper inmate was straightening the bed as we entered the ward, and there was an unpleasant effluvium from it; a patient with consumption, whose temperature was taken night and morning, and charted; a woman with fits; and a case of senile debility. About three other women were in the ward, but the rest were in the day-room. On the men's side there were two cases of "bad legs," and one of old age, and the other patients were in the day-room.

The bedsteads are of the full width, the bedding is a cocoanut mat over the laths, and beds of flock or chaff, with an ample supply of blankets; such beds as we saw were clean and. fit.

There are no wards for isolation, but there is a separate block called the isolation hospital, which we were told is condemned; it is not kept in a state of readiness for use, but the master informed us that a bad lock case would be placed in this hospital, and be nursed by the nurse of the infirmary. It has a complete set of separate offices, and it struck us that a little soap and water would soon make it serviceable; a tramp was in one of the rooms infected with itch.

The infirmary is licensed for 72 beds; that includes 12 in isolation hospital; there is one trained nurse, who is also the midwife; the nurse whom we saw had only been a week in the department, having succeeded a trained nurse who has left; she has pauper help — a wardsman or woman to each ward. During the night the inmates are supposed to help each other, and such of them who can go out to the closets on the landings are supposed to do so. We did not see any provision of dressing gown or slippers for this nocturnal walk. One or more paupers would be told off to watch beside a patient seriously ill, or the nurse would be called up. The tramp isolated with the itch would be his own warder in the night. There did not seem to be any means of communication with the nurse's quarters, nor with the responsible officers for night use.

In answer to inquiries, we were informed by the master that the only means of isolation was the separate hospital mentioned above; it is condemned, and therefore not put in order for the reception of patients. Besides this building, there is no means for the keeping apart of the lock cases; there are small wards in the infirmary, but we could not ascertain that the patients were classified in them. The imbeciles and idiots were among the patients in both the large and small wards. We did not see any ward for sick children; the child with gangrene referred to above was in a cot in the large ward. There is a lying-in ward of six beds with separate offices, where the mothers can remain until quite convalescent.

The infants are lodged in rooms close to the women's quarters; the nursery is a small room, rather bare of furniture, but warm and comfortable. There were six infants in the room-three in cradles and three running about. They were in the care of an inmate, but the management seemed faulty, for their mothers could have access to them as they came to and from their quarters, and there was no means of knowing whether the infants were properly and systematically fed. At night they slept with their mothers in small bedsteads. No bathrooms or separate offices were provided for the nursery. The poor little things looked as if they would do better under the care of a paid nurse. This department is supervised by the trainer, but her time is fully occupied with the care of the older children.

The diets are under the direction of the medical officer, but on analysing the dietary for the sick we were surprised to see how very little milk was allowed. On the "milk diet" the amount was 2¾ pints for the males, 2½ for the females, and 2¼ for the children; this diet does not include pudding. On the "milk and beef-tea diet," 2 pints of milk and ½ pint of beef-tea per male, the same for the females, and 2¼ pints of milk and ½ pint of beef-tea for the children. The adults have a pint of tea and a pint of coffee besides, with 6 or 7 ounces of bread at breakfast or supper. In this diet there is not much to make or repair the human frame, especially in the case of the sick; but, though it does not appear on the dietary, the doctor can doubtless order extra milk for the night.

The water supply is ample; hot and cold water are laid on to the ward landings and bath rooms; the fittings of the waterclosets are old, and the flush did not appear to be sufficient. There is the usual difficulty in keeping the paupers from soiling the baths. We saw some litter in some of the bath rooms, and the nurse complained of the wilful want of cleanliness on their part.

The wards are ventilated by means of windows; the ventilation of the ward where the gangrene patient lay was defective. There always is a difficulty in keeping sweet wards where there are a number of old people. The wards look bright with strips of brick-red linoleum down the middle, and there seemed a fair supply of arm chairs. The airing courts are yards with turf in the centre and a few bushes at the sides.

RECOMMENDATIONS.

The structure of the infirmary leaves little to be desired. but we would recommend: An increase of the nursing staff for the day, and the appointment of a night nurse; the separation of the idiots and imbeciles from among the sick and infirm; provision for the isolation of the offensive and lock cases; a paid attendant for the infants, and the provision of sleeping cots for them at night; bath room and separate offices for the nursery department; improvement of the ventilation of the wards by Tobin tubes or other similar method.