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BMJ Reports on the Nursing and Administration of Irish Workhouses and Infirmaries, 1895-6.

LISBURN WORKHOUSE INFIRMARY, CO. ANTRIM.

Dr. Mackenzie, the medical officer of the workhouse, having kindly undertaken to show us over the infirmary, we turned our steps one morning towards the union, which is a little way from the town. It was market day, and the Board was gathering for the meeting, the guardians standing in groups about the lodge. As Lisburn is the county town, standing in the midst of a thriving district, we were prepared to find a large house, and hoped that it might show some improvement on those recently visited. How far our hopes were realised we leave our readers to judge for themselves. A cultivated garden, and ivy and other creepers growing over the lodge, redeemed the aspect of the building from the usual dreariness.

The infirmary forms, as usual, the third block of the plan, and has a capacity for 100 beds, exclusive of the fever block. It is a two-storeyed block, but the ground floor is disused; there is an average of 60 patients. Most of these are chronic patients, as the County Infirmary takes the acute and operation cases. The women are in four wards, having a total of 40 beds; one of these is a long ward in which young children are placed, as well as the adult sick and infirm. The other wards are smaller; that for the lying-in women being in communication with the long ward. The men's wards are smaller; there were 22 patients in three wards. The surgery and nurses" room are on the ground and first floors. The infirmary stands east and west; the windows face each other, and ventilation is by means of the upper half of the window, which falls inwards on toothed bar. The walls are plastered and whitewashed, roof pitched and plastered, the fireplaces very old and wasteful, and can hardly suffice to warm the wards in severe weather. The bedsteads are narrow iron frames, with straw tick and pillow, resting against the wall, as there is no head to the bed; there are a few tables between the beds, and a few arm chairs and benches. The floors throughout. are boarded, and we saw some pictures on the walls. There are no screens to secure privacy, and the beds are too crowded for the cubic space. From the appearance of the wards we should imagine that it was the intention of the builder to provide space for a single line of beds, but that pressure on, the accommodation had doubled in number.

The nursing is in the hands of a head nurse who has been trained by Dr. Mackenzie; she has an assistant, and there is a night nurse. The paupers who work in the wards are supposed to be kept. to scrubbing and cleaning, but as the number of patients is. quite beyond that which two nurses can possibly attend to, we conclude that either the work is left undone, or that the paupers are pressed into the service. Several patients were in bed; there was a sad case of cancer of the jaw in a male, which required careful dressing to keep it in a wholesome condition; one of strumous disease of the arm, and the rest appeared to be old age, paralysis, and infirmity. A bed card stating name, age, sex, and disease is hung by a string over each bed.

On the landing outside, and in close proximity to the wards, there are water-closets, one on each side, but these from some cause were a great failure as sanitary appliances; the flush was inadequate, the pan encrusted with filth, and the odour powerful. These small enclosures serve also as cupboards for pails and brooms, which were mixed up with bedpans, etc., and among this heterogeneous lumber was a pailful of pieces of bread. We understand that these places are condemned, and it is time, for such ill-ventilated closets are a standing offence to sanitation. The privies outside are also condemned; those into which we looked were in a most insanitary condition; soil and moisture over the floor and fittings, and no attempt at keeping the miserable structure in even an outward state of cleanliness.

The lunatics, whose department is under the roof of the infirmary, are housed on the male side in a lean-to addition to the cells, forming a corridor, in which their beds are placed head to foot along the outside wall. Stone-paved floor, whitewashed walls, small windows, bad fireplaces, crowded quarters. Is it possible to imagine any place more unfit for the occupation and treatment of this unhappy class? The cells are rarely used, and Dr. Mackenzie was urging the Board to convert one of these into a padded room. We saw one cell tenanted by a pauper who had been drinking. The head nurse is held responsible for the lunatics; among the males her assistant is a lunatic, in whose care they are left at night, with occasional visits from the night nurse. The females are better lodged; the lean-to corridor is not used for sleeping quarters, the beds being placed in a dormitory better lighted and better ventilated; the cells are only occasionally made use of for unruly patients. The epileptics and imbeciles are kept here with the lunatics. This ward is stone paved. One woman was in charge of a special attendant. The airing courts are square, shingled, enclosed spaces off the infirmary and the lunatic wards. The doctor is trying to induce the Board to erect sheds and seats in these courts, for no day rooms are attached to these blocks.

