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

AYLSHAM, NORFOLK.

The workhouse belonging to this Union presents a palatial appearance; it is a modern red brick building, with two wings and a central block, standing in well kept gardens, and, as seen from the railway, might easily be mistaken for the residence of a county magnate. It was built in 1846 to accommodate 600 inmates, but the largest number that has sought its shelter of late years is 130. There were about 100 inmates when we visited the house. The Medical Officer, Dr. Morton, having furnished us with an introduction we were shown round the house by the master.

The sick and infirm are lodged in the main building on the first floor. A sick house was built a few years ago at some little distance from the house, but the master prefers to use some of the empty rooms in the house for the sick, keeping the detached building for infectious cases. The interior of the house is disappointing; the passages are narrow and dark, and the staircases also are narrow and enclosed; the inside might be twice as old as the outside.

The wards for the men hold nine beds in two rooms; the smaller ward for four beds is not occupied at the present time. Two men were in bed; one with paralysis of the bladder and the other a case of old age; the rest of the patients were seated in the armchairs about the room, among them a little boy suffering apparently from rickets, who had been brought in from the nursery to have the more thorough nursing of the infirmary. There is no day room, but the master said that the men used the empty ward, and they also have the use of the airing courts, which are the gardens in the recess formed by the projection of the wings.

The female wards are in the same part of the building, the nurse's room forming the division between their quarters and those of the men. The women's room is much larger; there are eight beds in it, and of these, five were occupied by patients; a young woman of 18, to all appearance in an advanced stage of phthisis, an older woman with the same disease, the mother of the child with rickets in the men's ward, two cases of senility, and one of paralysis; the other patients were up. There is a small unoccupied ward which can be used as a day room if required. The bedding is straw or flock, except in the case of the paralysed man; he was on a mattress.

In the passage communicating with the wards the master showed us a fireproof lift working outside one of the windows, which would, he felt, be of the utmost service in rescuing the helpless patients in the event of a fire. It seemed to us that this lift would be of more service in moving the sick than the staircase.

We were not so well pleased with the lying-in ward. It is at some distance from the nurse's quarters, and was the drying room before it was adapted to its present purpose. It accommodates two beds, has two windows, and is warmed by a stove with a long iron chimney. There are no separate offices, and it is deficient in the appliances for its work. We doubted the possibility of regulating the heat and ventilation, and consequently the sanitariness of the room. There are about four confinements a year.

The nursery is on the ground floor; it is a stone-paved room, large and dreary, with a couple of benches by the fire, and at a little distance two large wooden boxes on rockers, capable of holding three or four babes together. There were two infants in charge of an old pauper, whom the master praised highly for her care and skill in rearing the young children. Two younger women were nursing the babes. We suggested that a little matting or old sacks on the floor would be an improvement, but the master said that these had been found unsatisfactory in practice; this was presumably because the paupers in charge have no idea of disciplining and educating the infants. We understood that there was a proposal to move the nursery upstairs, to a room with a south aspect and a boarded floor; the fireplace of the proposed room being adapted to this purpose.

There is a watercloset on each landing for the male and female wards. with a good flush; hot and cold water is drawn from taps on the landings; movable baths are in use as there are no bath rooms.

An old married couple are living together in a room at the end of one of the wings, and the guardians, with thoughtful consideration, are preparing a piece of ground as a little garden for them to cultivate.

The nurse is not a certificated midwife, nor is she trained, but she has had long experience in the work. The present nurse has only recently been appointed, succeeding a similar officer. Paupers help in the nursing of the patients, making the beds, washing and attending to the sick. There is no night nurse, nor are any of the inmates on duty at night. The nurse stated that there was no feeding at night, and that the patients helped each other if necessary.

RECOMMENDATIONS.

The weak points in the arrangement of this house appeared to be the lying-in ward and the nursery. If the room shown to us as the labour ward is the only one available, we would suggest an open fireplace of a good size, with a spacious chimney, and a small boiler added to it would be found most useful. As the nursery is to be moved we have nothing to say about the present room, but in furnishing the new one we would suggest cradles instead of the insanitary old boxes, and boat-shaped bottles instead of the tube feeding bottle.