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

KILRUSH WORKHOUSE INFIRMARY, CO. CLARE.

This house is finely situated, standing on a hill outside the town overlooking the wide estuary of the Shannon. The buildings are distributed on both sides of the road, the body of the house and the probationary wards on the one hand, and, on the other, the infirmary and the fever hospital. The infirmary is practically the hospital of the district: patients requiring hospital treatment who did not avail themselves of the aid provided here would have to go right across the island to Dublin as the most accessible place.

The medical officer, Dr. Foley, courteously offered to take us round the buildings, and we turned in through the gate that opened into the infirmary enclosure. Here were two whitewashed two-storeyed buildings; the first is the infirmary, and the other for fever patients. The wards are on the plan which must now be very familiar to our readers — long, narrow, and low pitched, with the beds on either side and a narrow passage down the middle; the walls are whitewashed, the rafters exposed to view; the small latticed windows are iron framed, the fireplaces old and with rusty grates. The bedsteads are of the old pattern, and have straw ticks and pillows. The latter are so unsuitable for the sick, that we never cease to wonder that they have not long since been superseded by feather pillows. The female wards were decidedly overcrowded, the bedsteads being much too close together; 18 and 22 patients were placed in wards suitable for only 12 beds respectively. In winter there is yet greater pressure on the accommodation. There was not room between the beds for a chair or small table, and the cubic space per bed was evidently most deficient. Most of the female patients were chronic cases. We noticed one sad case of Bright's disease, the patient being very dropsical and unable to lie down. Among the patients were some harmless lunatics who required nursing. Not many of the patients were able to be up. At the end of each ward a small space was partitioned off to serve as a lavatory, and we also noticed a dwarf screen across the door to protect from the draught. Some attempt had been made to enliven the general aspect by the use of plants and pictures, and the appearance of both wards and patients was clean and cheerful. On the ground floor is a small ward used for a paying patient, either male or female.

The male infirmary was not so crowded with patients, but the beds are placed quite as close, and we understood that in winter there is the same pressure on both sides. Here also the cases under treatment were chiefly chronic or infirm cases, but as more of the men were able to be out of bed, it was evident that the ward was comparatively empty of serious cases. The structural arrangements are the same. There are no day rooms attached to the infirmary. Behind is a long low building, like a shed, for infirm men and women. It is a comfortless dreary structure, with rough walls and pitched and unceiled roof, furnished with backless benches for the use of its aged inmates. As we looked in, we disturbed a prayer meeting among the men, which was conducted by one of themselves. In the winter this building must be bitterly cold.

The fever hospital forms part of the infirmary structure, but there is provision for the complete isolation of the patients. Of these there were two under treatment for typhoid fever, on the ground floor, the large ward on the first floor being empty. This is the only part of the infirmary to which an inside convenience is attached, and even this is in an insanitary situation, being in immediate contact with the ward and ill ventilated. The windows of the hospital are small square apertures, placed high in the wall. The plastered walls are whitewashed.

The nursing of the hospital and of the infirmary is carried on by nuns, assisted by the inmates; at night there is one trained nurse on duty for the infirmary. This latter officer is most uncomfortably circumstanced; her room, a small one adjacent to the ward, is the only one available as a casual ward, and is at times used as such. The nuns are not trained, but the Superior has worked in the Limerick Hospital, and has thus gained experience of various forms of disease.

Crossing the road we entered the workhouse proper, where are quarters for the old people, the lunatics, the infants, and the able-bodied. On the day of our visit the inmates numbered 326, of whom 117 were on the doctor's books. From this it will be seen that Kilrush is a large union, serving a considerable tract of the wild coast district. The hospital buildings are appropriated to the lunatics, who are on both floors. There are 19 males and 23 females, under the charge of paid attendants, lodged in dormitories, not cells; the more infirm are on the first floor, with whom, also, are the epileptics and harmless imbeciles. There is one cell on each side, used very occasionally for the detention of an unmanageable patient. The employment of paid attendants has a distinctly beneficial effect on this unhappy class; their appearance was far less wretched than common, and the wards looked better cared for. The small airing courts at the back, paved with stone on the men's side and turfed for the women, are the only recreation ground for the lunatics.

