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

OMAGH WORKHOUSE INFIRMARY, CO. TYRONE.

Our visit to this house was, unfortunately, made during the absence of the medical officer (Dr. Fleming), but the master and matron courteously gave us every assistance for the purposes of this inquiry. The house is of medium size, standing at a little distance from the town. As we entered the gates it was pleasant to see an old man enjoying a rest on a sheltered seat in the drive. This is the first time that such an indulgence has come before us.

The hospital department has overflowed into the house, where a male and a female ward on the first floor in the infirm wings have been set apart for the use of the chronic cases. The male ward had 9 patients, and the female ward 12. Some of these appeared to be feeble minded, but not of the lunatic class. In the hospital the 34 beds are generally full. The hospital wards occupied the two floors, the nurses' quarters being in the middle of the block. Besides the adult wards there is a small room for children, holding 8 beds; here we found three little ones, all out of bed, under the care of a wards-woman. They were retained in this division on account of delicacy, which unfitted them for the rougher life of the schoolroom. The lying-in ward is on the first floor, holding 3 beds, which were empty. We were struck with the cleanliness of the room.

In the wards there is a painted wooden dado, except in the male ward on the first floor; the top of this dado forms a shelf, and there are besides bracket shelves between the beds, on which we saw fancy mugs and cups, evidently personal property. Most of the beds are the "harrow" frames with straw pillows and ticks; there are a few wire-wove mattresses scattered about the wards. The merits of straw as bedding are an open question; much may be said for and against it, and a good deal depends on how the tick is filled and how often the straw is changed; but there can be no doubt as to the unsuitability of narrow wooden frames (2 feet 3 inches by 6 feet), without sides, for use in a hospital ward. The windows are on one side only, the north, and there are small slits in the opposite wall. Some of the bed heads were across the window, and in winter the imperfect frames admit more weather than is suitable for a sick ward. As the grates, one to each ward, are of the old style, the wards in winter must be cold and draughty. There are no day rooms, and the wards were decidedly crowded. We saw no bed cards. The flags on the ground floor wards are covered with cocoanut matting; a strip of the same material is laid down the middle of the upper wards, and also on the landings.

The lunatics are placed as usual at each end of the hospital block; their quarters are decidedly superior to those provided in many other houses; the cells have been entirely removed; the ceilings are boarded; one room is used as a day room and the other as a dormitory. The walls are coloured, and there is an endeavour by means of pictures and such adornments to make the surroundings cheerful. The patients looked clean and had a brighter aspect than many we have seen. There is an attendant on each side, not trained, or paid, except by rations and extras. There were seven men and eleven women in these divisions.

There is one nurse to take charge of six wards in the hospital and two large wards in the body of the house, these latter being in a distinct building at some distance from the hospital. This nurse is not trained, and her assistants on the female side are the unfortunate women detained with their, children in the house; and on the male side, the nearest approach to a decent able-bodied pauper who can be found in the house. As Dr. Fleming says in his report, the selection "has to be made from material damaged mentally, morally, physically, or in all three ways combined." There is no night nurse, nor are there any bells placing the wards in communication with the officials.

In justice to the nurse we would note that her wards were clean, her patients and their bedding appeared to be clean, and certain slight details betokened thoughtfulness for the patients; mugs and cups showed individual possession; the crockery for the service was not only pretty, but bright and clean. In the absence of Dr. Fleming, we asked no questions as to the various diseases of the patients under treatment; several, perhaps about half, were in bed; among these were the chronic and helpless cases and senile patients; winter increases the number of admissions and the severity of the cases. It is therefore evident that though the nurse is capable her hands are overfull, and hence the nursing is not as good as it might be. At this point we cannot do better than refer our readers to Dr. Fleming's exhaustive report published in the Tyrone Standard of September 21st, 1895.

The infirm wings having been invaded by the patients from the hospital, the infirm class are placed not, only in one of the ground-floor wards, but some of the women are on the second floor, these wards holding 27 and 22 beds respectively. We saw some of these old women in bed, the matron telling us that she did not enforce the rising of the old people every day if they seemed unfit for the exertion. The old men and women looked clean and neat in their persons and clothing, and the wards also were clean and tidy. The only light came from a window at either end; stoves were used for heating the wards; there was need of more armchairs for the use of the old people. The beds are the harrow frame, with straw ticks and pillows. A wider frame would make these beds much more comfortable. The men have a day room; that for the women is taken for the nursery.

This room is of the same size and shape as the infirm ward; the long low-pitched room, with a window at each end, one fireplace, and a door leading into the female infirm ward, is difficult to warm in winter, and rarely bright and sunny in summer. This department has successfully resisted the civilising influences brought to bear on the other parts of the house. There were six dirty, untidy, uncared-for infants with their mothers; the air was close, the cradles filled with straw contributing their unsavoury odour to the atmosphere. We saw no apparatus for washing or bathing the infants, nothing but the slatternly women with their dirty children. An inmate may have been responsible, but she was evidently unable to exercise control.

The house has made no advance in sanitation. The sick wards, infirm wards, lunatic wards have no indoor conveniences; pails and buckets placed in the wards are all the provision made, which is neither decent nor sanitary; these must remain in the locked wards all night. There is no service of water in the hospital, and therefore no baths or means of giving such. We saw a washstand and basin in each ward of the hospital, and also in the infirm wards, but these offer a poor substitute for the generous supply of hot and cold water in a properly constructed lavatory, and for the bath.

RECOMMENDATIONS.

There were many points in the management of this house which betokened humane and enlightened care for the inmates on the part of the guardians and their officials, but no amount of thoughtfulness will correct the evils of an antiquated building, or supplement the services of an overworked nurse, and it is to these two points that we would direct the attention of the guardians. The nursing of the sick is carried out under the disadvantage of the patientsbeing located in widely separated wards; and when we add that the only nurse has only pauper assistance of a doubtful kind, it is clear that the work cannot be done efficiently. Then the sanitary arrangements add to instead of saving the labour of the staff, and, worked at their best, are unsatisfactory from all points of view. We most heartily endorse every word of the report which Dr. Fleming has placed before his Board, and we would add our suggestions that the nursing staff be increased by at least a second nurse by day and by a trained nurse by night; that bells or some other means of communication from the hospital and wards be contrived with the lodge and the master's quarters; that the whole of the sanitary system be overhauled with the intention of bringing it up to date. It would be found a more satisfactory method of working to place all the sick under one roof. Lastly, the infants should be placed under the charge of one nurse, the mothers having access to them at stated hours.

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