BMJ Reports on the Nursing and Administration of Provincial Workhouses and Infirmaries, 1894-5.

SWAFFHAM, NORFOLK.

Our wanderings brought us in due course to this little Norfolk town, the centre of a district mainly agricultural, though part of the land is suited for little but the rearing of the game with which the country abounds; rabbits, hares, and pheasants may be seen in large numbers in an afternoon's drive. Like many another Norfolk union the accommodation provided in the workhouse exceeds the demand; this house once held 300 inmates, and at the time of our visit there were about 40 people under its roof. Norfolk is rich in churches and in workhouses, but the people, who filled both in earlier days, have moved away.

The House is one of the oldest in the country. The introduction with which we were furnished secured courteous attention to our wishes, and we were at once shown the quarters provided for the sick.

The infirmary consists of a ward for female patients holding six beds, and a detached building standing some distance from the house for the male patients, holding 20 beds in two wards. This detached building may be emptied of its ordinary patients and used as an infectious hospital if need occurs.

The patients in the female ward were all cases of old age, except one poor creature placed in an armchair, and artificially supported by cushions, a case of complete paralysis. The doctor, whom we saw later, explained that he required the attendant to get this poor woman up every day in order to prevent the formation of bedsores. That pathetic figure haunts us now; if the ratepayers could only see and realise the wretched discomfort of this poor creature it would plead more earnestly than any word of ours for the trained nurse, and might stir the public mind to a sense of its responsibility to these helpless human beings.

On the male side was a man suffering from phthisis, wearing an aspect of weariness and suffering, and in the next bed a case of acute bronchitis, treated with frequent poultices and brandy every two hours. This ward was under the care of a pauper inmate and we concluded that he made the poultices and administered the brandy; the matron spoke highly of his care of the acute cases, and we see no reason to doubt her verdict as far as regards kindness and good will, but this is not nursing. The other patients in this ward were up; there were rheumatism, heart disease, local paralysis, and the usual cases of infirmity.

The nurse, so called, is a paid officer, and as we were going round the wards we came across her making toast at the kitchen fire; in addition to her duties as nurse she appears to act as assistant to the matron and caretaker of the children; she is moreover required to help with the needlework. We must not blame her for not being in the wards, for it may be that the efficient pauper is more acceptable to the patients than the official who is really their responsible attendant, but it is another instance of the fact that the untrained nurse often fails to realise her position in regard to the sick. The matron informed us that when an addition to the nursing staff is required special inmates are told off for the duty; or a trained nurse is engaged from the home in Swaffham.

The midwifery cases are attended to by the doctor, who resides nearly a mile from the house. The labour ward is quite apart from the house and has separate offices; it holds two beds, one for the patient, and one for the inmate who looks after the case until recovery. The ward was empty at the time of our visit; it was quite clean and ready for use.

Bells of communication ring from all the wards, and other parts of the building to the porter's room; we were informed that the nurse did not sleep near her wards, and that there was no bell from the male infirmary out in the garden. The doctor is summoned at night by a messenger.

The bedding is long straw, and the beds felt elastic to the touch, and were supplied with ample clothing, but all the bedsteads were too narrow for comfort. The wards are all on the ground floor having a pleasant look out on to the gardens; the ventilation was by means of the raised sash and the block in the window frame. The male ward on entering felt wanting in freshness but it was not foul. The patients are well supplied with armchairs, but they had no day rooms.

The closets were either the earth or water system. A bath room was attached to the female ward, with a cold water supply; it was fitted with a heavy wooden cover, which certainly protected it from being a receptacle for odds and ends, but also concealed dirty water, as we saw by lifting the cover. The bath room for the male infirmary is of the same kind, no hot water is laid on. The whole system of drainage is behind the time.

The imbeciles and idiots were kept among the infirm; there were very few in the house at the time of our visit. We were pleased to see that the inmates were allowed to wander all over the gardens; we saw some of the infirm patients walking in the garden, and seats were placed for their use in a delightfully shady spot. We quite agreed with the matron in thinking that the inmates were well off in that particular.

RECOMMENDATIONS.

We almost always find it necessary to end our reports with the same suggestion, namely, that efficient nursing should be provided for the sick; these infirmaries in remote country towns are the only hospitals for the sick poor, and they should be equipped as such. We also recommend the placing of the sick under one roof, with the nurse's quarters in communication, and the labour ward in the same part of the building. Would it not be possible to adapt a part of the house for this purpose? in which case the separate building could be kept entirely for infectious work. An additional nurse should be engaged when the nature of the cases under treatment requires it, the paupers being retained for the service of the wards only. The adaptation of the disused part of the house to infirmary purposes should include the construction of bath rooms and suitable closets.