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The Lancet Reports on Metropolitan Workhouse Infirmaries, 1865-66: Islington.

In 1865-66, The Lancet — as part of a campaign to improve the conditions in London's workhouse infirmaries — conducted published a series of reports detailing the results of its visits to a number of the capital's workhouse. Below are extracts from the report on the Islington workhouse.


The infirmary of this house contrasts very strongly with that of St. Leonard's, Shoreditch. It is an example of a thoroughly bad edifice, with wards ill built, too small, too low, badly lighted and badly ventilated, rambling in plan, and closets opening into the wards; in short, combining all the faults which an hospital building could well have, but in which, nevertheless, the wise liberality of the guardians and the activity and intelligence of the medical officer — a man of superior order of mind, not overworked, and well supported by guardians, master and matron — have combated, as successfully as may be, these overwhelming defects, and have established within very unpromising premises an excellent infirmary system. It would be a waste of time to describe in detail the construction of the wards, and to point out their inapplicability to their present purpose; for this is, we believe, admitted by the guardians, who have purchased a site at Upper Holloway, including seven acres and a half of ground, on which they purpose to build what will, we hope, be a model establishment. We trust that they will pay proper attention to the construction of their hospital buildings; and we may bo excused for dwelling upon this hope, because many of the recent buildings erected as new workhouses are false to the best principles of hospital construction. We would venture especially to call their attention to the reports of the Barrack and Hospital (Army) Commission, as laying down, concisely and intelligibly, excellent rules which the guardians cannot do wrong in requiring their architect to follow; otherwise architects are apt to do a great many things in the way of hospital designing which surgeons and patients afterwards vainly deplore.

Earnestly calling upon the guardians of the parish to press on their project of new building, which is advancing somewhat slowly, we fear, at present, we omit to pass that detailed censure upon the present wards which, in point of construction, they amply deserve. And having omitted that judgment, we are happy in being enabled to leave out with it the necessity of saying anything which will be unpleasant to any person concerned in the management, or which will give anything but pleasure to those who care for the sick poor.

The infirmary accommodates 150 patients. Mr. Ede, the medical officer, visits daily; there is a resident dispenser, and the guardians find the drugs. Thus there are the best elements of successful medical care. Within the wards we found prescription and diet cards, properly written, over each bed. The wards, low, small, and ill-lighted as they were, have yet an aspect of cheerfulness and comfort. The walls were coloured cheerfully; there were prints hanging on the walls, and a few ornaments about the fire-places. In every window were a few flower-pots or flower-boxes. The linen was very clean, for here two clean sheets are allowed per week. Every ward had a full supply of bed-rests for bed-ridden patients, who could thus be propped up in bed. At the end of each ward was its clean and shining array of stomach and feet warmers for three or four aged and sick persons. Each ward had its proportion of shawls for the use of the sick in cold weather. The patients were very cheerful, very grateful, and much better kept as to their faces and hair, and their personal linen, than is often seen. In every case they had had their medicines regularly. The dressings were well applied. Sore backs were unknown as arising in the house, and we examined paralysed and speechless patients, who had been bedridden for years, and found them clean, comfortable, and with unspotted skin. We cannot speak well of the ward furniture: the tables are too small, and the chairs old and broken; so are the bed commodes, but still clean and well kept. We observed two little details which speak volumes for the good order and cleanliness of the house, and the proper spirit which animates its managers. Every ward has a supply of small dinnercloths for use when the patients are bed-ridden. These little cloths being spread, save the bed from grease, and give an air of comfort to the dinner arrangements. Besides these, each ward is provided with a number of squares of light muslin, which being thrown over the faces of bed-ridden patients, protect them in hot weather from flies, etc.

The nurses are chosen from amongst the paupers; they are, however, paid from 1s. to 1s. 6d. a week, and are well dressed. One sees here certainly the best side of parish nursing. Most of them have been in office for long terms of years; and they seem on the whole well-conducted, zealous, and well managed, conscious that they are thoroughly looked after, and anxious to deserve good opinion. It may serve to explain some of the general spirit which pervades the house that the surgeon has habitually encouraged the visits of various hospital surgeons, and that he takes pride in treating serious surgical cases successfully, and invites professional publicity. He has successfully tied here the external iliac artery, and has many times performed other capital operations — such as herniotomy, &c. There are very few imbeciles, about half a dozen, who are mixed up with the other patients. There is an ample supply of books, which are lent to the patients to read.

There is a want of day-rooms and convalescent wards; also an absence of bath-rooms. But all this must be set down, probably, to the inherent defects of the fabric, which is only fit to be destroyed. In the body of the house we noticed many double beds, which are objectionable.

The midwifery ward is the only ward which calls for animadversion. It is wretchedly cheerless; there is a want of chairs and arm-chairs; the walls are bare; the women were very unkempt; the bed-linen was unclean, and their personal linen in some instances filthy. There was a deficiency of the means of cleanliness, small baths, &c. The defects were partly accounted for by the circumstance that the nurse in charge had the day previous been dismissed, and the new nurse had not fully entered on her functions. But this only partly explained the general air of neglect and discomfort which made this ward a contrast to the other sick wards. It is managed by a midwife and nurse, and the doctor has a general supervision; but we cannot help feeling that this ward is not so well looked after as it should be. There is obviously an impression that for the many profligate women who are admitted something like penal discomfort is wholesome. With this feeling we do not sympathize; and we feel bound to tell the guardians of this union that, while the rest of their infirmary does them credit, this ward is something of a reproach.

We would call attention also to the bad arrangements for tramps. To bathe them is exceptional: it should be the rule. The washing arrangements for these wards are bad.

It is not, however, with that word that we wish to close this report. We would rather conclude by awarding the general meed of praise deserved. And we desire to point to this house in contrast to that of Shoreditch, inasmuch as the one shows how by a good management the defects of a bad house may be partly neutralized, and the other how by bad management the merits of a well-built house may be effectually counterbalanced. And since it is our aim by this investigation to render practical service to the State, we can but hope that the lesson resulting from the contrast may not be lost upon either board of guardians.

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