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

MAGHERAFELT WORKHOUSE INFIRMARY, CO. DERRY.

The workhouse stands about half a mile from the town and is of the second class. Being in the midst of a populous district, its hospital department is of great importance, receiving patients in every stage of sickness. We were so struck by the amount of serious illness under treatment, that we obtained from the medical officer, Dr. Vesey, a list of the eases on his hooks on the day of our visit.

The infirmary is similar in style and equipment to those already described. The wards for male and female patients are on either side of the middle portion, in which are surgery and nurse's rooms; on the ground floor, besides the wards, we found the idiots' cells, and above these on the first floor are the larger wards. The box bed, a variation of the "harrow" bed, is used in this hospital, with a few iron and wire-woven bedsteads, with, in one case, that necessary adjunct for the infirm, a bed pull. Hair mattresses are placed on the iron bedsteads, on the box-beds straw ticks and straw pillows. The walls are smooth surface, the lower half whitewashed, the upper coloured, and in the male ward on the ground floor the walls are painted. On the north aspect are iron-framed, ill-fitting latticed windows, the upper portion falling inwards for ventilation; the opposite wall sash windows have been constructed, to the benefit alike of light and ventilation. We noticed some beds immediately under the draughty windows on the north side.

About fifty-seven patients all were in the six wards: among these was a recent amputation below knee, and a second amputation, healed; a fractured kneecap; abdominal tumour; disease of metacarpal bones, and two other cases of struma; bursitis on knee; double harelip; operated on (the fourth case in the same family); scald of foot; injury to face and side, just admitted; severe internal haemorrhage, admitted that day; kidney disease, probably malignant; three cases of heart disease; three of asthma (one bronchial); two of bronchitis; two of rheumatism; four cases, of which one symptom was want of retention; acute inflammation of breast, enteritis, stricture, thoracic disease, tuberculosis, and a woman confined four days previously. To this list must be added the old age and chronic patients; almost all were in bed.

For the nursing of this hospital full of patients there was one nurse and a probationer, no night nurse, a pauper help in each ward, some of whom on the male side were old men, themselves also patients. We inquired of Dr. Vesey how he intended to nurse the haemorrhage case, as the man's pallor and exhaustion indicated his serious condition; the doctor's only "specials" would be pauper inmates. There are no bells from wards to officers' quarters. The wards were crowded; even that on the first floor nominally set apart for children was crowded with adults. The lying-in ward, holding 2 beds, is on the ground floor. A small ward on the first floor has been adapted for operations, but it does not deserve the name of theatre.

The fireplaces are all inadequate and of old pattern; this is especially the case in the maternity ward. The infirmary kitchen has an old style open fireplace, of which the boiler is out of order, so that all hot water for this formidable array of patients must be heated in kettles. This kitchen was dirty and its equipment extremely meagre; the cooking was done by a pauper. The nurse has her separate linen store; the hospital washing is done in the main laundry once a week, on Thursday; in the interval it lies in bundles in the airing courts.

The lunatics, as we mentioned before, are in the cells, prison cells, neither more nor less. There were 10 men and 11 women in this class. The hospital nurse is responsible for these inmates, and if any mischances occurred she would suffer blame; her only assistants by day or night are paupers; our readers can judge how much she must trust to these inefficient subordinates. Many of the cases were heavy; some we saw in box beds in the cells, some up in the poor lean-to corridor called the dayroom, with its benches and table. There was one piteous case of a lad, quite helpless and blind, having a severe form of rickets, very dirty in his habits, and requiring feeding like an infant. What skilled nursing could such, a case receive under the circumstances ? This class is made up of imbeciles and epileptics; and the nurse is set the hopeless task of keeping them clean without baths or lavatory; it is needless to say they were dirty and unkempt.

The fever hospital stands behind the infirmary; it holds 10 beds in 4 wards; 3 beds were occupied with typhoid fever patients. It is under the charge of a nurse, and has its own kitchen and laundry. Being of more recent date it is of better construction than the other hospital; the wards are loftier, there are waterclosets off the wards with cross ventilation, and water is laid on, though there are no baths. Behind the fever hospital we found a small shed, close to the building, which was the mortuary, but it also served as a receptacle for clothing and a disinfecting chamber. Its sole apparatus was a shelf for either clothing or corpse. A new disinfecting chamber was being built, the upper floor for the reception of purified clothing, the lower for the purposes of disinfection. The latter was simply a room where, as we understood, Jeyes' fluid was to be used, but there was no oven for dealing with the heavy woollen articles. We are of opinion that the guardians have not been well advised; an oven might have been erected for the same or less money (£70), and would have been more effective.

The infirm wards were next visited; they are on the ground floor in the body of the house, and hold 20 beds each. The aged inmates are treated alike all over Ireland — kept in dormitories, allowed no liberty but the use of the exercise yards, locked in at night, and left to such attention as they can give each other. Here we observed the usual want of cleanliness and tidiness in the persons of the old people, and the usual squalor in their wards. One basin and a round towel is all they have for toilet purposes; buckets and pails are their right conveniences.

The nursery was in charge of an inmate, the mothers being at work in the house. The wooden cradles are filled with straw. We saw a tin bath for the use of the infants; all the hot water is carried from the main kitchen.

This kitchen, like the other, was very dirty, and as unfit for its purpose as can well be conceived. There were two large coppers, each having its own furnace, and a third for storing water; no cooking range, the dresser black with age and dirt combined, the walls grimy, and the floor uneven. A male pauper was in charge. As we have so often spoken of these antiquated kitchens ,we here show the picture of one; it was taken from that in a smaller house, but the arrangements are almost everywhere similar.

The water supply is largely drawn from a well condemned by the medical officer. It is in the kitchen yard, the uneven surface all round it being saturated with slop water from the scullery trough, which overflows and is not flushed away. The water from this well is pumped up into a tank, from which there is a draw off tap in the kitchen; until this tap is disconnected there is nothing to prevent the use of that water for culinary purposes. There is a second well in one of the yards, the water from which is fairly pure. There are no fixed baths for sick and infirm, nor is any hot water laid on, and the service of cold water is very limited; nearly all that is used has to be carried.

The sanitary system exhibits a state of culpable neglect on the part of the authorities which must be seen to be realised. The hospital privies stand with their backs to the hospital at the side of the yard; the small doors intended for the withdrawal of the wagon or trough which should receive the soil were leaking with faecal matter soaking the wall and ground. Briefly, there is no receptacle; when these doors are opened the contents pour out; when they are shut the liquid matter oozes out, and this opposite the lying-in ward, which has no other ventilation than into the yard. In the infirmary we also noted that wooden unpainted buckets are provided for the night chairs. There are no indoor conveniences except in the fever hospital.

RECOMMENDATIONS.

Where there is so much that requires improvement, not to say radical reform, we hardly know how to make any suggestions which will meet the case. An increase of the nursing staff is urgently called for, especially at night, but in such wards and with such inadequate machinery the work cannot be done efficiently even by a larger staff. Then the want of sanitary arrangements has so poisoned the soil that great expense must be incurred to make the courts and yard wholesome. The domestic offices require bringing up to the mark. All this means outlay, but when we think of the sick in the wards and the unhappy lunatics in the cells, we cannot but urge the enlargement and reconstruction of the hospital, the demolition of the cells, and the appointment of more properly trained nurses for day and night duty, and paid attendants for the imbeciles. It may be that in amalgamation guardians who are handicapped by unsuitable buildings may find some solution of their difficulties.

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