The old men and women we found as usual in the wings. In each ward were about 18 beds of the "harrow" frame make, with straw ticks; the walls were whitewashed, the flooring of the roam above exposed, one fireplace in each ward, on which was a turf fire. A window had been opened in the side of each ward, in addition to those at either end; this made the wards a little less dark and dreary than some we have seen, but there was as usual an utter absence of anything approaching comfort in these quarters for the aged and infirm. As there are no day rooms, or rather no place worthy of the name, these poor old people have no relief from the monotony of their existence.

The nurseries, for there are two, are in the same wing as the old women; in the first nursery the children from 2 to 5 years old are kept. Here were about ten children, under the care of an inmate. As the room is both day and night nursery the cots or beds half filled it; the children were all up, except one child who appeared to be seriously ill. We looked in vain for any bathing apparatus, or any of the usual appliances of a children's apartment. The room was unspeakably dreary, its inhabitants dirty and unkempt, and the atmosphere foul. The second nursery, for the use of mothers with their infants under two years, was no better, if anything worse, for we found here, as elsewhere, that pauper-mothers make bad nurses; thee infants were dirty, untidy, and fretful, the room dreary and dark, the air close and unwholesome. There are no sanitary appliances for the use of this department. The maternity ward is a small room in the house; the confinements are about 10 in the year.

The domestic offices are quite antiquated; the kitchen has the time-honoured two boilers, large unwieldy receptacles difficult to empty and clean, each with its separate furnace. The laundry showed no advance on its primitive conception; there was a complete absence of labour-saving machinery, though, as we were informed, the supply of able-bodied labour is quite insufficient for carrying on the work of the house. The dirty soapsuds stood unemptied in the tubs; the drying room is heated by a stove only. The infirmary has a so-called kitchen, but there is no range, only a large open fireplace, which wastes the coals and also the time of the cook. The only baths are in the probationary wards, and no water is laid on to the various departments. Of course there is no hot water except such as is boiled over a fire, or in one of the kitchen coppers.

The pail and bucket system prevails at night in all parts of the house except in the hospital, where the services of a night nurse ensure decency. The outside privies were thoroughly bad, the fittings and floors soiled.

As we crossed the yard we saw the uncomfortable two-wheeled car in which the sick are jolted over miles of rough country on their way to the infirmary, and the four-wheeled waggon used for the fever patients.

RECOMMENDATIONS.

As we went round this workhouse we came to the conclusion that the guardians are actuated by a more enlightened spirit than that which appears to rule many of the Irish Boards, and that such defects as we have commented on, some very serious, are due more to the absence of special knowledge than to that utter carelessness as to the welfare of the inmates which seems to obtain elsewhere. The overcrowding in the infirmary is very serious, and is detrimental to the patients; we would suggest that the fever hospital be thrown into the infirmary, and a new fever hospital built. The defects in the nursery department come next in importance. We would suggest, in the first place, the appointment of a paid attendant, who with the assistance of an inmate could do the work of the nursery, the mothers having access to the children at stated intervals. More light and air should be admitted into the rooms, and a bath and lavatory constructed, with an ample supply of hot and cold water. It would also be well that the little children should have a playground apart from the older children and adults. The quarters for the aged and infirm in both divisions need humanising by additional comforts, such as more light, armchairs, comfortable day rooms, with pictures, etc., to relieve the dreariness of the walls. We would also suggest that modern bedsteads should be provided throughout infirmary and infirm wards, and better fireplaces and ventilation. It is hardly necessary to add that the deficiency in the sanitary appliances should be remedied, and an ample water supply laid on throughout the buildings.