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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 Reading union workhouse.

READING.

Our request to visit and report on this infirmary met at once with a ready assent on the part of the Board, the Chairman (Mr. Apsley Smith) was waiting to act as cicerone on our arrival. It is a pleasure to turn from some of the squalid ill-found houses with which we have made acquaintance to a country union which is doing its best to meet the wants of the inmates and to bring itself abreast of the times, and as we went through its various departments we could see evidence of thoughtful consideration on the part of the guardians seconded by their officers.

We turned our steps to the infirmary which stands well apart from the house to the left hand after passing through the gates. It is a new building of two storeys in the form of the letter H, the administration block being in the middle connected with the male and female wings by an open covered causeway. The ground around the infirmary was still being turned up by the workmen, but it is intended that the recreation grounds for the patients shall be both in front of and behind the hospital. On entering the middle block we found the "sister's" quarters, the nurses' dining-room, waiting-room, and surgery, and the lying-in wards, the latter on the first floor. The nurses' quarters are not yet finished, for it was found that the plans had not provided sufficient accommodation for the nursing staff, the original estimate of staff not being adequate to the needs of the hospital.

The lying-in wards consist of three wards, the labour ward with two beds in direct communication with another ward, also with two beds, for the patients after the labour is over; a larger ward holding six beds for the convalescents. The women remain in this department for at least a month or longer if it is necessary. The sister, who is the midwife, informed us that the number of confinements was about 26 in the year. This department has its separate offices of modern construction, an ample supply of hot and cold water, and a bath. There were two convalescents in the large ward.

The wards form the two uprights of the letter, the entrance is in the middle with wards on each side on the ground floor and upstairs; on the female side each ward holds 16 beds, on the male side the wards hold 18 beds. The construction of the two sides is alike, oblong rooms with windows on each side, a bed between the windows, and windows at the end, one of which is a door opening on to the garden or a balcony on the first floor. At this far end of the ward are the sanitary arrangements located in turrets, the bath-room on the one hand the lavatories on the other; these latter comprise two closets and a slop sink, the latter is a useful detail that is often overlooked. The bath is white porcelain set out from the wall; the floor is tiled, the walls cemented; hot and cold water are laid on. On the landings at the other end of the wards there is a small kitchen common to both wards, store-rooms for linen and clothing, for ward stores and medicines; also a separation ward with 3 beds, and in one case we found that the small ward had a closet, and hot and cold water supply adjacent. These separation wards are on every landing. The landings are tiled, the staircases are of stone, fenced by low brick walls. The walls of the wards are cement, painted in two shades of terra-cotta. The windows appeared to us to be set rather too high in the walls; they are sash windows, and above the sash is a ventilating section that opens outward, with a regulating bar. The wards are warmed by a central stove, the flue passing under the floor, the fires facing two ways; supplementary to the stove are steam pipes that are carried round the ward at the skirting. We noticed small ventilators in the walls at the level of the cornice, but it was evident that the chief method of ventilation is by means of the windows.

The bedsteads, most of them fitted with spring and hair mattresses, struck us as rather narrow, — 2 feet 9 inches. This, we were informed, is the width recommended by the Local Government Board; we should have preferred another 3 inches for comfort. The mattresses were made in three sections, facilitating the removal of any section that may be soiled. This is a good plan, but we would suggest that, instead of being of equal size, the section at the head should be smaller, and that at the feet larger, when a restless patient would not so easily disarrange the bed. Some of the old bedsteads are still in use, a flock bed with a feather bed on the top. We also saw some open locker tables between the beds; they consisted of two shelves, divided by a partition, the top being wider to form a table. The various oddments of personal possessions were not tidy to the eye, but it is more cleanly to have the contents in view. Tables, benches, armchairs, and a merlin chair completed the ward furniture. There are no day rooms, nor separate wards for the children.

The sister informed us that the wards were exceptionally light for the time of year; the greater number of cases that we saw were old age and paralysis. We noted with pleasure that the incontinent cases were distributed in the wards — were not relegated to some out-building or back ward, treated as the pariahs of the workhouse. On talking this method over with the sister, she said that in her experience — and this extends over twelve years — such a practice was unnecessary and exceedingly unwholesome. A severe case of ulceration of the leg on the female side was being treated in a small ward; iodoform was the dressing. Cases of phthisis, heart disease, rheumatism, and paraplegia were in the general wards. On the male side, beside the usual cases, there was a man with aneurysm, another convalescent from pneumonia; the sister feared that he was developing phthisis. In a small ward there was a man dying of phthisis. In conversation with the medical officer, Mr. Guilding, he said that with the material at his disposal he would be able to undertake any operation in the infirmary or to carry through any treatment. We noticed the absence of bed-cards, but these are under consideration, the present medical officer having only just been appointed. One of the female wards is at present used by the female imbeciles, the separation wards for these cases being in the hands of the builder. The patients are not classified as medical and surgical, the latter bearing a small proportion to the former.

