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

MALLOW WORKHOUSE INFIRMARY, CO. CORK.

This house serves a district extending for twenty miles round Mallow, a market town of some importance, which is also the junction of two lines of railway. We were therefore prepared to see the establishment of considerable size which met our eyes as we drove up with the medical officer. The number of inmates was about 400, of whom about half were on the doctor's books.

The ground plan follows the usual lines, and there is in addition a long low building at right angles to the body of the house, assigned to the infirm class, both male and female. We have usually given the sick the first place in our reports, but here the miserable condition of the aged class demands the precedence. The men are lodged in the ground floor of the first half of the long building above mentioned, which is little better than a shed. Light is admitted by small windows on one side only; unceiled rafters support the empty ward above, to which access is gained by an open staircase from the lower ward; rough walls, a broken, uneven floor, benches, old rusty grates, harrow-framed bedsteads with their straw ticks, buckets, and a dirty round towel complete the picture of the old men's home. There were about 30 occupants in the two wards. Having no dayroom, they prefer the ground floor, because they can then wander in and out of the yard on to which the ward opens. The amount of warmth possible in winter in such wards must be just sufficient to maintain life, but certainly not enough to give any sense of comfort, and a more wretched existence can hardly be conceived.

The aged women's quarters continue the building towards the infirmary. On account of the lie of the ground their wards are placed one above the other, and access to the lower ward is by a few steps from the yard. The interior is a shade better than the men's; the floor is in better repair, the walls, though rough, are white-washed, and there is more light, but there the improvement ceased. A portion of the ground floor is taken off for the female idiots. There were about 60 old women in the lower and upper wards together, and about 19 in the idiots' division.

Access to the upper storey is gained by a staircase out of the lower ward. In a bed just at the top of the stair we saw a miserable little infant of about 2 years, suffering from marasmus. It was uncleansed, and sucking at an empty tube feeding-bottle. Our guide explained to us that it belonged to one of the wardswomen in the infirmary, where, of course, infants are not welcomed. Here was yet another instance of the evils of employing these women about the sick; unless their infants are under proper care and supervision, either the patients or the infants must be neglected. This wailing child must have been a trial to the old women, and it was dying by inches, the victim of a vicious system. This upper ward was brighter and more homelike, but the disadvantage of the stairs prevented its infirm occupants from getting out of doors. There are more aged men in the wing of the body of the house; and except that the wards are larger and in better repair, they are no better off. A window at each end of the ward, benches, one fireplace in each dormitory, and unceiled rafters gave a comfortless look to these quarters. In these wards there are bells communicating with the master's quarters and with the porter's lodge.

We now made our way to the infirmary, which is situated as usual behind the body of the house. It holds about 56 patients when quite full, including the maternity ward. On the ground floor on the male side is a ward of 6 beds, which Dr. Montgomery called the "broken leg ward." In it were three men; one whose thigh had been broken was now recovering. His "fracture bed" consisted of three broad planks or slats, with a mattress, resting on low trestles. We noticed two pulls for patients — a useful aid to nursing usually conspicuous by its absence in Irish workhouses. Beyond this ward was a similar ward set apart for cases of skin disease, or other patients whom it was desirable to keep separate. A man was here recovering from a severe burn. On the floor above was a long ward of 22 beds for general cases, whether medical, surgical, or chronic. This ward was not quite full, and many of the patients were able to be up. Beyond was a small isolation ward, in which was a case of amputation for gangrene of the foot.

On the female side, the arrangement of the wards is similar, except that the maternity ward is taken off the long ward, reducing its capacity to 18 beds, and the small ward corresponding to the male isolation ward is appropriated to the night nurses. In the maternity ward was a convalescent patient. These cases average about 30 per annum. The other wards are for general cases, the more severe surgical cases being on the ground floor. One ward is set apart as an operating room, and is fairly well appointed. Among the women was a serious case of paralysis, which must have been a great tax on the nursing. We noticed among the patients two women who looked very superior to the other paupers. There were some heavy green baize screens, very undesirable from a sanitary point of view, and far too cumbersome to be of practical use.

The aspect of these wards is bare and uninviting; the rough walls are whitewashed, the windows in heavy metal frames, the rafters unceiled; one of the old-fashioned grates was smoking, and the others bore traces of the same fault. In one window, behind a sick bed, we saw and remarked on some broken panes which admitted much of the weather. We were told that the "contractor" had not yet been round to mend the windows. Between the beds are small tables or shelves, and the night chairs. We noticed very few chairs for the patients, and none very suitable for the sick, or for old folk.

