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

EDENDERRY WORKHOUSE INFIRMARY, KING'S COUNTY.

In the absence of Dr. Duigenan, the medical officer, we presented our credentials to his locum tenens, Dr. Martin, who kindly escorted us round the infirmary, giving us all the assistance in his power.

The workhouse, a small one, is on the highroad. The total number of inmates on the previous night was 80, and, as usual, we found that more then half the number were on the doctor's book or in the infirm ward. The ground plan of the house was that with which we are now familiar. On our way to the infirmary we looked into the chapel, which in our rounds among the workhouses has often been, as here, the one bright spot in a very dreary picture. Here the poor inmates can escape from their sordid surroundings into an atmosphere of peace, where their eyes may be gladdened by the sight of colour, and their spirits refreshed among holy associations. Our authorities in England might well profit by Irish example in this particular, by first making the workhouse chapels brighter and more inviting, and then leaving them open for the use of the inmates.

But to return to the infirmary. The wards are not full in summer, and one was being whitewashed. There are four wards on either side of the middle staircase, on two floors; on the female side one ground floor ward is appropriated to the children; in it are 9 cots and 1 bed. The walls are whitewashed throughout, with grey dado and black skirting. There is no ceiling to the lower rooms, but the pitched roof of the upper wards is plastered. Ventilation is defective in the larger wards, where there are only the windows on one side; in the small wards square apertures high in the walls, with a pivot sash, face the two windows opposite. None of the windows are really weatherproof. On the male side are some spring beds; on the female side only the "harrow" frames resting on a continuous rail, an arrangement which harbours vermin and dirt.

The patients in general were suffering from diseases of a more acute class than we have generally found in the workhouses at this time of the year (summer). A woman was dying of disease of the liver, no screens were round her bed; another had cancer of the os uteri; a case of paralysis; others of old age; and an idiot child had been brought in off the bog with disease of the fingers and toes. On the male side there was a very bad case of offensive diarrhoea; a patient with acute bronchitis off the bog; a case of ulcerated leg; an infant with marasmus, sucking at the feeding bottle; a bad case of hemiplegia, and other cases of senility.

THE NURSE has had experience but no training, and at the period of the visit there was no night nurse, though we are glad to note that the guardians have since appointed one. When we went round six months ago the only assistance for all these serious cases at night was rendered by the wardsman or woman, who had to get up if wanted. There are bells from the wards to the nurse's room, which is in the middle of the block. There is a ward master on the male side, a paid officer. The wardsman, as the medical officer made his rounds, gave his account of the cases, stated his opinion of the ulcerated leg, and made his report of the night. The wards were not tidy, vessels and bedpans were lying about, unemptied, the beds were disordered and looked uncomfortable, but the linen and patients appeared to be clean. There was a basin and a roller towel to each floor, the latter changed, we were told, as often as required. The fireplaces were old-fashioned wide grates, and turf is the fuel.

The lunatics are in the charge of inmates; they are lodged in ground-floor wards at either end of the infirmary. The beds are crowded together, but they were not all occupied. There were 6 women and 4 men of this class, including the epileptics. The wards are dark; there is no appearance of occupation for the unhappy inmates, who have no day room and only the grass-grown yard for exercise. The men, however, if capable, work on the land and the women in the house. There was no evidence of treatment; but what scope has a medical officer among such surroundings and with no responsible officer in attendance? This class sleeps on straw ticks on "harrow" frames.

The fever hospital has 24 beds, and is in the charge of a trained nurse; it was empty when we visited, but had been used for small-pox, scarlet fever, typhus, typhoid, and measles. It is of more recent construction, has its separate laundry and kitchen, and the wards are much more suitable for the treatment of patients than those of the infirmary block.

The maternity ward is in the infirmary block, on the first floor, and has three narrow straw beds and no labour bed. We fear that the proximity of Dublin must be held responsible for the immorality of the district; but from whatever cause, we learned from the master that in three years 36 illegitimate children had been born in the house. The nurse is the midwife. The ward was empty.

The infirm wards in the body of the house were rather empty, and the women's ward was being whitewashed. They are long, comfortless rooms, with a window at each end, and old fireplaces, one to a ward, which must be quite insufficient for heating the ward in winter. The walls are rough, the rafters unceiled, the furniture "harrow" beds with straw ticks and benches without backs. There were seven men and eight women in this class. We have never believed that the straw ticks were free from vermin, and our opinion on that point was confirmed by the master, who gave a graphic description of their condition, especially in summer. He believed that wood-wool mattresses were shortly to be substituted. The day rooms are flagged, and are really only four walls and a roof. That on the female is also the nursery, where we saw three or four infants with their mothers. The room is thoroughly unsuitable — too large, ill-lighted, badly ventilated, and at the same time most difficult to warm. There are no appliances, nothing but the cots. The whole system on which workhouse infants are reared in Ireland is rotten at the core, and breeds a race of paupers.

The domestic offices remain as they were when the house was built, over fifty years ago. The large cauldrons, each with its separate furnace, are still in use, though one boiler now suffices for the present number of inmates. Cocoa nibs were being boiled down, at least so the master informed us, but as there was no aroma from the process, we fear that the bulk is not of the same value as the sample. The dietary is a poor one, as indeed it is in all the houses we have visited. The sick cooking is done in the infirmary kitchen by a pauper. There is a small inefficient range, and the kitchen was far from clean. The laundry has a supply of hot water from the boiler. There is no drying room, unless a stove surrounded by clothes horses may be so called.

With regard to the sanitary system Edenderry can give no better record than the other houses treated of in this Commission. There are no baths but those in the probationary wards, not even for the school children; no hot water is laid on to any department, except that there is a pipe from the laundry boiler to the troughs. Commodes in the infirmary wards and open soil buckets in the infirm wards and lunatic division are the only conveniences provided for those who are confined to the house, which is the case for all at night, when these remain unemptied to foul the already close atmosphere. The privies are on the waggon system, and as privies they were in a wholesome and creditable condition. The water supply, we were informed, was ample.

RECOMMENDATIONS.

Our first suggestion would have been the appointment of a night nurse, and we are glad to find ourselves anticipated; to this we would add the appointment of trained nurses, one is insufficient to do the nursing properly without employing the pauper inmates, whose duties should be confined to cleaning and service. Once again we ask that some attention should be paid to the condition of the infirm; they require more warmth, more light, better ventilation, attendance, and. comforts. With regard to the lunatic class we would suggest that the guardians should consider the possibility of distributing the harmless lunatics among the inmates, such as are really insane being removed to the asylum. The guardians of Cootehill have successfully carried out this reform. We plead also for the infants; the small number in the nursery perhaps makes the employment of an officer a difficulty, but even the selection of the most suitable among the inmates for the post, and forbidding the access of the mothers except at stated times would be an improvement. Or the nursery might be made part of the infirmary, and this would bring the department under the supervision of a responsible officer, who might find it possible to superintend their feeding and cleanliness. Finally, the provision of baths, of hot and cold water service, and of indoor conveniences accessible by day and night for all who are able to rise, and attention to sanitation at night in the infirm wards for those who are unable to leave their beds are all reforms which are, urgently required.