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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 St Alban's union workhouse.

ST. ALBANS.

The next house that we visited was St. Albans, situated at a little distance out of the town, and standing on a slight elevation, with open space all round. The inmates are drawn from an agricultural population, and this class is low in intelligence, and enters the infirmary at an advanced age. The building set apart for the sick is small, crowded, and unsuitable for its work, but the matron informed us that the guardians were contemplating the erection of the new infirmary.

The matron was most obliging in showing us over the infirmary and in giving us every information. The wards were rather empty, but when all the beds are occupied there must be overcrowding; they are small rooms, holding five or six beds and these wards serve as dayrooms, the meals of those patients who are up being taken in them. The dinner was being served when we were going round; it consisted of boiled pork and potatoes; it was well cooked, but the thick slices of fat pork could hardly be an appetising morsel for a sick man. Special diets are ordered by the doctor, such as fish, milk puddings, eggs, beef-tea: these we saw on the bed cards, and the matron informed us that milk and beef-tea was given to the sick at night, for they have their last meal at 6 o'clock.

In the infirmary there are two nurses, the senior being fully trained, and the assistant having had some experience in the infirmary work. There is no night nursing of any description, the usual wardsman or wardswoman sleeping in the ward. In the event of a patient being seriously ill, the watches are taken by the two nurses; no patient dies unattended. There are fifty-eight beds in the infirmary, the heaviest work just now being on the male side; the cases included paralysis, rheumatism, bronchitis, and several of senile debility. The paupers help with the bed making, and wait on the patients, except those serious cases which are attended to by the nurses themselves, who also wash the patients. The labour ward is small, opening out of one of the infirm wards; it is not often used, and then principally for unmarried women.

The imbeciles are kept apart; there is no provision for dealing with the insane, but in the event of a patient being uncontrollable, paid attendants are hired to take charge of the insane until removal to the asylum. There were no lock [venereal] cases in the building at the time of our visit, nor is there any ward for their reception; such as may require isolation are kept in the receiving ward.

The bedsteads were the miserable 2 feet 3 inch bed with a flock mattress and a proper supply of bedding, but we were pained to see the poor old people, many of whom never leave their bed, condemned to lie on a bed which was almost too narrow to turn round on; one big woman to whom we made this remark said they were most uncomfortable, and more easy to roll out of than to lie in. The bathrooms are on each floor, but from the overcrowded state of the infirmary they were full of a miscellaneous collection of articles, making it evident that they could not be frequently used. They were supplied with hot and cold water, and there was a good flush in the closets. There are no slop sinks, nor did there appear to be any convenience for emptying water except in the closet.

There is an infectious hospital attached to the Union, at this time empty; it is provided with a disinfecting oven, but here we noticed that the important duty of placing the clothing in the receptacle is entrusted to a pauper. What is the use of having complicated apparatus, when they are rendered useless, or worse than useless, by neglecting to provide a responsible man to see that they are properly worked? Nor was the infectious hospital kept ready for the reception of patients; a nurse would have to be found, a certain amount of lumber to be removed, and the place cleaned up. It is a new building, so perhaps the guardians do not yet understand the use of their possession.

RECOMMENDATIONS.

That a new infirmary be built bringing the sick of both sexes under one roof, thus economising the nursing staff. A paid attendant to be put on duty in the sick wards at night. The setting apart of wards for the insane and the lock cases. That a responsible officer be put in charge of the disinfecting apparatus, and that the infectious hospital be maintained in a state of efficiency.

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