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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 Oldham union workhouse.

OLDHAM, LANCASHIRE.

The chairman of the Oldham Board of Guardians himself responded to our request to be allowed to visit the workhouse infirmary, and courteously acted as our guide through the sick quarters and such other parts of the house as we wished to see. The workhouse is situated on the outskirts of the town, of which the staple industry is cotton weaving. The bulk of the inmates are drawn from the town, but the union embraces also some of the agricultural population. The house is well situated as regards air and light, and the infirmary proper stands to the side of the main building and at some little distance from it.

The infirmary is built on the pavilion scheme, and consists of three blocks of two floors each; these are connected by a light iron bridge on the first floor level; there is no covered ground floor passage. Two blocks are for male patients and one for female, each block holding about 90 beds. The wards vary in size from 6 beds in the small wards to 25 in the large wards. The staircases are wide and open, communicating with spacious landings. The surface of the walls is glazed brick. The heating is by means of central fireplaces, one or more according to the size of the ward, the flue passing under the floor. The lighting is by gas. The wards are ventilated by large windows, which face each other in the large wards, and by Tobin tubes. The cubic space, judging by the eye, is ample, as there is wide space from bed to bed, and in the middle of the ward.

The patients are not strictly classified into medical and surgical cases, nor are the wet cases kept apart (this is not necessary where the sanitation is good), but the lock cases are in a separate block apart from the hospital, under the charge of the children's hospital nurse, and the imbeciles are cared for in separate wards attached to the main building. One ward in the hospital is set apart for male phthisical patients. The cases treated are such as may be found in the wards of a general hospital, and the medical officer informed us that, with the resources at his disposal, he should be prepared to do any operation, or to carry out any treatment he considered necessary.

The wards are fitted with all appliances for nursing; the bedsteads are hospital size; the material of the beds varies. In the male ward we found some spring mattresses; on the female side the beds are flock, but in the lock wards, for special cases in the general wards, straw is used. Each floor has its own bathroom, with hot and cold water supply, lavatories, and waterclosets; also a small scullery attached and nurse's room. There are no day rooms, but one ward in each block is used for convalescents. The men smoke in the wards. The wards are in telephonic communication with each other and with the master's quarters.

The lying-in ward is an eight-bed ward on the first floor in the female block, exactly the same style of ward as those for the other patients. We were surprised to find no labour ward, and this we think should not be omitted from a modern hospital. A poor woman should have more privacy at such a time than the doubtful seclusion of screens, and the expectant patients are better able to face their trial if spared the knowledge of all the details of another's case.

The nursing staff in these blocks consists of a charge nurse and two probationers for each block, under the supervision of a superintendent nurse, lately promoted from the post of senior nurse to the entire charge of the infirmary. At night one charge nurse and two probationers are now on duty, assisted by wardsmen and women. This is an increase on the amount of night nursing which prevailed until recently, but we cannot but regard the night staff as still insufficient.

The superintendent nurse is the midwife; the probationers are kept in training for two years, and six of them have just completed that period. We had not an opportunity of learning from the medical officer what course of instruction is pursued, but we understand that he has only recently been appointed.

The children's hospital intended for the reception of patients from birth to 16 years of age, is a separate building complete in itself. At the time of our visit there were 57 patients under treatment, cases of hip-joint disease, excision of the hip, spinal disease, hypertrophied heart, rheumatic fever (recovering), strumous disease of the glands, tuberculosis — such cases, both acute and chronic, as are to be found in the wards of a general hospital for children. In the same building, and included in the above-mentioned number, are the children with their mothers who are in quarantine. Before the newly-admitted children are passed into the schools or the body of the house, they undergo quarantine in this block for a fortnight, and are under the care of the nurse of the hospital. The appointments of the block are good, the cots and bedsteads suitable, the wards and day rooms airy and cheerful, with toys and books for the amusement of the patients.

There is one nurse on duty; besides her charge of the sick children she is. responsible for the families in quarantine and the lock patients in the separate block. When we consider that the quarantining of the families includes the handling and cleansing of children who are often in a filthy condition when admitted, and who may have some contagion about them, we can hardly regard this as a good distribution of offices; it might introduce a most troublesome and expensive epidemic among the little patients. The quarantine department also appeared to us to be dangerously close to the children's wards; it is under the same roof.

There is no night nurse in this block, nor has the nurse any skilled assistant. She informed us that her nights were of necessity frequently disturbed, and we wondered how those recumbent cases and the child with hypertrophied heart were handled at night by the pauper women.

The infirm and old are lodged in the house; there is no paid attendant in this department, only pauper help. This part of the house looked older than the infirmary buildings.

The infants are in the house with their mothers; we understood that the system was that the mother should have the entire charge of her child until it was old enough to pass on into the schools. We asked the chairman whether there was any supervision over the feeding and rearing of these babes; he replied that there was no special officer, but that no reason for altering the present system had arisen, nor was there any ground for supposing that the food issued for the nursery was tampered with. Our impression as we passed among the infants was that it would pay to have a responsible nurse in the improved physique of the little ones; it is the period when the foundations of a healthy constitution are laid, or the tendency to disease accentuated.

The imbeciles and fit cases are in separate blocks under the care of day and night attendants; their wards are somewhat crowded, especially if a case of sickness has to be nursed there. The Chairman informed us that the Board is endeavouring to improve this department; but there is some disagreement between themselves and the Local Government Board over the details of the scheme, and the whole matter is at a standstill.

We were in the house at the dinner hour. The food for all the departments is prepared in the kitchen; it is carved and divided on a heated table, and despatched in jacketed tins; the nurse informed us that it reached the infirmary quite hot. The sick diets are in the hands of the medical officer.

The airing courts for the hospital are the gardens in front of the blocks, with grass plats and flower beds, or the courts behind the pavilions. The convalescent children were playing on the terrace in front of their hospital.

The nurses are lodged at the schools, so that they sleep quite away from their patients. The superintendent nurse has her quarters in the hospital. There is no resident medical officer. Pauper help is used to a limited extent. The beds of the convalescents and of the simpler chronic cases are made by the inmates. They fetch, and carry, and do the cleaning, but they do not meddle with the patients. A wardsman or woman is on duty in each ward during the night.

RECOMMENDATIONS.

The structure of the hospital is modern, and well adapted for its work, except in the particular noted in the lying-in ward, which is a blot, and might, we believe, be altered without much expense. We would recommend, further, the removal of the quarantine department to a safe distance from the children's ward, and the placing it under another officer. We would suggest, also, an increase of the nursing staff, especially for the children. There is valuable material here for the training of probationers, which should be utilised, and the most is not done for the children while they are not nursed at night. The appointment of a night superintendent for the hospital and of a responsible attendant for the nursery is also desirable.

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