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BMJ Reports on the Nursing and Administration of Irish Workhouses and Infirmaries, 1895-6.

COROFIN WORKHOUSE INFIRMARY, CO. CLARE.

Our route from Ballyvaughan to Corofin lay over the Burren Mountains, through a fine stretch of mountain scenery. The road is so good that it is surprising that the district is so little visited by tourists. Corofin lies at some distance from the foot of the range, and is a town of fair size and importance. The workhouse is outside the town; in structure it resembles Ballyvaughan, the main edifice being a large square whitewashed building; the infirmary is, however, a distinct section, standing behind the main block.

On reaching the house, we were so fortunate as to find the medical officer, Dr. Macnamara, making his rounds, and he at once placed himself at our disposal. The average number of patients is about 50, but the infirmary can comfortably accommodate only 32. In times of pressure as many as 48 or so have been placed in these wards, and the overflow has to be accommodated in the infirm wards in the body of the house. The house is of medium size; the total number of inmates on the day we went round was 71. The master said that he had no able-bodied inmates on the books that day.

The wards in the infirmary are on the two floors, having staircases and isolation wards between the male and female divisions. This is an unusual arrangement, as these rooms are generally assigned to the nurse; in this house the matron is also the nurse, and although sleeping in the infirmary block has her rooms in the body of the house. The style and appearance of the wards betokened more attention to cleanliness than we had lately been led to expect; the walls have a smooth whitewashed surface, and a wooden dado carried all round takes the heads of the beds. The top floor has a pitched plaster ceiling. The windows face each other, the grates are old and insufficient for heating; we noticed various contrivances to cover the wooden floors, pieces of cocoanut matting, scraps of carpet or of ticking between the beds and in front of the fires. The bedsteads were of the trestle variety, that is, planks, or in some cases the "harrow" frame supported on low trestles; on these were placed the ticks, filled mostly with fibre, and in some instances with straw. The frames were narrow, and thoroughly uncomfortable for any patient who has to lie continually in bed.

The medical officer's report mentions among the reforms desirable "iron bedsteads, two of which to be provided with curtains to secure privacy or increased warmth, the bedding material to be changed for some material more suitable than cocoa fibre." We have not heard that any improvement has been made in this particular. Dr. Macnamara also asks that "the present fireplaces in the hospital wards be fitted with proper and suitable grates." We noticed that there was a heavy rug placed on the beds by way of a coverlet; this must be trying for patients who are very weak, nor can such rugs be recommended from a hygienic point of view. The wards were comparatively empty at the time of the visit, the majority of the patients being able to be out of bed. We were glad to observe an air of comfort in the wards; the patients were clean, the wards neat; the pieces of matting on the floors redeemed them from the usual uncared-for look to which we had grown accustomed, and which makes us welcome such small mercies as a scrap of carpet on the floor. There was but little furniture in the wards in the shape of armchairs or lockers, but the space is too circumscribed for such additions. There is a washstand and basin on the landings outside the wards, but no service of hot or cold water; any water that may be required for the patients or during an operation is heated in a kettle. Dr. Macnamara stated that he considered the absence of a hot water service a most serious defect, and that lie found it extremely inconvenient if operations were necessary. The patients were all chronic cases; only about four were in bed on each side, nor was there any overflow from the sick wards into the body of the house. This was, however, in the summer, and we should be sorry to convey the impression that even then there was no sickness in the wards. Chronic cases demand as much skill in handling as more acute disease. The office of nurse and matron is combined, with the result that there is practically no nurse in the infirmary, for the responsible and multifarious duties which devolve on a matron are hardly compatible with the careful supervision of the sick. The patients are in reality nursed by the old inmates, one of whom we saw in each ward, and at night there is no attempt at attendance on the sick. To refer again to the doctor's report, he asks for "two trained nurses, one of whom shall be trained in midwifery." The maternity ward is one of the small wards in the infirmary; the cases average 6 per annum, and at the present time there is no midwife on the staff. In view of these criticisms on the insufficiency of the nursing staff, we would ask our readers to bear in mind that the nurse is responsible for the idiots and imbeciles; in this house there are 8 certified patients of this class, not a very large number, but these patients are always difficult to manage, and add to the anxiety of the officer in charge. These unhappy inmates are on the ground floor of the body of the house; a large room is set apart for each sex; uneven brick floors, rough walls, unceiled rafters, deficient lighting, and bad fireplaces, with a total absence of all attempt at occupation or amusement constitute the environment in which they spend their days. A more dreary lot it is hard to imagine. We noticed with surprise that there were several infants in the female idiot ward, an arrangement which calls for attention and remedy on the part of the authorities. Even though the infants may be with their mothers, it is not fitting that the feeble-minded should be trusted with the duties of a children's nurse. It seemed to us that the idiots were quartered in the space usually allotted to the nursery, without any provision having been made for nursing the children elsewhere.

