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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 Lanchester union workhouse.

LANCHESTER.

In the quiet little village of Lanchester we found a compact union, having a small infirmary built apart, the whole standing in a pretty flower garden, in front of which was a pauper engaged in cutting the grass. In response to his query, "Will ye be inside?" we asked for the master, who at once introduced us to the nurse, and left us in her charge. The infirmary is planned for 49 beds, and the nurse, who is a midwife, is trained in general nursing.

The wards are on the ground and first floors, the nurse's quarters being between; though they are of a pleasant aspect, with windows on each side, they are too small, and the ventilation is not effective, as we found on going into a male ward in which there was an offensive case, a poor man with paralysis of the sphincters. The bedsteads are spring, with hair mattresses, and the wards were supplied with armchairs and other comforts, such as dressing gowns and slippers, for the patients who have to leave their beds at night. Commodes are used at night, as the conveniences are downstairs on the intermediate landing. There are no wards for isolation; we saw in a male ward a man with syphilis, a most decidedly offensive case; and all the feeble-minded patients would be in the infirmary. The labour ward is on the first floor, and, if we remember rightly, has two beds, one of which is the labour bed.

The nurse informed us that she felt much indebted to the lady guardian for the improvements that had been introduced into the infirmary; until the lady guardian was appointed there was no one on the board with whom she could talk over the feminine matters that appertained to her department.

Part of the drains were being taken up at the time of our visit, but they are not yet satisfactory. The system of closets is earth; they were certainly most unsavoury when we looked into them. This ought not to be, for the earth closet in the country must be more wholesome than the water where there is no main drainage system, and in a place like Lanchester, where the guardians have a large amount of ground under cultivation, the failure in the supply of earth must be from want of organisation. Hot and cold water are laid on to the infirmary on both floors; there are two bathrooms on each side but no slop sinks.

The medical officer told us that the work in the infirmary was good; being at some distance from a general hospital all the poor came to the workhouse. We saw several patients in bed — a woman in advanced phthisis, a man with disease of the foot, another necrosis of the arm, recovering, and the usual sprinkling of infirm and old age patients. Nurse was very proud of her surgical patients, and she had good results with carbolic lotion and vaseline dressing; she told us that she was liberally supplied with all that was required for her work. Water pillows and mattresses, linen, mackintoshes for the beds; those that we looked at had an ample supply of bedding and were clean. All the wards are in telephonic communication with the nurse's room, but the hospital is not placed in communication with the master's quarters.

The services of the inmates are not made use of in the wards except to assist in the minor details of the work, and in the cleaning. The nurse is responsible for the actual service about the sick; but at night the wards are left to the paupers, who are charged to call the nurse at any time that her presence is needed; under these circumstances there are times when the nurse is more out of bed than in.

The question of suitable food for the sick is one that requires attention. The diets as we saw them set forth on the cards were hardly such as some of those patients could eat, and if unsuitable food is sent to the wards it is double waste — waste of the food cooked, and waste because it takes the place of other nourishment that might help on the course of treatment. Perhaps the lady guardian may have time to study the food as supplied in the infirmary.

RECOMMENDATIONS.

This little country infirmary made a pleasing impression on us; the patients appeared happy and well cared for. Still, we would suggest that more accommodation for isolation should be provided; the offensive cases above referred to are a distinct evil in a ward, and if there is want of sufficient ventilation in the daytime when the nurse is about, what must it be at night when the paupers are left to their own devices? Also we suggest the employment of a night-nurse, who, besides her own especial work, would be available to relieve the day-nurse and herself be relieved by the day-nurse. The sanitary arrangements need attention, as it is nothing short of a disgrace that the necessary supply of earth for the closets, and the frequent change of the same, is not a matter of routine in the midst of the country.


The BMJ subsequently published its response to a letter from Mr. Will. Logan, Chairman of the Lanchester Board of Guardians, in which he questioned the accuracy of some of the commissioners' statements:

LANCHESTER UNION WORKHOUSE INFIRMARY.

1. Mr. Logan states that from eighteen years' experience he agrees with the medical officer that the ventilation is effective, and he denies that there was an offensive case (paralysis of sphincters) in the male ward. —On the occasion of our Commissioner's visit there was a strong odour of urine in the male ward, and the nurse stated that a patient suffering from paralysis had no control over the sphincters.

2. Mr. Logan states that there are two wards for isolation. —Our Commissioner's statement was based on the information conveyed by the nurse that there was no ward in which an offensive case could be isolated; and we gather from Mr. Logan's observations that the isolation wards to which he refers are for infectious cases.

3. Mr. Logan disputes the statement that there was "in the male ward a man with syphilis, a most decidedly offensive case." —Our Commissioner's statements were based on notes, taken at the time, of the diseases for which the patients were stated to be under treatment.

4. Mr. Logan takes exception to the statement that all the feebleminded patients would be in the infirmary, on the ground that at the time of our Commissioner's visit there was only one feeble-minded patient in the infirmary; the remainder of the feeble-minded inmates, fifteen in number, being in the workhouse. —Mr. Logan has misunderstood our Commissioner's point. The remark applied to such feebleminded inmates as might be from time to time admitted to the infirmary for treatment. For them there is no separate ward.

5. The statement of our Commissioner as to the labour ward, which was guarded by the phase "if we remember rightly," was incorrect. Mr. Logan states that there is one bed in the labour ward and five beds in the lying-in ward. He adds that before the visit of our Commissioner alterations had been, and are, contemplated.

6. Mr. Logan states that the drainage put down fourteen years ago had not been touched during that time, and is still in perfect order. —Our Commissioner's statement was founded upon information given on the spot, to the effect that certain excavations were in connection with work on the drains, which were not yet complete. Mr. Logan assures us that this work was in connection with the water supply.

7. Mr. Logan quarrels with the statement that the earth closets were "unsavoury;" he will go no further than to admit that there is a "smell" when they are used. Reference to the report will show that our Commissioner upheld the system of earth closets, but condemned the manner in which it is carried out at Lanchester, where the earth was insufficient to cover the soil.

8. With regard to food Mr. Logan writes: "There are three dietary tables in the infirmary, any one of which the medical officer may order, and he can go further and order any addition or alteration that he may think the patient requires. I most emphatically assert that any of the diets is superior in quality, more varied, and better cooked than the patients would have received in their own houses, if fortune, in their position in life, had always smiled upon them, and sickness had overtaken them in their homes." The question of food is not peculiar to Lanchester. The diet for the old and sick, as sanctioned by the Local Government Board, requires revision.


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