BMJ Reports on the Nursing and Administration of Provincial Workhouses and Infirmaries, 1894-5.

LISKEARD.

The workhouse which serves this little Cornish borough and its district stands close to the station, presenting a modest front to the high road. Provided with an introduction from Dr. Nettle, the medical officer, we asked for the master, from whom we received every attention.

The infirmary, which stands behind the main building, is very old. It is licensed to accommodate fifty-four patients. It was obvious at the first glance that it was idle to expect anything like the modern system of hospital nursing in the total absence of the necessary appliances. Our visit was timed at a somewhat unfortunate moment, for the whitewashers were in possession of the wards, and everything was upset. The matron was in despair, for there were at the time but few able-bodied inmates in the house, and most of these were imbeciles; indeed, the method, or rather the absence of method in the cleaning operations was an index to the capacity of the staff of assistants on whom she had to rely.

The wards were being colour-washed, but the rough surface of the walls must prove a sure receptacle for dust and dirt, and the cleanliness will be short lived. In one ward on the first floor we found the boards and ladders of the cleaners at one end, then a tangle of beds, and at the other end a solitary old woman, who had recovered from a fractured thigh, but was kept to her bed. The stairs from the ward below came up into the middle of this room, dividing it into two halves. It was somewhat startling, to those acquainted with the modern doctrines of germs and with hospital theories of antiseptic treatment, to see the dust of years swept off from the beams of an unceiled roof on the beds below, where it lay in lumps, together with a litter of old brooms and the oddments which are turned out during a house cleaning. One incident was characteristic. As we entered the ward the pauper attendant was attending to the wants of the old patient, and had just helped her out of bed. On seeing us she turned and fled down the stairs, regardless of her patient or of the matron's call to her. It was finally the latter who assisted the helpless old woman back to bed. All the other female patients were up except one who was suffering from severe fits; she was lying in another ward in a padded bed. The matron told us that she had tumour on the brain. On the male side there was a patient in a separate ward with a bad leg; it was stated that he was kept apart because of bad conduct and language. Under his bed was an unemptied vessel containing faeces and urine. In the adjoining ward was a man recovering from pneumonia, a patient with an abscess in the groin, a man crippled with chronic rheumatism, old age, and paralysis, in all six men in bed. In the ward above, holding seven beds, all the patients were in the day room. In a separate ward some children were isolated on account of ringworm, and in another there was a bad case of syphilis. The ward in which this poor woman was lying was dreary in the extreme; the walls were whitewashed, it had a small fireplace and a small window, and the door opened out immediately on to the yard. Among the infirm patients there was an unusually large number of imbeciles, both male and female.

The lying-in ward is on the ground floor; it is a mean, dark room, holding 3 beds. The labour bed is a cumbersome four-poster, placed against the wall. There is a small fireplace, no separate offices, no hot water supply; the ventilation must be difficult, as the windows are overshadowed by projecting parts of the building.

The feeble-minded and the imbeciles are ward attendants, as they seem to be the only available form of able-bodied service; they act under the direction of the one nurse who is in charge of the infirmary. This officer is a trained nurse and midwife. The paupers make the beds and wash the patients, but the nurse attends to the backs and dresses the wounds. There is no night nurse or other attendance beyond that of the imbeciles above mentioned, who are, however, in bed themselves at night. There are bells from the wards to the nurse's room, but no communication between the nurse's quarters and those of the master. The doctor, who lives about half a mile off, is summoned at night by a messenger. We were pleased to see separate towels hanging over the bed each of patient, and there was an ample supply of mackintoshes for the use of the nurse. We saw very few armchairs in the wards, but perhaps they were away being cleaned. The only screens were heavy canvas screens, practically useless.

The dinner was being served at the time of our visit, it consisted of meat and potatoes. The plates containing the food were piled one above the other, and were thus carried to the wards by a paralytic wardsman. We wondered which suffered most, the food or the quilt on which the greasy bottom of the plate would rest. The food was nicely cooked, and we were informed that extra milk was issued for those patients who required nourishment during the night.

The nursery is a large wilderness of a room, having a fireplace at each end, half the floor is stone and half is boarded. With a strange want of the sense of fitness, the stone floor end was chosen for use, and neither mat nor rug was provided for the infants to crawl upon. There were five infants in cradles, in charge of a pauper inmate; one of these looked very sickly; the matron said that its food disagreed with it. The long tube feeding bottles were in use in the nursery, and the two taken in connection, the faulty feeding bottle and the pauper attendant. were probably the cause of the disagreement of the food. The cradles were fitted with a straw pad, and over this was a mackintosh sheet. It must be difficult, if not impossible, to keep this room warm enough in winter.

The infectious hospital stands at some little distance behind the infirmary. It is a self-contained building, but the only baths available are long baths, which have to be filled and emptied by hand labour. The hospital was empty at the time of our visit. The matron stated that when small-pox was isolated there, the guardians were unable to procure a trained nurse, and the patients were placed under the charge of an inmate. We wonder how those in authority could have acquiesced in such an arrangement, or how any master could have accepted such a responsibility.

The sanitary appliances are, as one might expect, quite insufficient. There was a bath room on the male side, but no hot water supply. There is no bath room on the female side. In the house there is one bath for the tramps and the regular inmates; there is no hot water supply. Cold water is laid on to the infirmary, the taps discharging over troughs on each floor; but all hot water must be heated in, and baled out of, a copper. On the first floor there are modern waterclosets, with good flush; but on the ground floor the patients have to use the closets in the yards.

RECOMMENDATIONS.

It seems hardly possible to amend satisfactorily the present building, and we are convinced that the most economical plan consistent with efficiency would be to build a new infirmary. As the guardians are responsible for the nursing of the sick poor over a wide district where there is no general hospital, it is of paramount necessity that the workhouse infirmary should be well appointed. As no nurse is competent to attend on 54 patients, be responsible for the lying-in room, and supervise an infectious hospital by day and night. it is obvious that the present nursing staff is wholly insufficient, for the feeble-minded pauper attendants cannot be ranked as nurses.