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

BISHOP AUCKLAND.

Bishop Auckland is in the centre of the Durham coal pits, and draws its inmates almost entirely from that class of workers. Bishop Auckland is built over the coal-pits, many of which are in the parish; the Bishop's castle stands on the borders of the town; the town itself is a quiet little country place, existing only for the colliers, and, as it is off the main line of rail, it does not attract many visitors.

The workhouse stands on the outskirts of the town, on rising ground. The infirmary is a separate block behind the main building. The medical officer (Dr. Wardle) was unable to meet us when we made our visit, but his place was supplied by the master and matron, who spared no pains in showing us the sick wards and other parts of the house. At the time of our visit the drains were being relaid, and the closets in all parts of the house were in the course of reconstruction with modern appliances. The master stated that the water supply was intermittent; but this was due to the source from which the water is drawn — the river Wear — and not to the machinery for distribution. The water is laid on to all parts of the building, and there are bathrooms on every landing with a supply of hot and cold water. Besides the bathrooms there are fixed basins outside the wards, but we did not see any slop sinks.

The wards are of varying size, and accommodate 115 patients, the average being from seventy to eighty occupied beds. The wards present a cheerful appearance to the visitor; they are adorned with pictures; there are strips of matting in the centre, plants, flowers, and newspapers for the inmates. In the large wards the fireplace is in the middle, the flue being enclosed; besides the fires there are hot pipes for the winter. We saw Tobin ventilators (not always in use, as in one ward the ventilator served as a shelf for books), openings in the ceiling, and open windows. As the wards were of all sizes, cross ventilation was the exception; some of the rooms were close and airless. Those on the female side are more modern, the long ward with the windows on each side and fireplaces at both ends; but this shape is not popular with the inmates, not being home-like. The bedsteads are of varying width, but most commonly the full size, and there are about twelve that have spring mattresses; water and air mattresses are used for such cases as need them. The bedding is chaff, and on those beds that we turned down there was an ample supply of blankets; all was quite clean. In one ward — and to this we were taken last — we found four old women, one with hemiplegia, another blind, one old age, the fourth with heart disease; these formed a happy family; the matron, with a touch of humanity, had allowed them to set out their treasures and hang up their pictures in the room, so that it looked more like an almshouse than a workhouse ward; here we were expected to sit down and admire the work, hear stories about the portraits, and bring our news from the outer world; these patients all helped each other, and the whole made a pleasing picture of the possibilities of workhouse life under humane management.

But there is a darker side to this picture, and that we saw when walking round the wards and studying the cases in bed; some of them, cases requiring hospital care but being treated under such circumstances and in such surroundings as make such care impossible. There was one poor man in a corner of the large ward, whose days were numbered; if he had been in a hospital he would have received a large share of the care of a trained nurse, a suitable or varied diet would have been given him, a resident doctor would have been at hand to superintend the treatment, and this routine would have been carried on through the night; what was the reality? This dying man was to all intents and purposes being nursed by paupers, for though there is a trained nurse, at this time she was far away in another part of the building, and as we hovered at the bed the wardsman was telling the matron of the progress of the case; we did not see anything near at hand in the way of food or drink, and at night that sick man would be left to the charge of the ward, all the occupants of which would be in bed. In that same ward there was an imbecile who spent his time in twisting his fingers until the knuckles were rubbed into callosities; he was the sole care of an inmate; the bulk of the patients in that ward were up where they lived as well as slept. The other patients in bed were a man with fistula, a severe case of heart disease, a man with pressure on the veins of the leg, consumption, paralysis, and old age; in all there were about twenty cases in bed on both sides. The doctor does any operation that may be requisite, as there is no hospital in the town. We saw one man who exhibited his leg with much pride; it had been a case of acute necrosis soundly healed, and he was shortly going out. There is no separate ward for the children. There is a watercloset close to each ward for use at night, and the usual lockers in the wards.

These 70 or more patients are under the care of one trained nurse, who is also the midwife; the doctor lives at some little distance, and if required in the night is fetched by an aged pauper. The nurse's quarters are in the women's infirmary, and in themselves are very comfortable. There is telephonic communication from the wards, and the same system of communication is laid on to the master's house. Pauper help is largely used in this house, as indeed it must be if the sick are to have anything like attention, and when going round we formed the opinion that the matron held them responsible for their several charges. The nurse did not go round with us, nor could we see where she came in; but as she had only lately come, doubtless she was new to the place. There is no night nurse, the wardsman or woman do what they can in the night, and when any patient requires "watching" an inmate is deputed for the duty. The poor man dying of dropsy had not reached the stage of "watching." In justice to the management we must say that the utmost was made of the inmates, they are drawn from an intelligent class; and we felt that, given a more generous system of nursing, with better appliances, the recoveries would bear a larger proportion, and much of the pauper help could be dispensed with. The lying-in ward holds four beds, it has separate offices, and is fairly suitable for the work; it is under the care of a pauper inmate, who works under the nurse.

There is no classification; the imbeciles and idiots were scattered all up and down the wards among the sane patients, but each feeble-minded patient had an attendant inmate in charge of him or her, and it was touching to see the interest they took in their simple-minded children. The lock cases are in small wards at each end of the infirmary, and there are separate offices for these wards. There is want of more dayrooms, especially on the men's side; there are dayrooms on the ground floor but not for the wards above. We could not judge of the airing courts, as they were in disorder through the drainage works.

The dinner was being served at the time of our visit. It was suet pudding with sweet sauce. The pudding was nice and light; the people said that they liked it; some of the patients were having boiled beef and potatoes; this also was properly cooked. The doctor is responsible for the extras, and, to judge by the bedcards, these were milk or beef-tea; the matron also made lemonade for those who could take it. Of necessity there is no systematic feeding through the night, and we wondered how that poor fellow with dropsy would manage to get through the night without any such alleviation. The hours of meals, as usual, are 8 o'clock breakfast, 12 for dinner, 6 o'clock for tea; tea is given in the sick wards.

There is a separate block for the isolation of infectious patients; it appeared to us that the situation was not well chosen; it lies between the infirmary and the children's quarters, and being a low-storeyed building, it is in a well, and might in the event of a prolonged epidemic become a source of infection. It was empty at the time of our visit, and if in use it is in the charge of an inmate. It is complete in itself.

We were glad to see an ample supply of cushioned armchairs for the old people, and the women, both those in bed and those up, were wearing comfortable knitted hoods of a bright colour with flannel jackets or shawls. They are provided with dressing gowns and slippers for use at night. Both the master and matron evidently bestowed all the care and thought possible on the sick; the defects we noticed when making our round are those of the system, and not on the part of the officers.

RECOMMENDATIONS.

We would recommend that the guardians appoint two more nurses; a second for the day to take either the male or the female side, and one for duty in the whole building at night; this is the very smallest amount of nursing requisite, even if the infirm were separated from the sick and placed under the care of a paid attendant; for this being practically the only hospital, it receives many acute cases. With regard to the building, we would suggest that the present isolation hospital be taken for some other purpose — for the use of the feeble-minded, for instance — and that another infectious block be built in a more suitable situation. Altogether we were pleased with the humanity and care evident in the management of the house.