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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 Exeter union workhouse.

EXETER, DEVONSHIRE.

As we walked up the road that led to this house we were struck by its venerable appearance, and the master afterwards told us that the middle block was built in 1701. The old house has a history, and is decorated in some places with full length portraits of some of its former benefactors; it has fallen from its high estate of a city charity to its present position of the workhouse of the union. The house is licensed for 550, and contained 227 inmates at the date of our visit. We were conducted over the house by the matron.

The sick and infirm are located partly in the house, but the great majority are in a separate building. In the house there are two wards; 10 beds for women and 10 for men; in the infirmary there are 52 beds for women and 49 for men. The walls of two wards in the infirmary had, at the doctor's suggestion, been smoothed and painted in two colours; the others were colour-washed; there could be no doubt as to the superiority of the paint as a wall surface. The wards are decorated with pictures and plants.

The wards are on two floors, and hold six, nine, or twenty beds. There are no day rooms, except one in connection with the men's infirm ward in the house.

There are some Tobin's tubes, but of too small calibre to be of much service. In many of the wards the windows are cross, and the ventilation is chiefly by means of the windows and by apertures in the ceilings. There is an open stove in each ward, standing out a few feet into the room, and on the top of each is a bright copper boiler. The long stove pipe was fenced by a wire casing, and served for airing clothing. The lighting is by gas. The supply of hot water, instead of being laid on over the whole building, is obtained from local boilers.

It appeared to us that there were an unusually large number of both men and women in bed, considering the time of year. We were sorry to see the children among the adults; there were enough of boys and girls both to justify separate wards. Among the adults there was rheumatism (the legs much contracted), dropsy, paralysis, ulcerated legs, and many cases of old age, some of the old people being apparently very helpless. Among the children cases of ophthalmia, scrofula, phthisis, debility, and a big boy whose home was wretched and degraded, and who returned time after time with his mother to the house in a condition which made it necessary to place him in the infirmary.

The lying-in ward, holding nine beds, is on the ground floor, close to the entrance. A confinement had only just taken place, so we did not visit this ward. There is no second ward for the labour, but the medical officer, Dr. Woodman, told us that the ward was very well appointed and satisfactory.

The isolated patients on the women's side are placed in a ward at the end of this passage. The ward is shut off by a door, and a recent alteration has been made by which these patients have their own airing court, and there is a separate closet and bath room.

This ward, holding six beds, was unoccupied when we visited the infirmary. On the men's side is a similar ward used for the offensive as well as for the lock cases The appearance of this ward was not so satisfactory as that of some of the others.

The bedding, of straw or chaff, was thin and untidy in appearance; these poor bedridden men want at least a sufficient padding over the laths of the bedstead. The ward had only one window, and looked crowded; it was not so well ventilated as the larger wards. There are no small wards for the isolation of a patient with erysipelas or for quarantining. All infectious patients are removed to the sanatorium.

The wards, though old-fashioned in their appointments, had an air of homely comfort; some of the bedsteads are wide and some narrow, and the bedding is flock; in the painted wards on the men's side there are spring mattresses. We noticed a plentiful supply of comfortable basket chairs, the high back forming an effectual screen. Cupboards were few and far between; in these same wards were soma lockers for clothing and personal possessions. At each bed head is a zinc tray and card holder, presumably for the medicine, but with no bottle in it, sometimes a brush and comb. At the foot of each woman's bed was a scarlet and black check shawl, to be used as a wrap when sitting up. The matron told us that each patient had a separate towel. We thought that the wards were crowded, since they served as day rooms also.

The large number of sick and helpless patients in the infirmary is nursed by two nurses, who are husband and wife. Both are without hospital training, but are experienced in workhouse nursing; the man was formerly surgeon's steward on board a large passenger ship; the female nurse attends the confinements. In each ward are the usual ward tenders, who of necessity do much of the nursing. The wards in the house are under the matron, and are tended by the inmates. There is no night nurse; in the large female ward in the infirmary an inmate is on duty during the night, three of the patients being quite helpless. We are never in favour of employing a married couple as nurses, as it limits the selection.

The baths are adjoining the wards on each floor; in most cases they are encased and placed against the wall; the water is heated in the ward boilers. The closets open off each ward; the flush was moderately good. There are no slop-sinks, nor do we remember to have seen washing-up sinks. Commodes stood in the wards for night use.

The only classification is among the imbeciles; for these there is a department in the house. They have their wards (14 beds for men and 14 for women), day rooms, and airing courts. These are certified patients, and they looked well cared for. There were single wards and rooms for violent patients and for epileptics; these separation wards are heated by hot water. Besides these imbeciles we saw some feeble-minded paupers engaged in work in the house, and some were in the infirmary.

The nursery was in the house, not far from the matron's quarters. Here, as at St. Thomas's, we saw toys and pictures, a nursery boat, and a fine wooden horse, and the room was cheerful and bright. The three infants were in the charge of an old pauper. One — a bottle-fed baby — was a poor-looking little thing; and we were sorry to see the objectionable tube bottle in use. These little ones are fed and cared for by their mothers, and the matron said that she had reason now to think that the children did always get their full allowance of food. They have new milk, but this milk is only delivered to the workhouse once a day.

RECOMMENDATIONS.

The medical officer has been pressing upon the attention of the guardians the defects which are evident from this report, and we would add our suggestions to his. The first thing to be improved is the nursing; in quality it may be satisfactory, but there is not enough of it. So many patients in bed means a large amount of helplessness and infirmity, and we could see that some of them required as much attention as an infant. The irresponsible and ignorant nursing by paupers can never be satisfactory, and at night, when all supervision is removed, it is an entirely unknown quantity.

We would therefore urge upon the Board the substitution of trained for untrained nurses, and the employment of a sufficient staff to supersede entirely the aid of paupers, except so far as their services may be needed for scrubbing and cleaning. Increased space is required for isolation, not only in the case of infection, but that the doctor may be able to place a patient alone for a time if such treatment shall seem to him desirable. A small ward for the actual labour should be added to the lying-in ward. Day rooms are much needed for the use of the patients when up, especially for the men, that they may have a place for smoking in other than the ward. When these improvements are complete, and we hope that these suggestions will not be summarily dismissed, we trust that the Board will be able to place all the sick and infirm in the infirmary, that it may be separated from the house management, and be worked under a hospital matron, herself a trained nurse; the hospital might then be available for the training of probationers in workhouse nursing.

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