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

RATHKEALE WORKHOUSE INFIRMARY, CO. LIMERICK.

We found ourselves in the midst of the pig-market as we drove into the town, for this is the great centre of the trade of the district, and "pigs had risen," our driver informed us; a very brisk trade had been done that morning, and many a peasant's cart went home lighter, and his pocket heavier. But to turn from pigs to paupers; the workhouse is on the outskirts of the town, and a letter of introduction from the medical officer, Dr. Hayes, secured to us every attention on the part of the master and the matron. This union had recently been amalgamated with an adjacent one [Glin] and the authorities had somewhat modified the usual arrangements of the house to accommodate the additional inmates. The dissolved house has been turned into industrial schools for the union, and all children over 7 years of age are drafted thither from Rathkeale. Rathkeale workhouse is certified for about 200; on the day of our visit the numbers were 185, of whom 80 were returned as sick. The male patients are in the usual infirmary block, and the female patients have two floors in the fever hospital, the fever patients being relegated to the top storey.

In the male wards we found about 39 patients, including the idiot class; the wards assigned to them occupy one half of the building; the other half is the convent for the nuns, who form the nursing staff for the sick. The men are in four wards on the two floors, the smaller wards holding 7 beds, and the larger ones 12 and 18 beds respectively; not all these wards were occupied at the time of the visit. The walls have a painted wooden dado, the wall surface is smooth, and coloured in two shades of green, the ceilings are plastered, that of the upper floor is pitched. Between the beds is a small table, or the ward commode; we saw no arm- .chairs, only benches with backs. New stoves had been recently placed in the wards, which, we were assured, were most satisfactory; the ventilation was by means of the windows, which faced each other. The bedding is of a mixed character; some of the mattresses are of wood-wool fibre; these are placed on iron frames with a foot. We .also saw our old friend the "harrow" frame with the straw tick. The pillows are of straw, or in some cases feathers. White coverlets and a pillow cover gave the beds a neat and .clean appearance, but these are not in use in all the wards. There are no dayrooms in this division; the airing courts are more cheerful and adapted for recreation than many we have seen.

In the same block there is a ward for the female infirm patients; it is on the ground floor under the convent at the extreme end of the building. This ward is too small for the purpose for which it is used; the small windows are set high in the wall, giving a dismal aspect to the ward; the walls are distempered and the rafters unceiled. The 12 beds that it contained were crowded; the inmates had not the contented well-cared-for appearance that we noted among the men. As we stepped inside the ward a woman called out "give us Home Rule, please," but though we denied all connection with politics, we felt as much interest in their wellbeing as the most ardent Home Ruler. These inmates have no dayroom.

We passed out of this division to the female hospital, which answers to the fever hospital in most other houses, only in this case the block is three storeys high, and was originally planned for male and female divisions. It compares favourably with the older infirmary block, the wards are larger and more lofty, there is more space between the beds, the windows are larger, giving more light and air, the ventilation is cross, an I besides the window ventilation there are apertures near the ceiling. The ground and first floors are used by the female patients, the top floor being reserved for the fever cases; there is a common staircase, that portion which leads to the top floor is locked off. These wards accommodate 72 patients; in the largest 10, and in the winter 12 beds are placed; the smaller wards hold each 7 patients. A ward on the ground floor is appropriated to the female lunatic class, and there is a small ward for the isolation of any patient for whom it may be necessary. Between the beds in the general wards is a high table, the windows are shaded with long muslin curtains, and the walls are brightened with pictures or other decoration. There was a pleasant home-like appearance about the wards and an air of comfort, giving proof that the sick are in good hands. The children are among the adults, and we noticed several scattered through the wards. Many of the women were in bed, and we gathered that most forms of disease were under treatment in the hospital, but, in the absence of Dr. Hayes, it was difficult to secure accurate information.

Among the men, besides the chronic and infirm patients, we saw rheumatic arthritis, hemiplegia, bronchitis, struma (rather bad), a man dying of phthisis (almost moribund), and some surgical cases. On the female side, among the children, were cases of hip-joint disease, marasmus, rickets, chorea; in the adult class, bronchitis, heart disease, paralysis, and the usual infirm and senile cases. Dr. Hayes has frequent cases of operation. This is practically the only hospital for the district, the nearest being at Limerick.

The nursing is in the hands of the nuns, and, as usual, we saw evidences of the method, order, and cleanliness that attends their work in the workhouses. There are six Sisters of Mercy in the Convent attached to the infirmary, though we were given to understand that the staff recognised by the Local Government Board is only two for the wards; at night a paid nurse is on duty in the male wards and one in the female; a nurse is in the fever wards. The small female infirm ward has a bell to ring to the convent. The nuns are assisted by inmates; on the female side Dr. Hayes will only employ the married women, so that this hospital is free from the disgrace of allowing the sick to be nursed by women of loose character. On the male side the most capable among the patients are used as ward men. The head Sister has had experience of sick nursing in the Limerick Hospital. We have already noted the evidence of the care that the Sisters take of their charges, and the appointments of the wards — the enamelled ware for service, etc. — were better than usual.

