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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 Bishop Portsea Island union workhouse.

.PORTSEA ISLAND UNION, HANTS.

By the kind permission of the Board of Guardians we were enabled to go over this infirmary, which deals with a very large number of sick and infirm patients It has accommodation for 436, and at the time of our visit 860 of these beds were. occupied. We were, unfortunately, deprived of the advantage of Dr. Knott's escort, as he was absent from Portsmouth, at the time.

The Board has to deal with a difficult structure, the house having been built in 1815 a period when, for some reason or other, buildings were erected which are in every way unsuitable for infirmary or hospital work. In many of the wards the wall surface is painted brick; the staircases are steeps and in, some cases between walls; the passages and landings are narrow, and, generally, insufficient attention has been bestowed upon light and air space. The infirmary buildings, stand behind the workhouse. They form a parallelogram, expanding at the ends into two cross wings, a recent addition, to meet increasing demand for space. The wings have three storeys, the middle building two. To each wing is attached an outside escape staircase with wide landings, which are useful as balconies for the patients. There are, in addition, a small one-storeyed building holding a few beds, and a separate block of two storeys containing 45 beds in 5 wards for the female lock patients, cancer cases, ulcerated legs, and other offensive cases. This block is quite distinct, standing in a field apart. The passage in the middle building is along; one side, the wards opening from it. This plan is not a good one for ventilation and lighting; in a few instances the windows light the ward from the passage, but not invariably.

The wards vary in shape and size, the larger holding as many as 23 beds, and the smaller ones in the wings 9. There are a few wards for isolation, holding one or two beds apiece. At the time of our visit the walls were being cleaned throughout the infirmary, the comparatively large number of, empty beds making it a suitable time. The wards are deficient in cupboards, lockers, and all such accessories. In the new wards we saw a few lockers for the patients' possessions, but space for clothing, linen, and ward stores was very limited. In the bath rooms and sculleries attached to groups of wards, the bedpans, bottles, and chambers were heaped on the ground for want of other places to bestow them; a method conducive neither to cleanliness nor economy. There is a strip of linoleum down the middle of each ward, and there are tables and benches; more armchairs would be advisable, as so many of the patients are put of bed during the day. In one small female ward in which all the women. were up, there was a table, two benches, and one chair. There are no day rooms in any part of the infirmary. Two wards in the workhouse are appropriated to the aged and infirm, that for the men having thirteen beds, that for the women fifteen; these beds were all full. We may sum up, our own impressions in the words of the recent admirable report of the Local Government Board Inspectors:

"The wards, though well kept and some of them of good dimensions, are in many respects old fashioned, and far-removed from what would now be considered good sick wards for acute cases. Some of the rooms are by no means deserving of even qualified approval."

We were surprised to find no sink for washing-up in the infirmary except that in the kitchen; there are no slop sinks. The closets serve groups of wards, and are mostly of the old, encased form. The bath rooms are also arranged for groups of wards, and in some cases are most antiquated, those in the wings being more modern. The fireplaces are open, and are placed at the sides and ends of the wards. The lighting is by gas. Hot and cold water is laid on all over the building. Ventilation is chiefly by means of the windows; there are outlets in the ceiling, but no means of ascertaining if these are clear of accumulation. The wards were quite sweet except one in the separation block, in which there was an offensive case. The intakes are on the lines of Tobin's tubes, but are too small in diameter and discharge at a greater height into the wards. There are ventilators in the floors, but these are wisely covered up by the linoleum. The bedsteads in most of the wards are modern, of hospital width, and are supplied with flock or straw bedding; a few spring mattresses are ordered.

A careful distribution of the patients according to their ailments is hardly possible; the top floor wards are used as far as possible for the surgical patients, as these are near to the room which has been adapted for operations. The more infirm seemed to be on the ground floor. There are wards for boys and girls, but the children mix with the adults in the grounds. The male lock patients are on the ground floor in the infirmary, and have the use of the men's recreation grounds if they are able to go out-of-doors. The female lock patients are in the separate building spoken of above. The imbeciles and certified patients are well lodged in two blocks of modern construction, under paid attendants, and are never brought to the infirmary.

