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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 Braintree union workhouse.

BRAINTREE, ESSEX.

The workhouse which serves the Braintree Union is a Y-shaped building, a plan much in favour at the beginning of the century. The foot of the letter is occupied by the tramps' quarters and the receiving wards, the stem by the kitchen and dining hall, and the two arms accommodate the male and female able-bodied inmates. The master readily acceded to our request to be shown the infirmary, and introduced the nurse, who had been trained at the great infirmary at St. George's-in-the-East.

The sick and infirm are in three different places; there is the hospital proper, a separate building, containing about 30 beds, which at the date of its erection was amply sufficient for the number of sick that sought its shelter; it is a two-storeyed building. having six wards and two day rooms. In "the cottages," originally intended for the married couples, but never used for that purpose, we found the idiots and fit cases. Finally, in the old schoolrooms in the house we found infirm and sick male and female patients, and also in wards upstairs, close to the dormitory of the able-bodied women. This distribution is the result of the increase of the sick, infirm, and helpless, who have overflowed the quarters originally assigned to them.

The master said that he had been in the house over twenty-five years, a period during which he had observed the gradual decline in the number of the able-bodied inmates and of the children, and the steady increase of the sick and helpless, a change which is everywhere converting these houses into asylums, instead of workhouses. The question of improving the accommodation for the sick had occupied the attention of the Board for the last ten years, but hitherto without result; and at the last meeting of the Board, a report of which is before us, the matter was shelved until after the elections.

In the meantime, the sick are located as above described. We found all the wards overcrowded; the small wards in the hospital, containing 5 or 6 beds, were only large enough for 3; they had one window, a small fireplace, and the door on to the landing. We can imagine the state of the atmosphere in these wards at night, when the window is shut (and, as two beds are quite close to it, it must be necessary to shut it in rough weather) for the small fireplace could do very little towards purifying the air. There was very little furniture in the wards other than the bedsteads; armchairs were few, but there was very little space to put them in. The bedsteads were of fair size, but rather low; the bedding a straw mattress, on which is laid a flock bed. The patients who were up in the hospital used the day rooms on the ground floor; these rooms were warm and bright, but the straight-backed benches offered very little rest for the old people.

The patients, many of whom were in bed, were such as are usually found in a workhouse infirmary. We were struck with the number of cancer cases: there were three, and the nurse said that the disease seemed to be prevalent in the locality. We saw several helpless cases among the patients in the hospital, or in the infirm wards in the house. Among those who were seriously ill we saw cases of phthisis, hernia, paralysis, and cancer; a little lad of about 8 years old was in the old women's ward; he had been sent over from the house, having "nettle rash." In the winter there are many more acute cases, such as pneumonia, pleurisy, rheumatism, bronchitis; there is a cottage hospital in Braintree, but a few operations have been done in the infirmary. In all there were about eighty patients under the care of the nurse, including the idiot and fit cases.

From the above it will be seen that very little classification is possible; the imbeciles are classed apart, but when one of them requires nursing he is removed into the sick wards, where we saw some cases with severe fits, also some cases of dementia. The provision for the feeble minded was but a makeshift arrangement; the day rooms are dreary, and there was no attempt at occupation or amusement; indeed there was no one to initiate such amusement, for the single nurse being chiefly in her sick wards, an inmate was told off to look after the imbeciles. Their dormitories are upstairs, and small separation wards having one or two beds opened out of the day room; these were heated by hot pipes. We saw no separation wards in the hospital or the house, and there are no children's wards.

The lock [venereal] patients are very few; the medical officer informed us that he should put such patients in the infectious hospital; this is a self-contained building of four wards, with accommodation for 16 beds; it stands in the grounds, quite apart from the house. Any case of infectious disease is nursed here by trained nurses engaged from outside. We found it empty at the time of our visit; it was kept clean, and could be made fit for use in a short time; the necessary bedding is brought over from the house, and burnt after each case.

The lying-in ward is in the hospital, close to the nurse's room. It is a small room holding three beds, and was tenantless at the time we went round. We noted with pleasure that it was kept in readiness for the next patient. The confinements average seven a year. The room lacks conveniences as a lying-in ward; it has one window, and a small fireplace.

The nursing of all these scattered patients is in the hands of one nurse, who is trained and holds the midwife's certificate; her assistants are inmates, one to each ward. A paid attendant comes from the town for night duty; she is not trained, but the Muse says that she calls her at once if more skilled attention is required. We could trace the trained nurse's handiwork all through the sick department, but the post is full of difficulty, owing to the scattered wards. There is a small surgery in the hospital, with locked cupboards for the poisons and medical stores.

The water is pumped up daily into tanks from a deep well; the master said that the supply was constant, even in the drought of 1893. There are no fixed baths in the hospital, nor is any water laid on upstairs, except for the closets. The hot-water is heated in a copper in the hospital, from which it is baled out and carried, and the baths have to be emptied by baling, as there are no sinks or gullies for carrying off the waste. We only saw two sinks, one on the ground floor of the hospital, and one in the house, outside the able-bodied women's ward. The waterclosets are on each landing contiguous to the wards, and there was a fair flush in nearly all of them; one, however, outside an infirm ward in the house, was anything but sweet; it was rinsed by turning a tap on the landing — a very curious arrangement. Commodes were used in the wards at night.

Ventilation is almost entirely by means of the windows; we saw perforations in some of the ceilings. but the master could not say that they were not choked. Most of the wards were sweet, but one of the old schoolrooms was very close; the windows in this ward open by letting the circular head fall inwards, the amount of opening being regulated by a cord, or the middle panes swing on a pivot. They were all closed when we entered the ward. Bearing in mind that the extra air spaces, such as lobbies and landings, are very small, the ventilation generally appears insufficient.

The kitchen is without means of roasting, and the master said that the meat was consequently nearly always boiled; it was occasionally baked, or made into meat puddings or broth. The sick dietary is in the hands of the medical officer. We saw on a patient's card "milk and beef-tea." The diets are all served from the house kitchen.

RECOMMENDATIONS.

It is a pleasure to be able to comment favourably on the nursing of a country infirmary, and in this particular Braintree is in advance of many places of which we have knowledge; but the nurse carries on her work under most difficult conditions, and structural improvements are most urgently needed. We would suggest to the guardians to build an infirmary for 100 or more beds, with the necessary appliances for sick nursing, and to make this building entirely distinct from the house, with due provision for nurses' quarters. We understand that plans for a new infirmary have been considered, together with an alternative scheme of adapting an existing part of the building to the infirmary department. We trust that the first scheme will be the one adopted, as being eventually the more economical as well as far more satisfactory. The old building does not lend itself to the requirements of the sick; it would need much alteration and adaptation and even then remain unsatisfactory, and inevitably coat more in the long run. Nothing can be done with the present infirmary quarters, and we therefore offer no suggestions on that head. More nurses are needed, but at present they cannot be housed. We should like to see Braintree Infirmary organised as the centre of the medical relief of the union, having its staff of nurses and midwives for nursing among the rural population.

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