BMJ Reports on the Nursing and Administration of Irish Workhouses and Infirmaries, 1895-6.
SLIGO WORKHOUSE INFIRMARY.
Our visit to this house was made at an inauspicious moment, owing to a recent outbreak of fever. It seems that during a long period of immunity from infectious disease the fever hospital had been used for the female sick, but, on its being required for its original purpose, the hospital patients were removed to the infirm wards of the body of the house. The male patients are nursed in the hospital proper. When we visited the house the fever hospital — cleansed and disinfected — was standing empty. We gathered that there was some difference of opinion among the authorities as to the use of the fever hospital for general patients. We are not able to decide as to the rights of the question, but any unprejudiced observer would be struck by the inadequacy of the present arrangements for the nursing of the sick. There is an average of 140 patients, who were thus distributed: the men in the hospital proper, where also we found the female lunatics placed at one end of the block and the male lunatics at the other. In this block there were about 70 beds. The female patients are on two floors of the female infirm block 30 beds on each floor in one long ward. If our readers will call to mind the plan of an Irish workhouse they will recollect that these blocks are distinct buildings, separated by wide open spaces. At the time of our visit the female patients far outnumbered the males: there were 70 women on the books and 38 men.
The female wards were crowded; the low-pitched roof and want of cross ventilation and the length and narrowness of these rooms rendered them quite unsuitable for sick wards. The passage between the two rows of beds was levelled up to the height of the platforms. An additional stove, with a flat top, serviceable for keeping food warm, was placed in each ward, and two windows had been opened in the outer long walls. The coloured plaster of the walls had a smooth surface. There were a few armchairs, small tables, and commodes. The bedsteads, which are close to each other down either side, are wire woven, and have blankets laid on them instead of mattresses.
The male hospital was equally crowded. As the wards were so full in the summer we wondered how accommodation of any kind could be found in the winter months for the additional patients, many of whom come in with phthisis in the acute phase. The large wards on the upper floor held twelve beds each; one on the ground floor had 19 beds, and a smaller one 5. We also found the bath room converted into an isolation ward for an offensive case. An inmate was in charge of the unfortunate patient, who looked very ill, dirty, and uncared for. Two beds were in this little room, already half filled by the bath; there was a small window and a stove. We judge from the appearance of things that the bath room was seldom used for its legitimate purpose. Upstairs the roof is pitched and plastered, the walls plastered and colour washed. The wards are ventilated by openings in the roof, and in some cases by perforated panes in the windows. The windows are small, and there is no cross ventilation; the old-fashioned fireplaces, one to each ward, are inadequate for heating purposes and very wasteful of fuel. There are no day rooms.
The patients in this hospital included a cretin of 23 years of age, who in size and general appearance resembled a child of 5 or 6. The poor little creature seemed to be a general pet in the ward, or perhaps we should rather say that he furnished some amusement to the inmates, who were many of them confined to bed with chronic ailments. The bedsteads in this division are "harrow" frames, with straw ticks and pillows; a board let into the wall forms the bed head. The majority of the cases were helpless old age and chronic diseases. In an inner room a phthisical patient was dying; he had just been visited by his priest as we came into the ward. There is no night nurse for these 140 patients.1 The day staff is quite inadequate, and, in the words of Dr. Murray's report, "the night nursing is in the hands of paupers." We saw one nurse in the male hospital and one in the female wards, and we understand that there is a third nurse on the staff, the senior nurse being trained, and the two junior nurses acting as assistants to her. A hospital of 140 beds, as large as some of our county hospitals, with 3 nurses by day and none at night! Among the women was a case of fractured leg; the other patients, of whom about half were in bed, were chronic or helpless cases.
The lunatics are in charge of paid attendants; the cells are not in use in this workhouse, but the quarters provided for this class, especially for the females, are cramped and unsuitable. As we mentioned above, the women of this class are lodged in two small wards at one end of the male hospital, with the result that they have no yards for air and exercise. The listless, apathetic air of the idiots and epileptics showed that nothing was done in the way of occupation for the lightening of their unhappy lot. Perhaps nothing was possible in their surroundings. The male lunatics are slightly better off; they have the use of an airing court, such as it is, some of them find occupation about the house, and they are not so overcrowded. As the workhouse is close to the county asylum the more dangerous inmates are removed thither as there is room in the asylum.
The infirm class on the female side are lodged in the quarters set apart for the able-bodied; they have no dayrooms because the sick are in their wards. We found the men in the ground floor ward of the male wing, and for them there is a dayroom. Men and women alike sleep on harrow beds with straw ticks; there is one basin and one roller towel in each dormitory for the use of 24 to 28 individuals. The women are crowded together in the room which should be the dayroom, where both light and warmth are insufficient. The only outlet is into the large yard, common to both firm and able-bodied, used also as the laundry drying ground.
