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

DUNMANWAY WORKHOUSE INFIRMARY, CO. CORK.

The difference is wide between Mallow Union and Dunmanway. The latter is quite a small town, and the workhouse, standing solitary a mile and a-half from the town and two miles from the station, is a fourth-class (this refers to capacity) house, with only 76 inmates, of whom 30 were in the infirmary. We had previously seen Dr. O'Callaghan, the medical officer, who though unable to accompany us, fully concurred in our wish to visit the workhouse.

The infirmary block is two storeys high in the middle, extending into two wings which have only one floor each. In the middle is the nurse' room, and above small wards, each holding 4 beds, where the more respectable inmates are placed. On the male side were two old men, both of whom, the master told us, had been ratepayers. One had heart disease and thought he was dying, and the poor fellow was asking for his wife, and that a messenger might be sent. He was evidently ill and very restless. His fellow patient, who was up, said he did the best he could for his companion. The male ward across the landing held 6 beds; in one was a patient with knee-joint disease, which the man told us he had suffered from for five years; there was a case of phthisis, apparently far advanced, but the patient was able to be up. The two other cases were of senile debility. Passing out of the ward and down a few steps we came to a ward of 8 beds. This was a miserable hole, low-pitched, ill-lighted, badly ventilated, and dirty. Some of the occupants were seated on a bench before a rusty ancient: grate. Small windows on one side, with small apertures high in the opposite wall, were the only means for light or air. A. few patients were in bed.

A general air of neglect pervaded this division; mugs and basins were lying about, vessels, full or empty, stood by the beds or under the beds; the beds themselves were untidy; it was hard to realise that this was a place for the treatment of the sick. We saw no sign of any washing apparatus, unless some cloths hung on one of the walls were intended for towels.

On the female side, the arrangement of the wards is the same — that is, the small one for the more respectable class, and the two larger wards of 6 and 8 beds respectively. In the first ward we came to the dinner, consisting of potatoes, was going forward. One old woman in bed had a dirty blue-check apron spread before her, on which she placed the scraps of potato peel as she removed them with her fingers. Plates, knives, and forks apparently did not exist. Some china mugs stood on the floor or on the bench, and unemptied vessels were also scattered about full in view. In the next ward of 8 beds was a young girl; the master did not know for what illness she had been brought in; there were besides cases of old age and infirmity. Here the windows were small and ill-fitting, and all ventilators were shut, so that the atmosphere was close. The ventilators are the upper half of the heavy metal frame which falls inward on a toothed rack, but these are so unwieldy that an average woman cannot move them one way or the other. The bedsteads throughout the infirmary are iron, with wire-wove mattresses; we only saw one wooden bedstead with the straw tick; but from appearances we should say that there is no bedmaking, and the wards had an untidy neglected appearance. The nurse, untrained, is about 70, and there are the usual pauper helps by day; at night there is no attempt at nursing. We think, therefore, the facts bear out the statement that the sick in Dunmanway Union are not nursed.

On the ground floor is a small single bed ward; there are no dayrooms. There is a maternity ward, but for several years there have been no confinements. For this reason there is no nursery; the few children were in the body of the house. The fever hospital has also been unoccupied for years; an old nurse lives in it to keep it prepared for use.

The idiots are not classified, the few feeble-minded being scattered among the able-bodied. We saw one harmless idiot pacing to and fro in the yard, and the master said that he was always walking in all weathers. As no seats are provided in the airing courts, his ambulatory habit may be the result of adaptation to circumstances.

The infirm men are in the wing to the side of the body of the house. There were 14 in all. The usual absence of all comfort impressed us as we passed down between the rows of "harrow" impressed beds. A bench on which to sit in front of an old fireplace, a table at one end, a poor light from a window at each end—that was all they had. There is no dayroom, but the master informed us that they were free to wander about as they liked.

The infirm women have not this privilege; they can only exercise in their yard. We were unable to judge of their quarters, as they were turned out of their usual ward owing to the necessity of extensive repairs to the chimney. The master told us that the guardians intended to supply iron-framed bedsteads and wire-wove mattresses to the infirm class. The infirm are locked into their wards at night, the wardsman or woman having the means of striking a light if necessary.

There is one bath in the infirmary, on the landing, with a cold water supply; but from its appearance, and from that of the patients, we concluded that it was seldom used, especially as there is no supply of hot water in the place. The only conveniences are outside: the privies are on the trough system, and were all in an insanitary condition. Indoors are the soil pails and buckets, uncovered, and unemptied during the night. There is an ample supply of water, pumped up daily by the paupers into the cisterns.

RECOMMENDATIONS.

When we see such a travesty of sick nursing as prevails in this Union we wonder why the guardians go through the form of providing the medical officer with drugs and an official called the "nurse." His only essential equipment is surely a book of death certificates and a pen with which to write them. In our opinion the sick department requires complete reorganisation; the wards are quite unsuitable, and the responsible officer, whatever work she may have done in the past, is now quite unfit for her duties, and should be superannuated. A. suitable infirmary and a staff of two trained nurses is our recommendation. Once more we plead for comforts for the aged, armchairs, better heating and lighting in the wards, a responsible attendant, and sanitary appliances which conduce to health and decency. There was a touch of humanity about the administration which we were pleased to note; the defects are those of an evil system more than of those who work it.