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

CROOM WORKHOUSE INFIRMARY, CO. LIMERICK.

The workhouse stands about a mile from the town of the same name. As we walked towards it we had the good fortune to meet Dr. Hartigan, the medical officer, crossing the stile from his residence on his way to make his visit to the house. A few brief words, aided by an introductory letter, put him in possession of our errand, and he at once gave us his assistance. The road to the workhouse is bordered by clipped hedges, as well-trimmed and kept as though belonging to a domain, and the appearance of the house at the end of the road was quite imposing. It is a second-class house; the inmates numbered on that day 163, of whom 84 were patients. The style and disposition of these buildings must by this time be familiar to our readers, and this house differed in no way from the usual plan; the grey stone of the walls, the pitched roof and pointed windows harmonised well with the neatly-kept hedgerows around the garden in which some of the paupers were at work.

The sick are to be found in the infirmary, also in the block usually known as the "fever hospital," and, bearing in mind that the sick represent a little more than half of the total number on the master's books, it will be evident that the space allotted to them in the original ground plan must be quite insufficient at the present time, when, in the process of evolution, the whilom workhouse is becoming more and more the home of the aged and the sick. Both sexes are in the infirmary block, the males on the ground floor and the females on the first floor. Whilst Dr. Hartigan was occupied in some routine business we accompanied the nurse into the female wards of the infirmary, where the first thing that caught our eye was the dead body of a woman lying on a bed covered with a counterpane. There were no screens round it, and the next bed, and indeed all in that ward, were occupied. We inquired of the nurse when the death had taken place; the poor woman had died shortly after admission the previous evening before 10 P.M., and the body had remained as we saw it all night, and at this time in the morning (after 10 A.M.) no steps had been taken to remove it. We did not discuss the question, but we judged from the matter-of-fact way in which the nurse gave us the information that it was not unusual to leave a corpse in a ward during the night.

The wards are long narrow rooms, holding on the first floor 10 or 16 beds; the smaller wards on the ground floor have 9 beds, the larger 16. The walls are smooth surface, colour-washed; there is no dado; the windows are small, facing each other, they are the old-fashioned heavy metal framed window and diamond pane, the ventilation is by means of the upper half of the window. The fireplaces are wide open grates, insufficient and wasteful of heat and fuel. The bedsteads did not look crowded; there were some of the old harrow frame and the straw tick, and besides there were iron frames and hair mattresses, and for the more helpless there is the box bed. Over the beds a blue cotton check is used for a coverlet, and the pillows are of straw. To the ground floor there is a ceiling, and the upper floor has a half-pitched roof, plastered.

In the fever hospital, which is a three-storeyed building, the top floor is reserved for the fever patients, the others accommodating the overflow from the infirmary; the first is used by the females, the ground floor by the males. This hospital is of more modern structure than the infirmary, and in such points as width and height the wards are better than those we have just been describing. There are four in this division, holding, as far as we could judge, 8 beds in each; they were not overcrowded, but as our visit was made in the summer time we saw the hospital when it would be most empty. A shelf ran round the walls, clearing the head of the bed, useful for medicine bottles, food, or personal possessions, and also for diverting the draught from the head of the patient in bed. A small table stands between the beds, except when the space is filled by the commode. The bedsteads are iron frames, with hair or straw mattresses.

The patients average about 70 in the year, the larger number being accommodated in the old infirmary. There is no separate ward for the children, and there are no rooms. The cases under treatment presented little variation from those we have found in other workhouses; there was a pregnant woman suffering from hip-joint disease, some cases of chronic bronchitis, ophthalmia, a severe burn, two cases of skin disease among the men, a case of retention of urine, disease of foot, paralysis, and old age. The majority of the patients were up, taking such ease and rest as could be found on the uncompromising benches which in Ireland are considered suitable furniture for sick wards. This hospital serves the district round, and the guardians have been glad to avail themselves of its aid. There were only two patients in the fever wards, cases of simple fever.

The lunatics are in their usual quarters at the extreme ends of the infirmary. We were not favourably impressed with these wards; they are small, dreary in aspect, and cheerless; the absence of dayrooms makes them quite unsuitable for the handling of a class for whom space, cheerfulness, abundance of light, and opportunity for some occupation are most desirable; but such conditions are conspicuously absent from their quarters. The wards had 8 beds in each; in that for the females, we noticed one bed close to the door into the yard, this without any screen to protect its occupant from the draught. The males are equally unfortunate in their wards, but their lot is perhaps a shade less dreary than that of the females, as the more capable are employed in the garden. The epileptics are treated in these wards, unless they are crowded out. There are paid attendants for this class, but they are untrained.