The male infirm attendant, known as Peter, a fine tall man, told us that he was working in Glasgow and doing well, when he injured his ankle, and, falling into the hands of the Poor-law authorities, he was sent back under the Act of Settlement to his native place, Sligo, though he professed himself able and willing to resume his work; and there he remains a burden on the rates, though he appears to be able to maintain himself. There is probably another side to the story, but on the face of it it appears to bear out the contention that timely and generous medical relief, coupled with discriminating assistance, would save many a man from becoming a pauper. We noticed some concessions to the old people which betokened kindly thought on the part of the authorities; the old men have their dinner in their own dayroom, which does not indeed afford much comfort or cheerfulness, but it keeps them apart from the ruder and noisier class. The old women are allowed to wash their own caps, kerchiefs, and other small belongings, and have the use of the laundry on one day in the week for the purpose. This privilege is much appreciated by the more respectable class, and we have heard of the women paying an inmate with tea to do this small service for them, rather than that their personal clothing should pass through the general laundry. It is the same old tale, almost nauseating in its iteration, of the entire absence of anything like decency or sanitation, when we come to the conveniences provided for the inmates. Outside are privies on the waggon system; indoors, buckets, pails, and commodes are in use in the sick and infirm wards, these vessels remaining unemptied and frequently uncovered the whole night. In considering the cubic capacity and amount of ventilation in a ward, we must remember that it needs to be unimpeachable in these particulars when the atmosphere is poisoned in such a way at night. We have already noted that these wards are crowded and doubtfully ventilated; nor are there any facilities for the cleansing of the inmates or of their surroundings.
A basin and a round towel are provided for common service among the sick, and a bath or two, without hot water. Every drop of water has to be carried to the wards for use, and carried away when used, and when warm water is required it must be heated in a kettle or fetched from the main kitchen. It is not surprising that we noticed a lack of cleanliness and sweetness in the wards. The town water supply is laid on to the workhouse. Some of the sewage is carried to a large pit at a distance from the house and some drains into the river.
The matron kindly showed us the laundry and clothes store. Both are under the charge of the same officer. The room set apart as a clothes store is anything but suitable; the brick floor and the walls were stained with moisture, and the window was very small. We saw no mangle in the laundry; the drying closets are fair, and are heated by steam from a central boiler. The same steam heats the jacketted boilers in the kitchen — there is no other means of cooking — where the stirabout for that day's meal was being prepared.
The fever hospital, then standing empty, is at the back of the hospital block. It stands on a slight hill, and as the building is also raised somewhat above the level of the ground it has quite an imposing appearance. In internal arrangements it is similar to other fever hospitals: four wards on the ground floor, two long wards above, administration block in the middle, cross light and ventilation. kitchen and laundry, all offering excellent accommodation for the unhappy patients now crowded into the infirm wards. We do not wonder that the officials felt aggrieved at the sight of the empty hospital.
The nurseries are in three sections for purposes of classification; the first division being for unmarried mothers who have had more than one child. Here we found, unhappily, several women with their infants. The second nursery is for unmarried women with their first child; here we saw three women, but are not sure that there were not others of the class in the house. The third nursery is for the use of the married women; this section was empty. An inmate is supposed to be in charge of each section, but as the inmates can have but little control over each other, we found the nurseries wretched, dreary, and bare; the infants dirty and unnursed, and the usual absence of order and method. But the classification whereby the unmarried women of the first class are kept away from the more depraved is a real boon.
Our visit to the house made it clear to us that the sick department had quite outgrown the limits of the hospital as originally planned. The first necessity, therefore, is a hospital department adequate to the number of patients. The temporary character of the present female wards is so evident, especially to those who have to work them, that we wonder they have been tolerated so long. With the remodelling of the hospital will come, we trust, a sanitary system in accordance with modern requirements. But even before this can be carried out the nursing of the patients should be provided for. It seems to us nothing less than inhuman to leave from 140 to 150 paupers — sick, helpless, and infirm — with no skilled attendance at night. and equally inhuman to expect the day nurses to face the alternative of either breaking their night's rest continually, or leaving their patients to die alone in the night. The nursing staff is lamentably insufficient; we would urge the Board to consider the whole question, with a view to superseding the pauper help by skilled service.
1 Since this report was written we understand that two paid nurses have been appointed, who are allowed to sleep by day.
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