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

HONITON, DEVONSHIRE.

Our tour brought us in due course to the town famed for its lace, an industry now, however, almost a thing of the past. We found a friendly matron quite prepared to show us over the house, which is built of the grey stone of the country, and stands close to the station on the outskirts of the town.

The infirmary is a part of the main building, but, being in a wing at the south end, and having a separate entrance, it is sufficiently apart from the rest of the house. The women's wards are above, those for the men below. There are 14 beds in each ward, but when we visited only half the number of beds were occupied. The clean, bright roomy wards of this infirmary were a refreshing contrast to the infirmary department at Crediton. The house is licensed for 250 inmates; 65 was the number at the time of our visit, and the matron said that 80 was the largest number that had been in the house for some time.

The wards are nearly square; the women's ward has a pitched roof and cross beams; the walls are colour-washed in both wards, and there are two open fireplaces in each ward. The windows are on one side and are the chief means of ventilation; they are of fair size. The bedsteads are low and narrow, of a very old-fashioned type, not suitable for old or bedridden folk, especially when of large stature. The bedding is straw, or a water mattress when necessary for an infirm patient. We saw no lockers or cupboards. There are commodes for use at night. Wicker easy chairs are provided for those who are able to be up.

In the female ward three women were in bed — two cases of old age and one of rheumatism. In one corner of the ward an inmate had been allowed to gather round her some relics of her former home, and she had made it comfortable and bright with her treasured possessions. Among the men two patients were in bed. One was a chattering imbecile, who was also blind; he was too long for his bed, and looked thoroughly uncomfortable; he must have disturbed the ward with his unceasing talk. The other was a case of senility.

The classification of imbeciles, as may be observed from the above account, does not exist, and, indeed, we found them everywhere. There are no means of accommodating lunatics pending their removal to the asylum, nor did we see any means of isolating such a disturbing patient as the one just mentioned.

The lying-in ward is on the same floor as the general female ward, across the landing. There are two wards each containing two beds; both rooms are small and ill-adapted for such work; ventilation and the proper regulation of temperature must be difficult with so small a window and fireplace, and scrupulous cleanliness in such crowded quarters almost out of the question. There are two women in the inner room, one with a month-old baby, the other with a baby of six weeks.

The water is pumped up, though the town supply might be available. All hot water is carried from the kitchen, and there are no baths or bathrooms. On each floor there is a closet with a fairly good flush, though they are not of modern make. The drains were, so we were informed, relaid a short time ago.

The nurse, for there is only one, has been in the service of the Board for thirty years, and though the appearance of her wards did her credit, we felt that she might fairly claim her superannuation allowance and retire. There is no night nurse, and the only other help is that of the usual wardsman and wardswoman, themselves well on in years. The nurse above mentioned is not trained, nor is she a certified midwife.

An isolation hospital stands in the grounds; we thought it rather near to the main building. It has six beds, and is self-contained; it was empty at the time of our visit. We inferred that this hospital was the only one available for the town in the event of an outbreak of infectious disease.

The nursery has not been used for some time, and was destitute of furniture. It has a boarded floor, two small windows, and a small fireplace. It is dark and cheerless, and therefore not suitable for the purpose for which it is designed; it must be difficult to maintain the right temperature with the existing fireplace.

The patients are free to walk in the gardens or to sit on the terrace on which the house stands. As there are no day rooms attached to the sick department this is a necessary concession, especially for the men, most of whom were out in the grounds when we visited the wards.

RECOMMENDATIONS.

We were struck by the evident consideration shown to the old people by the officials, and our suggestions are addressed to the guardians, who have it in their power to make material addition to the comfort of the sick. We would ask, in the first instance, for wider bedsteads. We do not quarrel with the straw bed; when fully filled it is quite comfortable, but the narrow bedstead is unsuited to a full-grown man or woman. The low bedsteads, moreover, increase the nurse's labour. The lying-in ward requires enlargement, and a proper supply of hot and cold water, with bathing arrangements. This last remark applies to the whole hospital; bathrooms are wanted, a regular supply of hot and cold water, and a slop sink for the vessels. More attempt at classification should be made, by providing one or more separation wards in the hospital, and especially a room for the detention of a lunatic pending removal. Any patient with fits, or such a one as we saw in the male ward, must be a perpetual disturbance to the other inmates of the ward. The question of nursing must shortly be dealt with, and we trust that the guardians will take the opportunity of appointing a trained nurse and a probationer, or junior nurse, to assist her. We feel more and more that these country unions might fill a most important function as the centre of the medical relief of the district, but if they are to serve this purpose the hospital department must be properly equipped. We would further suggest the use of gas in the infirmary. If the Board can be induced to make these improvements we think that the sick poor under their care will have little to complain of.