The food for the patients is cooked in the hospital kitchen, where there is a good range; the cooking is under the superintendence of the nuns. The kitchen was clean, having a business-like air in its arrangements. There is a small oil stove on the landing in the male hospital for heating the food during the night, or for boiling water. The reserve food is kept either in the kitchen or on this same landing. The dieting of the sick is practically in the hands of the doctor, who orders extras or stimulants as he judges necessary; and as there is proper machinery for cooking he can give his patients meat, beef-tea, or soup, besides bread, milk, eggs, and, occasionally, butter.

The maternity ward is in the body of the house, and is formed by a slice taken off a ward in the infirm female wing; it holds six beds, one of which was occupied at this time. It is a fair ward, was clean and wholesome, and has a separate entrance. The confinements average from six to eight per annum; the nurse has been trained by Dr. Hayes. This nurse is at the same time the female lunatic attendant.

The nurseries are also in this wing; there is a small one for the married women and their infants. Here we saw two infants. The larger nursery is for the unmarried women; in tins room were three infants with their mothers, and also was the inmate who has charge of the nurseries. In both nurseries was the invariable aspect of dreary squalor and neglect; the rooms are deficient in light and air. We noted wooden cradles filled with straw, a low bench, a stove, some washing drying by the fire, but no bathing apparatus or sanitary conveniences; and the infants themselves shared in the prevailing neglect and untidiness.

The lunatics are scattered between the two hospitals. The male imbeciles and epileptics are in a ward on the ground floor of the infirmary block; this ward holds eight beds. There are no cells in this workhouse. The ward is too small for the number of imbeciles, for no dayroom is attached, and there is only the small airing court to relieve the ward. The females are in a ward on the ground floor of the female hospital, also holding eight beds. It is a better ward than that occupied by the men, but it is also unprovided with a. day- room, and these cramped quarters serve as sleeping and living room, and, in the winter and inclement weather, for recreation. There are separate attendants for the men and women; we noticed traces of care in their persons and in the wards. The women were occupied with needlework or fancy work, and such of the men as were capable worked in the grounds. The aged class are in the wings of the body of the house. The wards in each wing hold respectively fourteen beds. The wards looked cheerless and comfortless — the rough walls, stiff benches, and "harrow" beds in rows against the walls, the small amount of daylight admitted into the wards, and the old fireplaces, all combined to give a picture of dreariness with which, now, we are unhappily too familiar. These wards are locked at night, and there is no means of communication with the officers in event of necessity. We observed some benches for the old people in the yards. The men have a dayroom, such as it is, and their dormitory was empty. The women, on account of the nurseries, have only their dormitory for all purposes, and we could not feel satisfied with this arrangement. There are a few baths in the hospitals, with a cold water supply only. There is no service of hot water in any part of the buildings. In the female hospital the w.c.'s are flushed, and are fairly good though of old-fashioned style, and they have been constructed without intercepting lobbies. In the male division we come across the insanitary soil bucket, which is the only convenience for indoor use; the privies outside, though most objectionable in principle, were kept clean and wholesome. In each ward in the sick divisions there are two basins on a stand, and round towel in common, and in the infirm wards basin and towel in common. The laundry is a fairly well appointed department; there appeared to be a sufficiency of labour. Cold water only is supplied in the taps; the hot water in the boiler is not laid on. There are good drying closets. All the linen is washed in the one laundry, the foul linen from the hospitals being first rinsed before being brought to the laundry, and this process was done daily.

RECOMMENDATIONS.

With regard to the sick department, we feel that we may safely leave it in the hands of the medical officer; we judged that his efforts on behalf of his patients were seconded by the nuns, and that the guardians were not unmindful of the needs of the sick; so we turn from the hospitals to the aged class and the infants. Much might be done for the old people to brighten their lives and relieve the monotony of existence without any great expenditure. The condition of the infirm class stands in need of the most earnest consideration on the part of the guardians. The wards want more light, both natural and artificial; the "harrow" beds should be replaced by wider frames, and the ticks, if retained, need to be larger a plentiful supply of wooden armchairs should take the place of the hard unresting benches; the wards should be better warmed, and day rooms with a few homely comforts provided for both sexes, from which the able-bodied should be excluded. Then at night, if the ancient custom of locking the wards at night must be enforced, there should be effective means of communication with the officials, together with responsible supervision during the night. Improved sanitary appliances are needed, especially for this class, at night, and the remodelling of all the obsolete conveniences outside the house. Then we would draw the attention of the guardians to the need of more baths, and the want of a hot water service in the hospitals, and for the aged and infants. With regard to this latter class, we never can feel that the mothers are the best guardians of their infants; if for the purposes of discipline it is necessary to retain them as nurses, the nursery department should be under the immediate supervision of a responsible officer whose knowledge and experience would make her supreme in her own department. We are convinced that the judicious expenditure of money on the nursery division would in the end save many sickly little infants from being a permanent charge on the rates. We commend these remarks to the guardians with the more confidence, as it is evident that on many points they are fully alive to the need of reform.

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