The patients are chiefly the aged and infirm, many of them being very helpless, but the acute cases are mixed up with these. There were, however, very few acute cases when we went round. There was a case of typhoid fever, recovering; one had recently died; a lad with pneumonia, and several severe cases in the female lock ward. The hospital matron informed us with pride that there had been four cases of amputation in the year, all the patients having recovered; we saw two of them: in both cases the leg had been taken off above the knee. There was also a case of lithotomy; the patient, who was over 60, was making a good recovery. Among the children there was eczema, ringworm in a chronic state, hip-joint disease in a Thomas splint, pleurisy (recovered), and a few cases of debility. The temperature of only one patient was being taken. There were two cases of cancer, but they had no open wounds.

The midwifery wards are on the top floor in the female wing, two wards with separate offices. The labour ward was in the hands of the cleaners and in some confusion. The labour bed, though elaborate and expensive, seemed too narrow and somewhat unstable. There are a large number of confinements in the year; four women were in the convalescent ward with their infants. There is a trained midwife, who has an inmate as her assistant.

The system of nursing which has hitherto prevailed in this infirmary is one which we believe to be peculiar to this Board. The hospital matron and the midwife above referred to are trained nurses; the medical officer selects as their assistants the most capable among the male and female inmates, one to each ward; these are promoted to be nurses, clad in a kind of uniform, and paid a small sum; they have a few privileges, and are spoken of as "nurses." As far as this system can go it has answered fairly well, for the Board has to do with an intelligent and superior class of inmates: but there are serious limitations. The inmates are beyond the trainable age; the field of choice is limited to those who may chance to be in the house when a vacancy occurs; the necessity of placing them at once in a responsible position precludes their receiving even such training and testing as they are capable of undergoing; above all these inmates can hardly claim the authority and respect due to a nurse. On all hands it is admitted that the results have been far better than could have been looked for with such a system of nursing — and that these results have been attained speaks volumes for the attention of the medical officer and the painstaking care of the hospital matron; but there can be no doubt that the strain and anxiety which it imposes on the responsible officers is very great. The matron said that she had taught these attendants to dress bedsores, and that she had now not one in her wards. The supervision of the imbecile blocks is also part of the duty of the hospital matron.

At night the place of these paid inmates is taken by paupers from the house (not paid), one or more for each ward. We asked the hospital matron if she could rely on these night watchers to give food or stimulant during the night. She replied in the negative, so that, if there is cause for anxiety about any patient, she must rise in the night to see that he is attended to.

We asked as usual for the nursery, as we have found by experience that in very few workhouses the babes are properly cared for. We found them in a large long room, airy and cheerful, with a boarded floor and two fireplaces. The room was full of infants and their mothers, the latter, if in the house, taking charge of their children until they are two years old, when they are passed on to the school. The responsible nurse is a pauper. We were sorry to see the old wooden cradle in use; it cannot be clean or wholesome, however much care may be bestowed upon it; these have a straw pad and covering quilt. We noticed also that the feeding bottles were not cleaned at once after use and put in clean water; the bottles were the proper boat shape, but they were lying in a basin with the remnants of food in them.

The receiving wards are at the back of the infirmary, quite detached, and there is a ward available for quarantining purposes. If infectious disease declares itself, the patient is removed to the hospital under the rural sanitary authority.

RECOMMENDATIONS.

As the whole question of the nursing and of increased accommodation is under the consideration of the Board, it is not for us to prejudge the matter; a study of the report will give an idea of our opinion. This Board has been fortunate in the superior character of the inmates of the workhouse; that fact, and the care and ability of the medical officer and the hospital matron, will account for what is satisfactory in the results hitherto obtained. With the improved system which we believe that the Board is about to introduce, we look to see the infirmary of the Portsea Island Union a model to other unions, and we trust that it will serve as a training school for probationers destined to work under the Local Government Board.

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