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

In 1894-5, the British Medical Journal — as part of a campaign to improve the nursing and medical facilities in workhouse infirmaries — conducted site visits to around fifty workhouses in England and Wales. Below are extracts from their report on the Axminster union workhouse.

AXMINSTER, DEVONSHIRE.

Axminster used to be the home of the carpet weaving trade, but the carpets which bear that name are not now made here; the factory is appropriated to another use, and the bulk of the population within the union is agricultural.

The workhouse, standing on the outskirts of the town, is well placed on a hill, and commands a fine view over beautiful Devonshire country. It is built partly of the grey stone of the locality and partly rough-cast. It dates from 1836, and is licensed for 430 inmates, 117 being in the house when we visited. From these numbers it would appear that the house is amply large enough; 136 is the largest number that has sought its shelter of late years.

The sick and infirm are lodged partly in the house and partly apart from it; there is one ward on the ground floor for the infirm old men who cannot go upstairs; on the first floor are two wards for the male patients, and above these wards is the dormitory for the able-bodied men. The female patients are in a two-storeyed wing built out from the main building, and reserved entirely for the sick. There are twelve beds in each large ward, and the small male ward has five beds, twenty-nine in all for the sick, without including the ground-floor ward for the infirm male patients. The staircases are such as ought not to be tolerated in a place for the sick and infirm; they are narrow and winding, some of them being of stone and some of wood.

We cannot praise the wards: they are crowded and destitute of comfort, the bedsteads narrow and low, the red quilts much too heavy; the windows are small and placed high in the wall, and, as ventilators are inconvenient, the whole window turns on a pivot, and has a bar to fix it open. The walls are colour washed; the seats for the old people are chiefly benches; there might have been one or two armchairs, but those who were very weary had to lie on their beds. The fireplaces (one to each ward) are open; the lighting is by oil lamps. The old men's ward on the ground floor is a dreary place; it has brick walls (colour washed) and small windows, and is quite without comforts.

The patients are all mixed without any attempt at classification; there were some imbeciles in the infirmary, and a boy with bad epilepsy. There is no children's ward, and we saw no wards that could be used for isolation. Among the able-bodied there is a ward where the imbeciles sleep, and this represents the only attempt at classification. There were three women in bed — a case of paralysis, one of old age, and the third rheumatic. One poor creature, who weighed 18 stone and was paralysed, was out of bed. There were about nine patients in this part. On the men's side there were eleven patients in all, of whom four were in bed; one an old man who wore his hat day and night, a harmless eccentricity in which the master indulged him, one with rheumatism, the epileptic boy, and a case of paralysis. These were in the two first floor wards, and there was the usual listless group seated on benches round the fire.

The lying-in ward is on the second floor in the main building; it is a single room with four beds, and was occupied by two patients. The room is of fair size, but badly ventilated; not a single window was open when we went into it. The patients were in charge of an inmate. The midwife who attends the confinements lives in the town, the infirmary nurse being responsible for the ward. There is an open fireplace, and the room was warm but airless. There are no offices.

Sanitary appliances do not exist in this house, there are no closets inside, nor any conveniences for the sick other than the commodes in the wards. No water is laid on for the sick wards, and the slops, etc., have to be carried down to the yard, and hot water is carried from the house kitchen. There are no baths, sinks, or any such accessories to cleanliness. The appearance of the patients did not suggest the idea that soap and water abounded, and who is to blame? We saw one bath in the house near the imbecile ward, to which cold water is laid on.

The nursery is on the ground floor, a wretched stone-paved room, with small windows, benches, and a wooden cradle or so, no toys, pictures, or anything for the infants' amusement. The infants are in the care of a pauper, herself the mother of illegitimate children. The mothers are responsible for the feeding of their infants, and they take them at night to sleep with them.

Some cases of measles were being nursed in the receiving wards at the front of the-house; the children were in the care of their mother, an inmate. This practice can hardly be too strongly condemned; measles may be a mild disease, but it may on the other hand entail permanent delicacy, and this will depend very much upon the nursing, and it is therefore essential that efficient and responsible nurses should have the care of children with measles.

The infirmary nurse has had experience in infirmary nursing, but she is not a midwife. She works single-handed with the usual pauper helps, and there is no night nurse. There are bells from the wards to her room, and if further assistance is wanted at night a messenger is sent for the doctor, who lives close to the workhouse.

The diets, the matron informed us, were varied for the sick as much as possible. The cooking is done by a pauper under her superintendence. She minces the meat for the old people or gives them puddings, and the doctor orders them extras. There is no night feeding, and the last meal seems to be served at 6 P.M.

RECOMMENDATIONS.

We were struck with the want of adaptability in the sick department; the space allotted to this purpose was crowded; there appeared to be no room for making the necessary offices, or for building the separation wards. Under these circumstances, it would seem to be the best policy to build a small infirmary, with a good supply of light and air, and all appliances necessary for the nursing of the sick. An immediate and pressing necessity is the construction of earth or water closets; the present state of things in the wards is not decent. The question of nursing must soon come to the front, and then we suggest that a trained nurse be engaged, who shall possess the midwife's certificate; but before that is done, we suggest that the present nurse have an assistant, who should take some of the night nursing.

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