The fever hospital, a detached two-storeyed building of more modern construction, was in use at the time of our visit, two male and two female patients being under treatment. On the ground floor are two wards on each side of the middle staircase, and on the first floor a long ward in each wing, the lower wards only being occupied by the above-mentioned patients, cases of fever. The long wards have not been need since the last eases of small-pox were nursed in them. One nurse is in charge of this block, with pauper assistance. The hospital is self-contained, having kitchen, laundry, and nurse's quarters. The sanitary appliances in this department are of modern construction and well flushed, with provision for cross ventilation, but there is no intercepting lobby, and with all the windows shut — as they were when we went in — the place was quite foul. (Was this shutting of the windows the work of the pauper helps?)

The nursery is as usual in the body of the house, forming part of the able-bodied women's quarters. It is a stone-paved room, with a railed-in grate, a small window, dirty whitewashed walls, and open rafters; but for the presence of the four infants and their wooden cradles and their pauper attendants we should have taken it for a stable or a barn. There was no nursery apparatus, such as bath or washing-stand, and the poor children did not appear to be very wholesome; the fretful wail of discomfort was the only apparent sign of child life. These hapless infants sleep in the dormitory above with their mothers, on straw ticks :laid on the Poor.

From the nursery we went to see the aged men and women, and for these poor creatures we found no better provision for either cleanliness or comfort. The dormitories, one in each wing, are like that of the nursery, except that the floor is raised about 6 inches on either side of the ward, leaving the middle pathway of stone pavement on a lower level. The day rooms also are flagged. There is a window at either end of these long wards; the walls are rough surface, colourwashed, the rafters open, rows of harrow beds and straw ticks against the walls, one old fireplace, quite insufficient to warm a long, narrow room in winter, no artificial light during the night, benches for the poor old people to sit on. We saw a group of wretched women listless and inert in the ward. It is a living death for the old men and women in an Irish workhouse. The conveniences for night are the open buckets and pails with which we are now familiar. The ventilation, by means of the two windows, is quite insufficient even in fine weather; in the winter and at night there must be practically none, for the poor fireplace would not give off sufficient heat to allow of open windows.

The kitchen and laundry are both behind the times; in the former are two large boilers, heated by steam, so that all food must be cooked by boiling only; the latter is small and crowded, though we were glad to see some machinery, such as mangle and wringer, for the proper handling of the clothing. The "feeding troughs" are used for serving the Indian meal and milk that forms the midday meal of the inmates in the body of the house. In the infirmary there is a serviceable range, and the cooking is supervised by the nurse. This range also heats the water for the wards.

The sewage from the infirmary and the fever hospital is carried into the town system, that from the body of the house drains into cesspools. There are no baths, but we were given to understand that the whole of the water and sanitary system is to be remodelled. We trust that the alterations will include indoor conveniences for the aged and infirm, and baths for the infants.

RECOMMENDATIONS.

Desiring to ascertain whether the sick poor in Irish hospitals are treated on the same lines as those in a workhouse infirmary, we visited the County Infirmary in Lisburn, and were pleased to find that in appointments and management it was on a level with some of our small country hospitals on this side the water. We would therefore ask the guardians of the Lisburn Union to follow our example, and study in the hospital of their own town what should be the treatment of the sick and infirm. The necessary improvements would include a wooden dado round the walls, improved fireplaces, new bedsteads and mattresses, a reduced number of beds to each ward, and the provision of comfortable chairs for the infirmary patients. The whole system, in so far as it affects the aged, the lunatics, and the infants, requires humanising, and the wants of each class need to be considered and provided for, for at present these three classes appear to have been overlooked.

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