There are two isolation buildings. One of these is "the cottage," in which are placed the male and female lock cases, tramps, under treatment, and some cases of offensive ulcerated legs. This building holds 12 beds in two wards, and can be used as male and female isolation simultaneously — at the time of our visit the patients were all males; there is bath-room and lavatory accommodation, and, by an ingenious contrivance of approach, was available for the two wards. The wards are heated by steam pipes and an open fire, the pipes were in use, and it struck very warm on entering. In another part of the grounds we came upon the infectious hospital, a one-storeyed hut, having two wards for 4 beds each, kitchen, bath room, and small laundry. The water supply is heated in the kitchen boiler. This hut is for the intercurrent cases only, and some of its space is being utilised for the additional nurses; when required for its original purpose, the nurses would be housed elsewhere.

As the department that we have been describing is that for which the sister is responsible, it will be well to state the number and style of her assistants. The sister is head of the nursing department, under the master, but she rules in her own department; there are four assistant nurses and two probationers to nurse the 150 in the hospital and those patients who are in isolation; two of the staff are on night duty, taking one month on night and three months on day duty alternately. The "cottage" is under the charge of a wards-man, the dressings being attended to by the nurses; he is responsible at night, calling aid if required. All the nurses are trained, the probationers are there as pupils; they will be instructed in nursing by the sister, who will also teach them midwifery; they will also have the advantage of lectures by the courtesy of the authorities of the Royal Berkshire Hospital. The pauper inmates are kept to the cleaning and service of the wards, except that they must help the night nurses with the bed making, until the Board is in a position to give more help at night. The hospital is in telephonic communication with the master's office. and the doctor's house is connected by telephone with the office.

The food is prepared in the main kitchen, where it is divided into portions on plates, and sent to the hospital in covered tins; we were informed that it was quite hot when served out. The dieting of the sick is in the hands of the medical officer. On looking through the table of that which is given to the infirm, we see that it includes fresh cooked meat three days in the week. and on the other days there is hash, meat pie, or suet pudding, and broth. With the meat they have potato, or other vegetable; they also have butter and tea allowed to them. We saw the dinner being served, and it looked well cooked. The bread is made in the house; both it and the butter tasted of good quality. The sister informed us that any special diets that may be ordered for the sick are always nicely prepared. The kitchen is under a man cook.

There are about 60 certified lunatics under the care of the guardians, for whose accommodation alterations are being made in one of the detached buildings. These plans did not recommend themselves to us, for they only include the female patients, the male lunatics having been removed to the house with their male attendant. This arrangement seemed to us to be extravagant as duplicating all the service, and necessitating the appointment of an assistant for the female attendant unless she is to be always on duty, and unless the guardians are prepared to run the risk of a casualty. This block comprises the dayroom, dormitories, and attendant's rooms, with the bathrooms, lavatories, and padded room. We understand that the original plan included male and female quarters, with attendants' rooms in the middle block, an arrangement that sounds more complete. The place was in the hands of the workmen, so that we could hardly judge of its capabilities, but we were unfavourably impressed with the padded room. The floor of this is laid in padded sections screwed to the floor. In the event of excreta being on the sections it would flow between the interstices, and the floor could not be cleansed except by removing the pads. The window also appeared to be quite unprotected. We noticed the same defect in construction in the padded room on the male side.

The washing for the whole establishment, with the exception of that used in the infectious hut, is done in the one laundry. It is a large, well-lighted building, the steam for the coppers comes from the great heating boilers, which are beneath the ironing room, supplying warmth as well as steam, so that the only fire in the laundry is the ironing stove. All machinery is turned by hand. The soiled hospital sheets are at once put in a large sunk tank with Jeyes' fluid as a purifying agent, before they go through the washhouse. In this same shed there is the disinfecting oven, heated by steam; we noted that there appeared to be no pyrometer indicating the heat, it might be well to add this. The two large boilers heat the water, and send the steam for supplying warmth all over the building. In the winter the master thought it would be necessary to work both boilers.

In concluding this article, we note with satisfaction the steady progress that trained nursing has made in this union. The nurse who now holds the post of sister has worked in the old hospital for twelve years in the face of many difficulties, at first with a male nurse for the men, and then later on single-handed. It must be gratifying to all concerned to see the results, and we cordially re-echo the Chairman's words, that it is well to have seen the end of two such abuses as pauper nursing and the male nurse.


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