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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 Hatfield union workhouse.

HATFIELD.

Hatfield is a small country town, which owes most of its importance to the junction on the Great Northern Railway, and to Hatfield House, the seat of the Marquis of Salisbury. The workhouse is less than a mile from the station; it is an old house, and scattered in its arrangement. On the immediate right on entering the gate is the new block for the male infirmary; on the left are quarters for the vagrants and casuals; in the centre, some distance from the gate, is the main block of the house. The building is nowhere above two storeys in height.

We were received by the Master and Matron, who most courteously gave us every opportunity of seeing all parts of the house; and Dr. Lovell Drage, the medical officer, was kind enough to accompany us.

The male infirmary is a comparatively modern building. It consists of two wards holding twelve beds each, a day room, and an empty ward, used for lock or other isolation cases. In a small lobby close to the wards is a sink for washing up, and two fixed washing basins, over which are taps, but there is no water supply. Outside the entrance is the closet, which is on the earth principle, but there was no earth in it at the time of our visit; it was simply a metal pan to receive the evacuations, and, considering its faulty construction, it was a wonder it was not more unwholesome than we found it. The wards are bright and cheerful, and nearly square, about 18 or 20 feet; the bedsteads are 3 feet wide, and the bedding is either flock or straw, the latter being preferred for its cleanliness. Of those in bed, the only acute case was one of phthisis; the temperature chart over his bed looked very businesslike. Each patient has his or her bed card, with the disease, treatment, and diet written by the medical officer. The other two cases in bed were senile debility; the linen was clean, and the beds comfortable. There is no bath room, nor is any hot water supplied to any part of the building; we saw in one corner a small copper supposed to be heated by gas, but, as it was set quite close to an external door in a draught, it could not be kept alight, nor if the flame were maintained would there be much chance of the water being hot. There were a few movable baths about, but these are not on wheels; they have to be filled by kettles and baled in emptying; to give such baths in an infirmary is to make a mock of bathing. The only fixed bath that we saw was in the tramps' quarter, and it was large enough for a good-sized child to take a comfortable bath.

The female infirmary is in a line with the main block, and is located in some old cottages, buildings as unsuitable for the purpose as can well be imagined. On the occasion of our visit we found about half a dozen old women huddled round a fire in a small room about 10 feet wide by 20 feet or less long. There were six beds in this ward, two of them being occupied by aged patients; the windows were small, there was no cross ventilation, but sliding shutters to admit the fresh air. On questioning the nurse she said that the foulness of the ward after the night was excessive; the only possible provision for their natural wants was the commode, and this was not emptied until the morning. The water-closet attached to the female infirmary was at a little distance out of doors, and to this they had to make their way in all weathers; moreover, this convenience was immediately under the window of the labour ward, and, though on the earth principle, was without that necessary deodoriser. This ward was in direct communication with the airing court, and the cold air easily made its way through the ill-fitting door.

The bedsteads were the narrow 2 feet 3 inch frame, the ward not admitting the wider bedstead. The ward above had six beds in it, but at this time it was empty. The quarters for the nurse are in this block. The staircases are narrow and steep, and the impossibility of carrying a corpse down decently, or of bringing helpless patients out in the hurry of an alarm of fire, was painfully evident.

The labour ward is a small attic about 8 feet square, with a proportion of the air space taken off by a sloping roof; there is a small fireplace quite inadequate to maintain a sufficient temperature in the depth of winter, and of but little use to the nurse. All slops and refuse must be carried down to the outside closet. The bedding was in a soiled condition, but the matron said that she was having new bedding made as fast as possible, and that she had supplied the nurse with mackintoshes; both she and the nurse had only recently been appointed. The only ventilation was from the window opening just above the convenience above named. We can hardly conceive that a board of guardians would acquiesce in this state of things, but wherever the difficulty of reform lies we trust that action will soon be taken either by the medical officer or the inspector to have them remedied. As long as they stand they are a disgrace to Hatfield, and if any deaths result from the low temperature of the ward, the board must be held morally responsible for them.

In making our round we came across another convenience, this time a watercloset, but without water; of course it was not sweet, and the matron told us that it was only by the liberal use of disinfectants that she was able to keep it even tolerably wholesome. The water that is used in the house and in the infirmary is pumped up by the tramps, though the town main passes outside the gates.

There is one trained nurse for these thirty-six beds, there is no night nurse, but in the event of a patient requiring more attention the matron divides the work with the nurse. There are no means of communication with the officials at night except by sending a pauper across the courts to the master's or the nurse's quarters, and the male infirmary is at some distance from either. The cleaning of the wards is done by the wardsmen and women; they have not been responsible for the nursing since the trained nurse came; the old wards-man who had been infirmary attendant over twenty-five years had become quite skilled as a nurse.

There were no lock cases in at the time of our visit; such cases are isolated in the small wards in the male infirmary, and the same course is pursued for the insane, attendants being sent in from the town to take charge until removal to the asylum. We saw one imbecile on the female side, but she was quite harmless.

The medical officer has a free hand in diets, and the food given is suitable to their condition. The doctor receives a salary of £30 for attendance and drugs, and there is a separate fee for operations.

The wards on the male side were provided with comfortable armchairs and — most unusual sight — a sofa; on the female side there was no room in the wards for anything but the bare necessaries. In the male wards we saw some screens, but so cumbersome that a nurse could hardly be expected to carry them. The airing courts are dreary prison-like yards, asphalted, the garden, with its wealth of flowers, being behind the house out of sight. We are at a loss for the reason why the sick poor are so carefully excluded from the use of the gardens; it would surely relieve the monotony of their lives to be allowed to walk among the flower beds. In view of the deficiencies disclosed, we append the following

RECOMMENDATIONS.

To build a new female infirmary contiguous to the male block, fitted with suitable appliances for sick nursing. The remodelling of the drainage and upply. The employment of a paid attendant in the wards at night. To provide a communication with the officers' quarters for use at night. To build bath rooms in the infirmary, with hot and cold water in them.

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