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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 Blackburn union workhouse.

BLACKBURN, LANCASHIRE.

According to the reports in the local papers the workhouse has been passing through a stormy time, so that we were pleased on visiting the infirmary attached to the workhouse to find that the storm had not reached the sick department, only the distant reverberation. The union buildings stand on a hill about two miles from the town, commanding an extensive range of country with a foreground of smoking chimneys. The infirmary, which is a modern building, stands in a line with the house, and a little apart.

Accommodation is provided for 164 patients in the infirmary and 92 in the house; these beds in the house are for the lock, itch, and infirm patients; they are kept in separate wards in a block that now represents the oldest part of the house, reminding one of the old infirmaries of past days, many of which still exist up and down the country. There is besides an infectious hut for 40 patients at the far end of the field; at the present time this hut was in possession of a family ill with typhoid fever, five in all. Another small hut, standing closer to the infirmary, is used for the detention of any suspicious case that may occur among the tramps or casuals.

The entrance is by means of a handsome door into a lobby, passing through swing doors to a corridor leading to the two wings. The administration block is in the centre, having the male and female wards on each side. On the ground floor there is the superintendent nurse's sitting room on the one side and the nurse's sitting room on the other; the nurses also have a mess room apart from their recreation room; above these rooms are the bedrooms. The wards are placed in the length of the building, having windows on each side; the largest wards hold twenty-eight beds and the smaller wards twelve beds; the smaller wards at each end of the block have the advantage of an apse, giving them a magnificent view over the country, and adding materially to their light and air space. The cubic allowance is ample. To each large ward there is an isolation ward available for eye cases or any other case that requires to be isolated for treatment. Ward kitchens are on each floor of each wing. The walls in most of the wards are the brick surface painted in two shades of blue; in one ward the surface has been plastered, with the effect of making a much cleaner-looking wall surface. The floors are polished, and have kamptulicon paths down the middle of each; tables with red table covers, plants and flowers, and pictures on the walls. Though there are fireplaces, these have been discarded for steam pipes, as the medical officer informed us that it was impossible to obtain sufficient heat from open fires in the winter. The artificial light is gas. The ventilation is cross, and besides the windows we saw ventilators near the cornice. One thing we remarked as being absent, and that is some form of light handy screen for ward use, those provided being so cumbersome as to be practically useless. We also saw an abundant supply of armchairs for the sick, but no couches.

We had the advantage of the medical officer's (Dr. W. Pollard) escort round the infirmary, and he showed a pardonable pride in pointing out all the improvements that he had been able to introduce by patient endeavour, and certainly the infirmary would compare favourably with some provincial hospitals in its appointments. The imbeciles, idiots, and fit cases are in a separate block under the charge of trained attendants; the patients in the wards are divided into medical, surgical, helpless cases, and children. At the time of our visit there were about 90 patients in bed; all kinds of diseases are under treatment, and the doctor informed us that he would undertake any major operation requisite, or be prepared to carry through any line of treatment. There was a case of irreducible hernia, just admitted, gangrene of both feet, amputation of the hand, an obscure case of injury to the spine in a child, necrosis of the long bones, pneumonia, in fact such patients as would be found in the ward of a general hospital, as well as the chronic cases of the workhouse. The sick are admitted to the infirmary direct, they are bathed or not on admission at the discretion of the head nurse, and in the event of the doctor's advice being necessary on the spot he can be communicated with by telephone.

The nursing is in the hands of trained nurses, and the sick department is practically distinct under the superintendent nurse, who has two charge nurses under her, one on the male and one on the female side, assisted by six probationers. Two of these probationers are on night duty, and with them a male and a female pauper. The probationer at the time of our visit was on duty in the isolation hospital with the typhoid family above mentioned. The superintendent is entirely responsible for the nursing of the sick under the direction of the medical officer; the house master or matron have the right to visit in the infirmary, but they do not take any control. The charge nurses are selected from the senior probationers as vacancies occur; these probationers can qualify for the L.O.S.; they have lectures from the medical officer and from the superintendent on general and on obstetric nursing, besides anatomy and physiology. We went into the lecture room, which was well furnished with diagrams (Marshall's), a skeleton, separate bones, and some models, and the lectures, if our memory serves us aright, were given three times a week. We also saw a very good set of surgical instruments and a case of post-mortem instruments, enabling the doctor to perform such operations as might be necessary without delay on the one hand, or, on the other hand, obliging him to travel about with a surgical instrument shop in his carriage.

The lying-in ward is close to the superintendent nurse's quarters; it holds 2 beds, with separate offices. The system in this infirmary is to keep the woman in this ward for nine days, and then, if all is well, pass her into the general ward.

The children's ward has been contrived out of an old lumber room in what is called the basement, though from the height of the ground floor this ward is really on the ground level. It is furnished with nice cots and hair mattresses, toys, picture books, and games for the amusement of the patients, and there is a lobby which serves as a playground for the convalescents. The children are nursed in this ward from 1 month to 12 years of age. It is bright and cheerful, and it has its separate bathroom and offices.

We were sorry to pass from the well-appointed hospital to the quarters provided for the lock and other cases as above specified; in the former case the work was done in a businesslike way, and here, on the other hand, we find the old style that ought to be a thing of the past. These wards are nursed by untrained attendants, with pauper help; without going so far as to say that the patients are neglected, we have no hesitation in stating that our impression of these wards was that it was quite possible that the abuses which have been brought to light by the investigation committee could occur under the existing condition of the nursing of these cases. The hospital sick received such care as would aid their recovery, but these poor creatures had less than a minimum of nursing, nor would the circumstances that surrounded give them much chance of recovery. As these matters are the subject of an inquiry we will leave them to be dealt with by the proper authorities, only we trust that public attention will not be diverted from this weak spot in the workhouse until it has been brought into line with the infirmary nursing. We have always found that the division of the sick, part under the trained nursed and part under the workhouse management, is a fruitful source of abuses.

The sanitary arrangements are, as one would expect, quite up to date; the bathrooms are most simply fitted with the porcelain bath in the middle; the baths appeared to us to be rather small for a full-sized adult. Besides the closets and lavatories, the nurses are provided with slop sinks. In reply to our inquiry as to the method of towels in use, the superintendent informed us that the children had each a separate towel, but that in the adult wards roller towels were used, a certain proportion to the patients (we forget the exact proportion), and that these were changed twice a day. Hot and cold water is laid on everywhere, and there is a good flush for the closets.

The airing courts present the appearance of small gardens; they are grass plats with flower beds around; of course they are a great outlet in the fine weather. In the hospital the men are allowed to smoke in the lavatories. Besides these airing courts, in some of the wards there is a glass lobby to the doors on to the courts, making a pleasant seat for some of the patients.

GENERAL SUMMARY.

From the above report it will be seen that there is little, if anything, to recommend for the comfort of the sick in the infirmary, and indeed the persistent efforts of Dr. Pollard to improve their condition have borne good fruit; we congratulate him and the guardians on the possession of a very complete hospital. We would, however, suggest that the ward walls should receive the same treatment of plaster as has been tried in the experimental ward, as being conducive to cleanliness, and that the heart of the superintendent nurse should be gratified by the providing of the wards with handy rail screens, to supersede the cumbersome ones in use.

With regard to the block tenanted by the lock, itch, and infirm patients, we would suggest that the same be erased from the system of work; that accommodation be provided for the same under the head of the sick department removed entirely from the control of the workhouse officials, and that the help of the paupers be discarded. We feel the more confidence in making these suggestions, as the present condition of the infirmary is an earnest that, given a reasonable time, the Board will erase this blot for the Union.

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