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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 Keighley union workhouse.

KEIGHLEY.

Knowing that the good people at Keighley have their own opinion as to the value of vaccination, we felt curious to see the workhouse infirmary, and wrote to the medical officer, Dr. Gabriel, asking that we might be introduced to the master. Dr. Gabriel most kindly met us at the infirmary, and we had the benefit of his escort and that of the matron through the infirmary.

The infirmary stands quite apart from the workhouse, within sight, but a quarter of a mile away on another road. It is nominally under the authority of the master and matron, but taking into consideration the fact of its situation, we wonder that the guardians do not appoint a trained nurse as matron over the infirmary. We found the ground strewn with building material, as extensive alterations and enlargement is in progress, and when these are finished the infirmary will be much improved. A porter's lodge is being built, containing receiving wards for male and female patients, as well as living rooms for the porter and his wife; and to these are added bath rooms and all other conveniences. Separate blocks are in progress for the imbeciles and fit cases, with provision for the separation and control of a case of insanity, and a separate block is being built for the lock and offensive cases. The present infirmary is deficient in all these particulars; it is crowded, and there is but little classification; the lock cases are kept as far apart as possible in a small block, the male patients being attended to by the porter.

The wards are in two blocks in the block standing to the front; there are six wards, three on the male and three on the female side; one large ward and two smaller on each side; in the block behind are four wards for foul cases. This provides accommodation for 98 beds. There is no children's ward; the labour ward is for four patients. it opens out of the convalescent ward, and has separate offices. Carpeting down the centre of the wards gives them a look of comfort, and these patients who were up were seated in cushioned armchairs; flowers and pictures distributed about the wards complete the picture. There is cross ventilation by means of the windows, and as one might expect in Yorkshire, there were large fires burning in the wards, which are lit with gas. There are bathrooms, with a supply of hot and cold water. We noted that some of the closets are on the lower landings; this always seems to us an objectionable arrangement, and we hope that it will be avoided in the blocks that are in process of erection. In each ward the patients have a large locker cupboard wherein they keep their own possessions; in the one that was opened for our inspection there was no food kept nor any vessels, simply books and some clothing. Bells ring from all the wards into the administration rooms, which are in the centre of the block, but there is no, telephone to the workhouse; if the doctor is required in the night the nurse has the power to send a messenger for him, without the routine of communicating with the master.

There are two trained nurses, one on by day and one by night; they take a month about alternately, and besides. there are two probationers in training; they are generally on duty during the day, unless, as was the case when we went round the infirmary, there may be special duty wanted by night, the doctor had a case of morphinomania, for whom he had the probationer doing special at night. Pauper help is made use of in the wards. The day nurse told us that the paupers make the beds and wash and bathe the patients, under the direction of the nurse; they also feed the patients and wait on them. The infirmary is, to all intents and purposes, a hospital — acute cases are under treatment, major operations are performed when necessary, as the only other hospital in the town is a small cottage hospital. The doctor has lectures for the nursing staff. The nurses' quarters need improving; they have no mess room, and have to take their meals in the kitchen. The infirmary has its own cook and kitchen, but we understand that these matters will receive attention in the new building.

We saw a number of acute cases in the wards — the morphine patient above referred to, of whose ultimate recovery the doctor had very good hopes, pneumonia, typhoid fever, bronchitis — in fact, such diseases as would be seen in a general hospital and the infirm and helpless cases besides; in all there would be about thirty patients in bed. The visit of the doctor is required every day once at least; on occasions he visits again in the evening. We felt that the nursing staff was under the mark, that the pauper helps must of necessity have more of the actual nursing to do than they ought, as these patients were in both blocks, and there was a good number of bedridden cases to be washed and waited on. There was a wardsman or wardswoman in each ward.

The airing courts were in the possession of the workpeople, so that we could form no idea of their extent or suitability, and they will be quite altered by the time that the work is done; at one end of the present infirmary there is a garden in which we are informed that the patients may walk under certain restrictions, but we must confess to a feeling of doubt as to how far the gardens are really for the use of the patients; we should like to see seats provided for them, and an air of welcome in these grounds. The poor old people would rather sit about than walk round the walks under certain restrictions, especially as we do not recollect seeing much day-room space in the infirmary.

RECOMMENDATIONS.

As the board are making an effort to increase and improve the sick department, it anticipates the suggestions that arise; but, from the long experience we have had in watching the working of the trained nurses under the Poor Law, we would urge that the infirmary should be made into a separate establishment, under a superintendent nurse; that the staff of nurses and probationers should be increased to take place of the pauper help, the latter being kept as servants in the hospital, and that the hospital be available as a place of training for workhouse nurses. This is quite possible under the care of the medical officer, who would then be responsible for the education of the nurses, their clinical duties being taught to them by the head nurse. This will complete the work that appears to be in satisfactory progress; but, on the other hand, if the hospital is only treated as a part of the workhouse, it is, a patch that will tear a rent in the discipline. In assigning the wards to the various classes of patients, we trust one is intended for the children; no hospital is perfect that does not keep the pauper children apart from the adults.


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