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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 Okehampton union workhouse.

OKEHAMPTON, DEVON.

Okehampton Workhouse having lately attracted the attention of the local press, we presented our credentials to the board at their fortnightly meeting, asking permission to visit. This was readily granted, and the matron was deputed to act as our guide.

The situation of the house would be admirable for a fishing lodge; it stands close to the river (the Torridge), with a sharply rising slope behind it, and a high bank facing it on the opposite side of the stream. This is not a suitable locality for a house designed mainly as a shelter for the sick and old. The present board, however, did not select the site, and will, we hope, shortly have it in their power to make a better choice, for the workhouse is so old and so faulty in construction that it can hardly be in use much longer.

The wards are on the first floor; that for the women is immediately off the staircase. It holds fourteen beds, the present number of inmates being six; these were all out of bed, and we found them in a small day room adjoining. This room was warmed by an open stove, which smoked persistently. The patients were cases of old age, or had some slight ailment which did not confine them to bed; some were occupied with needlework.

The appearance both of ward and day room was comfortless and bare; the walls are whitewashed, and without any attempt at decoration, unless the dado of matchboarding in the day room may be considered such; the roofs are pitched, with transverse beams, and from these are suspended some temporary bed-pulls made with cord and a bit of wood. We were struck by the absence of armchairs; there might have been one or two, but many of the patients were seated on a bench against the wall. There were no pictures, no plants, nothing to relieve the weary monotony.

The bedsteads are narrow (33 inches) and low; the bedding is chaff, changed twice a year, or oftener if necessary. It was sufficient, and quite clean.

The ward is heated by an open fireplace at one end. The ventilation is by means of the windows, which are swung sashes, and there are some apertures in the roof, but we suspected that these were blocked by an accumulation of dust and dirt.

The male ward is similarly placed in the other wing. It holds thirteen beds, and there is no day room. Three men were in bed in this ward — one with chronic rheumatism, his legs being contracted, one with softening of the brain, and the third with senility; about five men were up, one of whom was the wardsman. The style and appointments of this ward are similar to those on the women's side; it was well warmed by an open fire at one end, round which the men were seated on benches, some smoking. The lying-in ward is on the female side, close to the nurse's room; it has two beds. The ward, though clean, is too small to be healthy; but we were informed that it is seldom in use, though always kept in readiness. The nurse holds the certificate of a monthly nurse from a maternity hospital.

In conversation with the medical officer, Dr. Burd, we were informed that any case that required isolation would be treated in the receiving wards, and that any offensive case could be put into a small ward off the female ward, which was not in use at the time of our visit.

The receiving wards open out of the court, and are furnished with a bath and water supply; there is a small ward on the ground floor, and another above it; in all, accommodation for three patients. These wards are clean, and supplied with fireplaces; but the nursing of a serious case of fever or small-pox would be carried on under difficulties in these quarters, for the fireplaces are small, the rooms are small, and, between window and door, it would be almost impossible to keep the patient out of a draught.

The sanitary appliances for the wards comprised a w.c. on each side contiguous to the ward, with a good flush; they were clean and wholesome; and a supply of both hot and cold. water. There was a long portable bath, both filled and emptied by hand labour. The only fixed bath we saw was in the receiving ward. Commodes are provided for use in the wards at night.

The nursery, in which we found five babies, is on the ground floor, a small room with fireplace and two windows, a boarded floor, and some most antiquated wooden boxes on rockers, the remains of the ancient cradles which in the old days were placed on a frame against the walls. The number of babes must have been formerly much larger, as the old nursery is a room twice the size of the present one. Here, as elsewhere, we noted with regret the absence of toys or picture book for the little ones, nor did we see any children's chairs or low seats for their use. The babes looked well, except one ailing little one, suffering from some temporary disturbance. The matron assured us that the infants had all the food that was ordered for them; she could quite trust the mothers to deal honestly by their children.

The children in this workhouse seem badly housed; they are sent to the village school, but have no satisfactory play room when in the house. That for the boys is a paved whitewashed shed, with benches round it, one window, and a stove in a solid iron grating. Boys are likely to take to mischief in such surroundings. There are not many children in the house — about twenty all told.

Wishing to verify the statements concerning the dietary of the inmates as published in the papers, and to reconcile these with the reply to our query that the diets "were liberal and varied," we wrote to the clerk for a diet table, but not having received one, we conclude that the published diet gives the facts as they stand. For the able-bodied men, per week, 6 lbs. of bread, ¾ lb. of meat (meat boiled three times a week), 1 lb. of pudding, 6 ounces of cheese, 3 lb. of potatoes, 10½ pints of gruel, 3 pints of soup, 1 lb. of stew, 6 pints of broth, and ¾ pint of milk. This is a low diet if anyone will take the trouble to analyse it, and we are still in the dark as to the manner of cooking it. We saw that the cooking is done by an inmate whose intellect is not of the highest order; this may be no blame to the officers, who have to work with the material that they have; we also noticed that the cooking is done in boilers, thus admitting of no variety in the style, and, though the medical officer may have a free hand in varying the food of the sick, the range of his orders must be much fettered by the limitations of the cook and the scanty apparatus in the kitchen.

Dr. Burd is much attached to the scald milk diet for the children, and he has a right to his opinion as borne out by his experience; therefore we prefer to quote the opinion of one of the highest authorities on the feeding of young children, Dr. Cheadle, who says: "I wish to lay special stress upon the paramount importance of a due proportion of fat in the food of infants;" and again, "children fed on fresh milk never get scurvy except when the quantity is extremely small."

The nurse recently appointed has not received hospital training, except as a monthly nurse, but has had experience of infirmary work. We understood from the matron that it was part of of her duties to bathe and attend to the female vagrants; we cannot commend this arrangement; it must place the nurse in contact with disease and infection — a danger no monthly nurse should run.

The workhouse infirmary would practically receive all the destitute sick of the district, as there is no hospital nearer than Exeter, but there are not many who avail themselves of the aid offered, and the medical officer informed us that it was a rare thing to nurse an acute case in the infirmary.

RECOMMENDATIONS.

We cannot in common honesty recommend anything less drastic than the building of a new workhouse; a comparatively small outlay in smoothing and colouring the walls, in providing armchairs for the patients, curing the smoky chimney, building isolation wards, and improving the children's quarters, would make the place far more satisfactory. Yet when we consider that both the laundry and kitchen are inadequate to the work of the house, that the house is a very old one, and that the situation is wholly bad, we cannot but think that the construction of a new workhouse, with separate quarters for the sick, would be far the better plan, and also more economical in the long run. The population of the district is increasing, and there is likely to be a greater demand for accommodation in the house in a few years time.

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