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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 Festiniog union workhouse.

FESTINIOG, NORTH WALES.

We visited this house one afternoon on our way through North Wales by the little narrow-gauge railway. The house stands close to Minffordd, on the Festiniog line, but at some distance from the quarries, which supply the trade of the place, and the bulk of its inmates are drawn from the agricultural population, the number of parishes in the union being comparatively small.

The house, which is a small one and very old, appeared to us quite inadequate for the work which it has to do. The only officers are the master and matron, and as the house is licensed for over a hundred inmates, the work, with the best intentions, cannot be well done. They were most courteous when we asked permission to see the inmates, and afforded us every information.

The sick are lodged in the main building, on the ground and first floors, the dormitories for the able-bodied being on the upper floors. The rooms are not ceiled, and the noise of trampling must cause much disturbance to the sick when the occupants of the dormitories are rising and going to bed. There are twenty-six beds for the sick, exclusive of the small isolation wards on the male and female sides.

The female ward on the first floor is a small, low-pitched, dark room, less, at a rough estimate, than 16 feet square, with a cupboard projecting into it; it had two small windows on the same side and a fireplace; it contained seven beds. The bedsteads are of a proper width; they have cocoa-nut matting over the laths, and the beds are filled with long straw and looked clean and comfortable. The bedsteads stood so closely together that there was hardly room to pass between. Several utensils were standing about, but there were no commodes or other provisions for the night.

This ward had no offices attached to it; the watercloset was outside; there was no bathroom and no water supply. This applies also to the lying-in ward, which opened out of a passage close to the master's and matron's quarters, all water, etc., having to be carried up or down. This ward held two beds, was small and inconvenient, and the labour bed was small and stood low. On the male side the wards were not so crowded; the ward for the infirm is on the ground floor, and contained five beds; all the patients were sitting up. The ward on the next floor held nine beds, and in it there were no patients in bed. There are no bathrooms, sinks, or slop-closets, and the watercloset is outside. There are no day rooms for either the male or female side. There is no means of ventilation except by the windows, and these were closed at the time of our visit, early in the afternoon.

Three women were in bed in the crowded female ward; one with a fractured femur was in a bed in the recess between the projecting cupboard and the wall: she was lying on the straw bed, and had no support for the clothes. One of the other patients was paralysed, and the other suffered from senile debility. An imbecile was sitting by the fire, an old woman with an enlarged neck; a harmless lunatic danced up to the master and professed her great friendship for him; she had been sitting on the edge of the bed of the patient with the fractured thigh bone.

There were no serious cases among the men; all were infirm and two were imbeciles, but they were all sitting up; they smoke, eat, and sleep in the wards.

It can hardly be said that there is any system of nursing; the master and matron undertake the care of the sick among their other duties. In answer to an inquiry as to what help the poor woman with the fractured femur received in the night, the matron informed us that she was rung up at night when necessary, that is, if more help was required than the inmates could render to each other. There is no midwife in the infirmary. The doctor now lives close to the infirmary, and the matron or an inmate remains with the patient until he comes.

When the isolation wards are used, and to the best of our recollection we were told that cases of small-pox had been nursed in them, an inmate is placed in sole charge.

There is no provision for the care of the insane; when an inmate needs watching he or she is put into a small ward, if such be vacant, and two of the inmates are told off to watch until the insane person can be removed.

There are bells of communication between the sick wards and the master's rooms, and also from the tramps' ward, though we doubt if the latter would be available in an emergency, as it is placed high in the wall, and is without a pull.

All dietary extras are ordered by the doctor. Tea was being served at the time of our visit, tea and bread and butter. There seemed to be every wish on the part of the master and matron to do their utmost for the sick; but as they had no assistant officers they had no time to cook extras, or in other ways do what was necessary for them. We did not see any bed cards in the infirmary.

We left the infirmary feeling quite grieved that anyone should be set so impossible a task; these two people have to govern the house, nurse the sick, overlook the able bodied, care for the children, admit the tramps, etc.

RECOMMENDATIONS.

After going round the house it appeared to us that the first thing to do was to appoint more officers; a trained nurse who should be a midwife, a porter, responsible attendants for the infants and the children. Next to build wards for the sick, where they would not be disturbed by the able bodied; to provide bath-rooms, slop sinks, and waterclosets in connection with the sick wards receiving and isolation wards; and day rooms for the infirm. There should be a paid attendant for the night, and an improved lying-in ward.

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