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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 Thomas union workhouse.

ST. THOMAS, EXETER.

Exeter is divided into two unions, St. Thomas being the one workhouse, and Exeter city the other. St. Thomas was built in 1835, in the form of the letter Y, a plan somewhat in favour at that date. It stands on a hill overlooking the city, the country extending beyond it. The master was pleased to show us over the house, pointing out with pride many recent improvements.

The infirmary is a separate block, behind and a little to the right of the main building. There is accommodation for 72 sick; we found 28 male patients and 25 female distributed on the ground and first floors. The wards hold from 6 to 10 beds a-piece, the larger wards being on the first floor. The wooden staircases lead to wide landings, and are the same on the male and female sides. There are also outside escape staircases, the spacious landings of which form pleasant balconies overlooking a wide range of country, and are used as airing grounds by the sick.

The wards were not crowded, plenty of space being left between the beds, and these were not all occupied at the time of our visit. The roof of the upper floor is pitched, with cross beams; there is a ventilator in the gable end and the upper window frame also serves as a ventilator, falling back to form a hopper. Open fireplaces are in each ward and plenty of arm chairs for the old people; at the head of each bed hangs the towel and the brush and comb bag for the patient. We noticed the want of cupboards in the wards or on the landings, also of lockers. Commodes are placed in the wards for the night. The bedsteads are narrow and low; the bedding is chaff or short straw, they were clean and appeared comfortable. There are no day rooms. Bells ring from the wards to the nurse's room and in the house to the matron's room.

The lying-in ward is on the ground floor; there is no labour ward. Here were two patients with infants of varying age. The poor weakly creatures were seated on ordinary chairs by the fire. We understand the feeling that prompts the hard measure so often dealt out to these women who make such a shameless use of the shelter which they can claim; but surely it is good policy to accelerate as far as possible their recovery and so discharge them the sooner, and a couch or a more restful chair might conduce to this end.

Isolation is decidedly defective: there is one small ward on the men's side that could be used if needed for any offensive case, (but we saw nothing for the women). There was a pregnant syphilitic woman isolated in a ward close to the tramps' quarters. The place hardly deserved the name of ward; it was a bare, whitewashed room, the door of which opened immediately into the court; it had a very small fireplace, one small window, and a convenience with a good flush. An inmate shared the room with the patient at night, and the matron was responsible by day. An isolation hospital was built some years ago; but it is too near the other buildings, and, as it is not self-contained, it has been used for a storeroom for vegetables for some time past. All cases of infection are removed to the sanatorium outside the city. There are no children's wards. The receiving wards are at the front of the building, and are provided with baths and conveniences, all of modern construction.

There were no acute cases in the infirmary at the time of our visit. The moat serious case appeared to be that of a man recently admitted suffering from some affection of the throat. Nine patients were in bed, mostly cases of senility or rheumatism. There is no classification, and we saw idiots and imbeciles in almost every department. When restraint is necessary the patient is placed in a separate room in the care of inmates.

The nurse, who has been in the service of the Board for some time, is. untrained, and, though she acts as the midwife, is not certified. The wards and the appearance of her patients. did her credit. There is no night nurse. Pauper help is used in the infirmary, and when all the beds are full these helps must be relied on for much of the nursing.

The sanitary appliances are up to date; the wash-out pan, the open seat, the porcelain, baths, placed free from the walls, with hot and cold water, all of recent construction, show that the guardians have been setting their house in order. One point struck us: the narrow covering to the pan affords no leverage to enable an old infirm person to raise himself; it is a real objection to these fittings in asylums for the sick and infirm, and it might be obviated by prolonging the seat a little on either side, or by a pull from the ceiling. Shelves placed in the bath rooms or closets for the chambers and pans would be an improvement. They were piled on the floor in confusion.

The nursery was one of the most cheerful we have seen; it was quite a pleasure to see the toys, pictures, wooden horse, and other accessories for a happy child's home. There was a bright fire, and the little ones seemed to be on good terms with the officers. The babies are kept here until they are 4, and longer if they seem weakly, as was the case with one little one now toddling about, but, being a backward child, it had been slow in finding its feet.

For exercise the patients can either make use of the fire escape balconies or go into the garden and field, as we saw them that day. The women's airing court is circumscribed as compared with the men's, but they have their days for going into the garden.

The bread is baked in the house, and tasted good. The infants have new milk, and the sick likewise, when this is ordered by the medical officer; the rest of the inmates, including the children, have scalded milk. The meat is roasted on two days in the week; and the portions being weighed and divided in the kitchen, are distributed in covered tins to, the various departments. We were informed that the sick diets were varied by the doctor.

RECOMMENDATIONS.

The defects in this infirmary are mainly structural: separate wards are required for isolation, especially for the lock cases; day rooms for the use of the more convalescent patients; a labour ward with separate offices; a separate department for the imbeciles, and a ward for the children in the infirmary. A trained nurse should succeed the present one when her time of superannuation comes, and a night nurse should be appointed at once.

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