The fever hospital is a grey stone structure, standing to the right of the main building. It has a capacity for fifty patients, but at the time of the visit there were only two cases of mild typhoid fever under the care of the two nurses. The wards are whitewashed and ceiled; the bedsteads of all kinds; we noted some wooden ones of which the head formed a shelf over the patient's head for food or medicine. This is not a cleanly arrangement. There are a few iron frames and wire-wove mattresses; otherwise wooden frames and straw ticks. The cooking and laundry work are done in this hospital, apart from the other buildings.

The nursing staff in the infirmary consists of one nurse, untrained, and two young assistants for night nursing. Thus one officer has charge of over fifty beds, containing, as we have seen, some very important cases. She is assisted by the usual pauper inmates — one to each ward; the female patients being nursed by women inmates, and the men by those among themselves who are most fit. All the patients are left at night in the hands of two young girls, who may be capable, but they are placed in work and in surroundings most unfit for girls.

The idiot class on the men's side is at the end of the infirmary, under the sick ward. We counted sixteen men in the ward, and this includes epileptics, unless the disease is of a severe type, when they are treated in the sick wards. The wards have a concrete floor, with a channel for carrying off the water when the flooring is swilled down; we were forcibly reminded of a stable, and we suppose analogous reasons account for the similarity of structure. The patients lie in box beds on straw, which was none too clean. They are under the care of an officer, but neither space nor fittings permitted of anything like the proper handling of this class. The female idiots are, as we mentioned above, in the aged women's block. Their wards are small and dark; they have a dayroom, and are under the charge of an officer, but nothing seemed to be done to occupy them.

A nursery for orphans or deserted children is in the infirmary block, where they are placed under the charge of a nurse. There was one infant in a cradle like a hamper; two sickly-looking children were seated on the floor, and there was a fourth with clubfoot. Two inmates (one an old woman) were with them. In this ward were also some beds for adults. We saw nothing in the way of toys or amusements for these waifs and strays of workhouse life. The other nursery is in the body of the house, where were a few infants lying in wooden cradles, more like large washing troughs than an infant's bed. These were full of straw, covered with a sheet, on which the infant lay in some untidy garment. The atmosphere was close and the straw smelt damp. We never believe in the cleanliness of these straw-filled cradles, as nothing short of a daily change of straw is satisfactory. With wearisome iteration we have to note once more the absence of all sanitary apparatus, with the exception of a wooden bath on each side of the hospital with a cold water supply only, and in neither case clean or well kept. In the infirmary the night chairs remain unemptied at night, and in the wards for the aged class the soil bucket or chamber also remains unemptied till the morning. There are no lavatories or baths for the nurseries. In the fever hospital there is a privy, which is supposed to be flushed daily; the seat was broken and the floor uneven. There is no hot water supply to the sick department.

The food is cooked in the infirmary kitchen, where the range is very defective; there are two steam boilers, the steam being supplied from a central boiler in the house kitchen. The infirmary kitchen was furnished with tin mugs and basins. The reserve of food for the night is kept in a separate place.

The airing courts are rectangular yards overgrown with rank grass. Dr. Montgomery suggests the laying out of flower beds: the cultivation of which would be an interesting occupation for the old people; also benches under lean-to sheds where the old men could smoke and the old women do needlework. As there are no day rooms it is to be hoped that these excellent suggestions will soon be acted upon.

The disinfector is at some little distance from the workhouse and outside the grounds in a building called the "county hospital"; the said building is in the custody of an ancient porter.

RECOMMENDATIONS.

The miserable condition of the aged poor in the workhouse is deserving of all sympathy, and again we would point out to the guardians of Mallow the wretched surroundings of the infirm paupers under their care. Surely it is possible to provide wards and dayrooms with furniture, and some simple comforts, that will enable them to spend their few remaining years in decency. Even the carrying out of the medical officer's modest suggestions in regard to the airing courts would be some improvement. We also trust that the nursing of the sick may receive some consideration. There should be at least two trained nurses, in the place of one untrained; the night staff should also be trained, and of more suitable age. A supply of hot water to the infirmary, and of baths and lavatories' to all departments is also greatly needed, and would add much to the efficiency of the work. The quarters for the idiots are also susceptible of much improvement. As there is ample space and a good situation, the Mallow guardians might soon, if they would, place their workhouse in the van of progress.

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