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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 Haverfordwest union workhouse.

HAVERFORDWEST, SOUTH WALES.

It has rarely been our lot to visit a workhouse infirmary more unsuited for its purpose, or more ill-provided with all that is necessary for the comfort of the sick. The master readily acceded to the request of Dr. Williams, the medical officer, to show us the infirmary; but we must confess to a feeling of surprise that the matron, whom we only saw for a brief moment, did not respond to the master's suggestion that she should accompany us through the female department. This union embraces a large extent of country, and takes paupers from sixty-six parishes; the town is the centre of a wide district.

The workhouse is well situated on a hill, and has extensive grounds around it; it is an old house, and in every part is quite behind the times. It is built round four courts, which form the airing courts of the various departments. There is accommodation for thirty-two sick, and there is besides a fever ward placed at the top of the house, at the present time empty. The wards are of variable size, and are distributed on the ground and first floors; the largest is for eleven beds, and the smaller wards hold two or three beds; the arrangement on the male and female side is the same. The wards are dreary places, the walls dirty, washed over with dingy yellow colouring, windows on one side, only one fireplace at one end, looking bare of furniture for the sick.

The iron bedsteads are low and on them are three planks held by a crosspiece, not always laid close, and on this a chaff mattress about three inches thick. We saw the helpless bedridden old people lying on these beds, and they must have found them a sorry rest for their weary bones. There are about four spring beds distributed in the wards, but they have only the chaff mattress over the springs. There is no means of ventilation but by the windows, and, as the fireplace in some of the wards is small it is hardly probable that the atmosphere is changed in the night.

The system of warming is peculiar to this part of the country. "Culm," which is clay and anthracitic slack kneaded into balls, is used in the grates; when quite alight it is red hot and must throw out a good heat, but it is slow in kindling and can hardly be of service for obtaining a fire quickly.

The classes of patients are of the usual description found in the workhouses. On one of the spring beds there was an old woman with hemiplegia, helpless all but one hand and unable to turn herself; in the male ward was a fine man with erysipelas in his leg. On inquiring as to the treatment the "nurse" told us that he washed it for himself twice a day with Condy's fluid, but that otherwise no dressing was used. We could not but think what a pity it was that more vigorous measures were not tried, since by a speedy curing of the leg the rates would be relieved of that man's keep. He was too long for his bed.

There were eight patients in bed in all; in this part of the infirmary, including senile debility, rheumatism, paralysis, chest complaints, and old age, and several very infirm men and women up in the wards. We were shown a small ward with four beds in it, all occupied; it opened immediately from one of the yards, it was without a fireplace, and was lighted by one small window. This is the tramps' sick ward. We could not ascertain that any one person was responsible for attendance in this ward, and, if assistance was wanted in the night, the most able-bodied of the tramps would have to go some little distance before lie could obtain it, as there is no communication bell.

The sanitary appliances are quite rudimentary; there is no water laid on to the upper floors; the only conveniences for the wards are commodes, of which there are a few in each ward; one is placed outside on each landing, intended for use at night, that for the men being enclosed within a screen, that for the women being open. It can hardly be expected that these poor infirm folk will go outside the wards on a cold night, nor is it well that they should. The commodes in the wards are emptied after 6 in the morning. On going round the wards we saw some ordinary utensils about, some of which were unemptied. The closets are all outside; they are simply cesspools, and some were very unpleasant. The water supply is ample, and is obtained from wells in the courts. The pumps in each court discharge over troughs down which the refuse water is emptied.

There is only one fixed bath, and that is in the tramps' room; it is a small one, sunk in the floor, with a tap to supply hot water, but the cold has to be carried in from the yard. We saw no baths which could be used for the sick, and, as every drop of water must be carried up or down, it is probable that bathing is not largely practised in this infirmary; indeed, the patients and their linen did not look particularly clean at the time of our visit.

The "nurse" is untrained; she is solely responsible for the care of the sick and of midwifery cases; there is no night nurse nor regular pauper help at night. On inquiring how the helpless patients were attended to during the night, we were informed that they had to obtain such assistance as they could from the more able-bodied paupers who slept in the ward. As we found that bedsores were recognised as one of the usual ailments in the infirmary, it can be imagined how much help these paupers are able to render to each other. We pictured to ourselves the sad condition of these helpless old people, passing the long hours of the dark nights on their comfortless beds, uncared for, uncleansed, unfed. We say "dark night" because we have ascertained that all lights were removed from the wards after the patients are in bed, nor did we see any appliances for lighting the staircases or passages. The labour ward is for two beds; it has no separate offices, and all refuse must be carried downstairs.

There is no system of classification; we saw the imbeciles and "harmless lunatics" among the patients in the wards; one half-witted boy was busy serving the dinners. There were no lock cases in the infirmary, and we were informed that there were no isolation wards for offensive cases. The "harmless lunatics" appeared to be straying about where they pleased.

On our way round the house we passed through the "nursery," a large ill-furnished room, the floor laid down with paving stones; there was a large table, two benches, two wooden cradles, a few chairs, the latter round a fireplace which was most insufficient to warm the room in the winter. In this room the infants stay with their mothers until they are 2 years old. There was a baby in each cradle, one looking very ill; its mother thought it was "sickening for something." There was no rug, or even a bit of sacking on which the infants might crawl; a more dreary place to be called a nursery can hardly be imagined. Though not properly coming within the scope of this inquiry, we mention this room as indicating the lack of a kindly and sympathetic spirit on the part of those responsible for the management of the house.

The dinners were being served at the time of our visit. It was "broth day"; the broth, made of mutton and vegetables, both looked and smelt good, but it was served in wooden bowls which were black with age and grease. We tasted the bread and butter, both of which were good. We saw no bed cards in the wards, but the master informed us that the medical officer has a free hand in ordering extras, and that milk and beef tea are taken into the wards for the sick at night. As the last meal is given at 6 o'clock, and the first at 8 in the morning, it is necessary that the old, people should have something to take in the night.

The day room on the men's side is used for sleeping purposes; there were four beds in it; it is also the tailor's shop where the male clothing is looked over and mended. It is a very small room, with one window, and at the time of our visit the floor was piled with clothing, and the air of the room was quite unwholesome. On the women's side the day room is not used for a sleeping room; it had one large settle in it, but no comfortable chairs or anything to make it homely. On passing through one of the courts we were shown the disinfecting apparatus. It is a small galvanised iron box, like a good-sized tank, the lid broken at the edges, and having underneath it a tray for the fire; this was standing in a shed close to the closets.

RECOMMENDATIONS.

It seems hopeless to make any recommendation in the case of this infirmary. The building is unsuitable for its purpose, and the system on which it is worked is faulty in every particular.

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