The infirm class is a very small one in this house, and it is as well, for the wards appropriated to them on the first floor are very unsuitable at the time of our visit they had no bedsteads, merely the straw tick placed on the raised bed spaces. The warming also is quite inadequate; on the men's side a stove has been placed in the dormitory, but there is none on the women's side. The windows have the old ill-fitting iron framed lights, so it needs no further description to show how ill-suited are these wards for the use of the aged class. It is, moreover, a disadvantage for the old people to be placed on the first floor; the difficulty of going up and down stairs hinders their getting out of doors when the weather would allow.

The fever hospital is a small detached building, having three wards on the ground-floor level and offices. It was empty at this time; when in use a special nurse is engaged to take charge of the patients.

The large kitchen in the house is not used; in the infirmary there is a range, but it was somewhat out of repair, and there is no boiler for the heating of the water. In the common laundry we found much of the machinery out of order; there is a large overhead tank, but the service pipes were severed, and the washing troughs which these served were disused. The washing is now done in tubs, some of which were standing with the dirty water in them. In the drying room there appeared to be much waste of heat; the hot pipes were of unusual diameter, and were sunk in the floor; the pipes were heated by a furnace in the room.

Outside the infirmary is an uncovered rain water tank, with a draw-off tap this water is not supposed to be used for drinking or culinary purposes, but as it is so accessible the officials cannot be sure that it is not taken for cooking at any rate. The privies, both near the infirmary and near the house, are on the trough system, but as the troughs are only removed with difficulty they are not emptied so often as desirable from a sanitary point of view. Structurally they are badly contrived for privacy. Inside we find the usual insanitary open buckets for use at night and by day for those too infirm to go outside.

The inmates are provided with grass-grown airing courts for each class, or they may go into the fields attached to the house; but we saw no seats placed outside for their use and when we consider the absence of day rooms in the infirmary, it is the more desirable that solve relief to the wards should be obtained by tempting the more capable of the patients out of doors.

RECOMMENDATIONS.

We can hardly do better than reiterate Dr. Macnamara's list of necessary improvements. First in importance is the need of two trained nurses, one of whom shall be a midwife, for though the infirmary was comparatively empty when we visited it, it is the only hospital for the district, and requires hospital equipment. The report then asks for more comforts for the patients, improved bedsteads and bedding, better grates, small tables between the beds and cupboards for the safe custody of ward stores; improved cooking, so that the food shall be eatable and appetising. From the patients the doctor turns to the water and sanitary service, where, indeed, there is much room for improvement; and it would be found more economical, as well as more efficient, to have modern appliances fitted up in the domestic offices and an adequate supply of water distributed over the workhouse. To these recommendations we would add, on our own part, that the imbecile class be dealt with as at Cootehill, where Dr. Moorhead has at last succeeded in getting the lunatic wards closed and the inmates placed in the sick wards, or in the house where practicable, the hopelessly insane being sent to the asylum. We would also plead for better accommodation for the aged and infirm. Surely in a house of the size of Corofin, with its few inmates, better quarters on the ground floor might be found for this class. We trust the guardians will see their way to thus improving the condition of the poor under their care.

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