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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 Crediton union workhouse.

CREDITON, DEVONSHIRE.

Our request to be allowed to visit the Crediton Workhouse was met by a demand for our credentials; we produced the commission from the Editor of the BRITISH MEDICAL JOURNAL, backed by the sanction of the President of the Local Government Board, and these were considered sufficient.

The workhouse is a small one, licensed for 280 inmates; there were 80 in the house the day we visited, and of these very few were able-bodied.

The sick are in the house en the first floor, in two wards, the nurse's room being between them; there were eight men and nine women under the care of the nurse, and a woman with puerperal fever in the lying-in ward. The wards are small and crowded, the beds are placed against the wall; and indeed we did not see that the feet could be brought into the room without encroaching too far on the passage way. The bedsteads are narrow and low, and the bedding looked thin and insufficient. There is a stove in the middle of each ward, the flue being carried into the chimney. There was very little air of comfort in the wards, the best feature about them being the windows, which were large and brought near to the floor.

The patients were mostly up; in the female ward was a helpless girl, deformed and dumb; she was in bed; there were also a case of paralysis and an imbecile; the others were up. Among the men the cases were apparently all old age. One man — an offensive case — was placed apart in a small room on the ground floor; it was a comfortless stone-paved room, but the doctor said that it was the best that he could do under the circumstances. The patients, doubtless, had the necessaries of life, but none of the special care due to the sick. The beds were untidy; there were unemptied chambers about, and there was an apparent want of cleanliness. There were a few armchairs in the wards.

The lying-in ward was above the female ward; it was one room containing four beds. An inmate was in charge of the woman with puerperal lever. The doctor had previously told us that he trusted that the patient would make a good recovery, but that if another woman was in labour he should have to keep her in the house, as he had no separate wards at his disposal.

An infectious hospital stands in the grounds, in our opinion too close to the main building. It is a two-storeyed building, self-contained. It has stood empty for some time, and the master stores his seed potatoes on the ground floor. This practice can hardly be too strongly condemned; an infectious hospital should be kept scrupulously clean, and ready for use at any time. A lock case would be put there if necessary, or any other disease which required. isolation. We conclude that a case of infection in the town would be sent there.

The sanitary arrangements are a disgrace to the place. Off the men's ward is a triangular closet, the water being turned on from a tap; the pan was foul and unwholesome. The women's was a shade better; but earth closets would be far more sanitary. There was one bath room on the women's side, made by taking off a corner from the girls' dormitory. The water is heated by a fire in the bath room, lighted, so we were informed, twice a-week; on other days hot water for infirmary use is brought over from the house kitchen.

Classification is practically nil. We saw idiots in the wards. There is no ward for the children, and no means of isolation for lock cases, except the above-mentioned infectious hospital. The scanty space allotted to the sick department renders subdivision impossible.

The nurse has been trained in workhouse nursing, but not in midwifery. There is no night nurse. All the nursing arrangements seemed to us to need attention; there was an air of carelessness about the work.

RECOMMENDATIONS.

It appeared to us that more space was needed for the sick; this might be obtained either by taking in more wards from the house part, or of course (and this would be the better plan) by building. The nurse told us that in winter the wards were quite full, and that there were many patients suffering from acute chest complaints. The wards are far too crowded and insufficiently ventilated for the satisfactory treatment of such cases. Small isolation wards are imperatively needed. We would also suggest that the infectious hospital be retained only for its original intention. Then a night nurse is needed, not of necessity fully trained. This workhouse might be organised as a centre of medical relief for the district. There is no hospital nearer than Exeter, and the Crediton house, with a staff of nurses for indoor and outdoor work, and an ambulance to bring the sick from the villages, would do much towards solving the problem of rural nursing.

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