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

FALMOUTH.

This house is beautifully situated some two miles from the town, overlooking it and the sea. It can be readily distinguished from the railway by its length of whitewashed walls. The medical officer (Dr. Bullmore) was unable to accompany us on our visit to the infirmary, but the introduction with which he furnished us secured us every attention. The doctor has held the post of medical officer to the workhouse for upwards of fifty years, and has witnessed many changes in the administration of relief to the sick poor.

The infirmary is a separate block, older than the main body of the house, with which it is connected by a covered passage. The old-fashioned style of the arrangements strikes the observer at once on entering the ward: the bedsteads are mostly placed with one side against the wall; the walls are whitewashed, with pictures pinned upon them; the rooms small, resembling those in old Cornish cottages. This gives a home-like aspect to the infirmary, and doubtless the patients were, as they said, quite comfortable.

The wards are distributed on two floors, and are licensed for thirty-four patients; the largest ward holds seven beds, the others have three or four beds in each. On the ground floor we entered a ward with six beds for females. There was a young woman with what appeared to be psoriasis, but there was no bed card to verify the diagnosis; an old woman crippled by an injured toe, a case of senile debility, and a weak-minded woman. The beds are narrow, the bedding straw or flock, with a few feather beds, which are used for the old people. Cocoanut matting is placed over the laths. The patients are well supplied with armchairs. On the next floor were two small wards, each holding three beds; in one was an old woman with a weak mind, brought on, so the matron told us, by her own misconduct; similar cases to that of this poor woman may be found in most infirmaries. Besides her there was a blind woman and a case of old age. In the adjoining ward all three were cases of old age. The matron informed us that at the time of our visit there were no offensive cases on the female side. We wondered where, if there had been such, they could have been placed so as not to offend the other patients.

On the male side, on the ground floor, was a small ward for three beds, used when necessary for the offensive cases; but, when we visited, the beds were occupied by an imbecile patient with a delicate chest, and two old people. On the first floor was a larger ward, in which were seven beds, the occupants of which were all up and in the grounds. There are no day rooms on either side; the men smoke in their wards. At this time of the year the wards are empty, but in winter there are always several acute medical cases, and the infirmary is then quite crowded. There seems to be scarcely any surgical work.

The labour ward is a small room on the first floor, having three beds; of these only two are used, by the patient and the attendant. It is a small inconvenient ward, but quite clean. It was empty at the time of our visit. The matron related that lately a dwarf had been confined in that ward, the child being taken from her by operation; both mother and child had died.

There is one nurse, untrained, for the whole infirmary, with paupers as her assistants; this nurse also acts as the midwife, having been instructed by the doctor in the duties of the post. The wardsmen and women that were pointed out to us were all old people, and, as there is no night nurse, the more helpless depend upon the less helpless patients for aid at night. There are bells from the wards to the nurse's room, which is in the infirmary, and from the nurse's room to the master's quarters. The doctor is fetched if required at night by a messenger on foot — a distance of nearly two miles into Falmouth.

In going round the wards we were struck by their "fustiness." The air was not perhaps very impure, nor were there any bad smells, but it was stagnant. The ventilation is carried on by means of the sash windows, the lowered sash having coarse perforated zinc over the opening; we saw no other ventilators, and the position of the windows did not admit of a cross current of air. As there were commodes in these small wards for use at night the atmosphere must be very foul in the early morning. There is a closet on each floor; they had no flush, and were offensive. There is no hot water but such as can be heated in the small infirmary kitchen, no baths but foot tubs. If the old people require a bath they must go over to the house for it, consequently they are seldom or never bathed. Cold water is laid on to the infirmary, discharging over a small sink on one of the landings.

An infectious hospital stands in the grounds for the reception of intercurrent cases; it is self-contained; it was empty at the time of our visit, and has never yet been used, being quite modern. There is also a small hut, holding two wards, for the isolation of any suspicious case. We saw no provision for the isolation and treatment of lock patients. The imbeciles are all in the house under the matron's care.

The diets consist of boiled and roast mutton and beef, stewed meat and broth; extra milk is given out for the night if ordered by the doctor.

The airing courts are in the immediate neighbourhood of the wards; they are enclosed grass and gravelled spaces. The matron informed us that the inmates were also free to roam over the grounds, and that seats were placed for them under the trees.

RECOMMENDATIONS.

The existing infirmary buildings are too old and inconvenient to be suitable for the needs of the sick; a new infirmary is wanted, with all modern appliances for nursing. Considering the size of Falmouth, and the difficulty there must be in providing for the nursing of the sick poor of the town and its neighbourhood, it behoves the guardians to make a complete hospital attached to the workhouse. With the hospital would come the staff of trained nurses for night and day, doing away with the makeshift paupers. There can be no doubt that the patients are kindly treated in the infirmary, and when not acutely ill are fairly comfortable, but they are not nursed, and under existing arrangements there is little scope for treatment.