In this same block, on the first floor, is the orphan's nursery, where we found five little ones in charge of an inmate. The appointments of the nursery were fair; we noticed some toys, and some pictures on the walls gave it a home-like aspect. The orphans themselves were a pleasing contrast to many infants we had seen; being in the charge of one person and her work supervised, there was less of the dirty squalor which we began to think was part of the nursery life. This nursery owes something to its situation, being near to the nurse, and under the eye of the doctor. The maternity ward is also under this roof; it has space for three beds. The number of confinements averages about 30 per annum; the nurse in this block is the midwife.

There are two nurses on duty by day, one in each block, and one nurse in each block at night. The day nurse in the infirmary is a trained midwife, the other nurses on the staff are untrained, and have had experience only. Considering the number of patients and the nature of the cases it is clear that the nurses cannot do the nursing with their own hands, and we find that, as usual, the paupers are used as nurses. On the female side are the women whose children are in the house; on the male side are the more active among the patients; there is a wardsman or wardswoman to each ward. We were informed that the guardians are liberal in furnishing any appliances which the medical officer may require, such as water mattresses or pillows. There is a small surgery in each of the hospital blocks.

The bathrooms are contrived out of the wards in the infirmary. On each floor a space is built off to make a small bathroom, and these are provided with hot and cold water; the hot water comes from a circulation boiler in the kitchen, from which it flows into a cistern. In the fever hospital the bathroom is on the first floor, having a hot and cold supply, a shower, and a "Russian" bath. The hot and cold water is also laid on to the surgeries. In the grounds there is a hot-air disinfector, an iron structure. In other respects this workhouse follows the bad practices common to the country. There are no indoor conveniences; pails or buckets are used indoors and privies outside; even the doctor's idea of pottery buckets properly closed would be an improvement on existing arrangements. As no excretions are emptied outside during the night, it is of extreme importance that, until proper closets are built, the air of the wards should be preserved from contamination. The outside privies are on the trough system.

The water supply is good; it is pumped up daily to cisterns on the roof. The hospital diets are cooked in the two hospitals; in the infirmary there is a range, and in the "fever hospital" a stove; there is therefore means for cooking meat, which the medical officer is glad to place on his dietary. We noticed in the kitchens the usual absence of equipment; we constantly find ourselves wondering with what and how the inmates eat their food when it is cooked, for plates, knives, and forks are rarely to be seen in the workhouses, and Croom was no exception to this rule. It is a relic of the old famine days, when porridge formed the food of the people; now it is milk, bread, tea, and broth. There is a separate laundry for the hospitals, where the linen appeared to be well washed.

Being pressed for time, we did not visit the aged and infirm in the body of the house nor the infants. The railway authorities do not frame their time-tables in the interests of commissioners, nor indeed of tourists.

RECOMMENDATIONS.

In this matter we will follow Dr. Hartigan's lead, and place as one of the most important recommendations to urge on the guardians the provision of dayrooms for both classes. Now that tobacco is issued by authority to the inmates, a smoking room is a necessity, especially in the sick department; many chest complaints are aggravated in an atmosphere laden with tobacco smoke, and it is neither cleanly nor safe to permit of smoking in bed. On other grounds, also, we plead for these necessary adjuncts to the infirmary: it relieves the sick to take out of the wards the more convalescent, whose talk and movements are trying to the sick; it gives more air for distribution among the patients when half of the number are away; it provides a room other than the sick wards where meals can be taken, and it permits of recreation for those who are in a condition to enjoy it. Sanitary deficiencies need the attention of the authorities; the present practice of having soil buckets in the wards, and leaving them unemptied until the morning is highly reprehensible; the closed pottery vessels suggested by the doctor would be a shade better, but as representatives of a medical journal we can be satisfied with nothing less than the provision of means for the immediate removal of all dejecta from the vicinity of the patients by day and by night. We think too that we have made it evident that in our opinion the nursing staff is insufficient both in quantity and in quality; and we the more confidently ask the guardians to do away with the pauper nurses because such a course will promote both the economy and the efficiency of their hospital. The employment of properly trained nurses would have made a scandal like that of having an unscreened corpse in the sick wards all night impossible. There was much in this workhouse that indicated liberal and humane management, and we trust that these suggestions, offered in the interests of the patients, will receive the consideration of the Board.

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