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

ATHLONE WORKHOUSE INFIRMARY, CO. WESTMEATH.

Athlone is beautifully situated on the banks of that fine waterway, the Shannon, where it widens out into Lough Ree, the town spreading on either side of the river, which is spanned by a noble bridge. It is an important centre, both of trade and agriculture, the Midland Great Western line passing through it. The workhouse, which is in the town, is one of the large houses. Dr. Shanley, the medical officer, was making his rounds when we applied for admission, and he kindly allowed us to accompany him.

The infirmary has a total of 80 beds, of which 71 were occupied; but we were informed that in the winter the wards are over-full. The structure of the wards resembles that of others already described; they occupy both ground and first floors, forming two long wings; the upper floor holds four long wards, and the ground floor four smaller wards, the lunatics' quarters filling the remaining space. The female wards at the end of the upper floor were being celled, the patients belonging to them being temporarily placed in the other wards or in the body of the house. The bedsteads are the wooden frame, with straw tick and pillow, but we were informed that hospital beds and wire-wove mattresses were ordered, and shortly expected; there are twelve feather pillows, which were lent for such cases as felt the need of a softer pillow. The wall surface is plastered and coloured, and sash windows had taken the place of the old ill-fitting iron frames.

The nuns are at work in this infirmary, and they have brought in order, method, and neatness in the place of squalor and dirt. There are four nuns at work by day; these ladies have not received a hospital training; such knowledge of nursing as they possess has been obtained in this and similar institutions, so that they have not had the advantage of learning the duties of tending the sick under skilled supervision. Their sphere of work is limited to the female wards, and to the supervision, but not the actual nursing, of the male patients; it does not extend to the maternity department. There is no night nurse. Watchers are placed in the wards with any serious case, who call the nuns when they, the watchers, think it necessary. The controversy between the Local Government Board and the guardians about the night nurse has extended over twelve months, and we see that since the date of our visit a nun, untrained but experienced, has been placed on night duty. As this appointment does not meet the requirements of the central department the Board of Guardians has been dissolved. There were several serious cases in the wards. Operations are performed by the medical officer when requisite, and., though the wards were light, we noticed many cases in bed—rheumatism, paralysis, bronchitis, asthma, besides the bedridden and helpless old people. The epileptics are nursed in the wards, Dr. Shanley thus providing nursing and attendance for them. The ward crockery, food, and medicine are kept in cupboards in the wards (it is very seldom that we have seen these valuable aids to neatness in the workhouses); the milk for the day is placed in the drink store on the landing. The linen store is in the room between the male and female wards.

The maternity ward is on the ground floor, at the end of the wing, where the female lunacy wards are usually found. The ward is dark, ill-ventilated, and quite unsuitable. There are two windows, but one is very small and set high in the wall, and both are on the same side. The walls are rough and whitewashed, the floor uneven and dirty, the beds with wooden frames and straw. The confinements average ten a year. They are attended by a midwife from the town, and afterwards nursed by an inmate. There was a very bad case of puerperal fever in this ward, an inmate being in charge of the patient. There appeared an absence of all sanitary precautions, no cleanliness in bedding, attendant, or patient.

The male lunatics are at the end of the wing, under the infirmary quarters, the cells not being in existence in this house. The five patients are in the care of an inmate who sleeps in the ward. The ward is dark, the beds close together, the rafters unceiled, the walls rough whitewashed, the window small, and the fireplace old. There is no day-room, the corridor, which is the usual apology for a dayroom, being used by the tailor as a workroom. The women are in a building at right angles to the hospital, a small square room with one small window, door opening directly on to the yard, rafters showing, dirty walls and floor, and old fireplace. One very noisy patient was in bed, the other patients were up. Both men and women in this class were untidy and dirty in. person and clothing. The nuns are held responsible, but the unhappy idiots are practically left to the care of the inmates. They live and sleep in these miserable quarters, which are a disgrace to any country.

The aged class are in the wings of the body of the house and occupy two floors, the cripples and more helpless being in the ground-floor wards, where there are seventeen beds, and fifteen in the wards above. The men use the general dayroom in common with the able-bodied class, the women have no dayroom. The "harrow" bed is provided for the old people; they had am comforts in the way of armchairs or cushions to the benches, nor any attendants but one of their own class. The aspect of the wards has been improved by opening windows in the long side walls, but at the best they are cheerless and dreary in appearance and arrangement. Here the old people are locked in at night in the dark, the ward attendants having candle and matches to use if required, and the insanitary practice of using soil pails at night obtains in these wards.

The nursery is on the first floor, near to the old people's quarters. It is a large room, destitute of all furniture except the wooden cradles, filled with straw, and a bench or two. The mothers were here with their infants; there was no attempt at cleanliness, either in the nursery or its occupants, except that a large display of nursery laundry was hanging on strings around the walls. One unhappy infant, suffering from marasmus, appeared to be dying, and what chance had it either of skilled nursing or scientific feeding, surrounded, as it was, by vice and ignorance? The atmosphere of the room was foul, and it is hardly possible to picture a more wretched place in which to rear children. We could not ascertain that anyone was responsible for seeing that the milk issued for their use was not tampered with or diverted from them.

Water is laid on to the hospital, where there are two large storage cisterns in the roof, and on the landing in the male and female portions; there is a combined bathroom and watercloset with a good water flush. In the hospital kitchen there is a new range, hot and cold water supply, and a large cistern. The kitchen was clean and business-like; there are wooden trays on which the diets are served to the wards and idiots' quarters. The nuns are responsible for this department. In the house and lunatics' quarters there are no indoor conveniences; soil-buckets are used in the idiots' wards, and outside the privies are on the waggon system.

As we passed out to the fever hospital, we were pleased to see that some attention had been paid to the women's airing court; the grass had been cut, there was a comfortable bench, and Dr. Shanley said that he hoped to have some flowers growing there before long. He also hoped to get these spaces enlarged, and to do something for the men's court. The fever hospital will accommodate twenty-four patients; it was empty, but was in readiness for use at any time. It is under the charge of a trained nurse, and has its own laundry and kitchen. There is also a separate laundry for the general hospital; this and the main laundry are very deficient in appliances, but the master informed us that a steam laundry with all modern improvements was shortly to be fitted up. There is a hot-air disinfector at the back of the fever hospital.

RECOMMENDATIONS.

We could not help being impressed by the improvement in the wards worked by the nuns, especially when contrasted with the other divisions where their influence was not felt; they are not trained nurses, but as our suggestions are for the consideration of the guardians or the acting guardians, this is not the place to discuss this question. We would rather urge on the Board to consider the condition of the lunatics, and ask them to improve their wards, to place them under paid attendants, and to provide them with sanitary requisites and decent places for exercise. The condition of the old people also calls for attention; improvement of their beds, more comforts in their wards, pleasant and cheerful day-rooms, a supply of lavatories and waterclosets adjacent to their wards, and seats and shelters placed for their use in the grounds, would alleviate their dreary lot. For the infants, a responsible officer, a clean and suitable nursery with means of bathing the infants, proper nursing when sick, control over the mothers when feeding or tending their children, so that these are not made the victims of the vice and ignorance of the parents: these improvements are all urgently needed. The maternity ward does not represent the best that should be done for the lying-in women. It wants better ventilation and light, separate sanitary conveniences, and, above all, efficient nursing for the patients after the midwife's attendance ceases. We trust that under the present administration of the affairs of the Union these matters may be attended to.