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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 Thetford union workhouse.

THETFORD.

Thetford is one of the most picturesque of the Norfolk towns; it was at one time the cathedral city, and the doctor showed us some ruins of the cathedral in his field. It is still a thriving country town, its prosperity being doubtless due in a measure to its situation on the main line from Cambridge to Ely and Norwich.

The workhouse is a mile from the station, and stands on the edge of a common in an open healthy situation. It is an old house, and the infirmary department is under the same roof. We found the female patients on the first and second floors, the more helpless and bedridden cases being on the first; for these last there are 20 beds in two wards, holding 10 each. The wards had a comfortable appearance; there was matting on the floors, armchairs for the infirm, the windows were cheerful, and flowering plants about. The bedsteads are unusually low in order that the old people may be better able to help themselves at night; they are of fair width, and the bedding of straw or flock, or a water mattress if needed; some of the beds appeared to be insufficiently filled with straw, and the flock beds were lumpy, and by no means conducive to repose.

In the first ward there was a woman in bed, a case of old age, and in the inner ward two other women in bed, also cases of senile debility; the wardswoman is an imbecile; the other women who were sitting about were suffering from infirmity. On the second floor the patients were all up, and among them was a girl of 12 or 14 with an eruption on the head.

The lying-in ward opened out of this ward; it held four beds and had no separate offices. The nurse (untrained), not being a midwife, is unable to attend to these cases, for which the doctor therefore is responsible. The matron told us that these patients were sometimes placed in the charge of the nurse, but the doctor subsequently told us that he did not sanction this, though on the other hand, as he could not undertake to be on the spot whenever his presence was required, such attendance was unavoidable.

The male wards are across the yard, on the male side of the building; here also are twenty beds in two wards. We saw seven patients in bed: one dying of phthisis; another a middle-aged man with dropsy, which he attributed to a chill taken while sheepwashing; one had softening of the brain; another was paralysed, and the rest were cases of senile debility. The matron told us that there were no offensive cases in the ward. We ascertained afterwards that these "dirty" cases are placed in the "back wards" on the other side of a yard, and are in the charge of an ancient pauper. In these wards are eight beds, four for male and four for female patients. We heard that a patient with wandering habits had been placed there, and the wardsman if absent for a time would lock the door and carry off the key. This plan ensures safe custody, but might lead to complications.

The patients are practically in the charge of the wardsman, whom we saw feeding the dying man, though there is a paid officer to attend on them. This wardsman was past middle life, and his was all the service available during the night. There are bells from the general wards to the nurse's room, but none from the "back wards."

The nurse was in former days an inmate of the workhouse; she is now clad in uniform, and is called the nurse; she has held the post for four years. This system recommends itself to some boards of guardians on the ground of economy, if that term may be used to describe a transaction which is represented by a low figure in wages, but a high figure in waste of food, of nursing appliances, and perhaps of human life. We saw the nurse flitting about, but not taking the place of a nurse in the ward where the most serious cases were congregated, which was perhaps as well. The doctor informed us that he did not recognise this system as nursing, and that he did not put it to the test by attempting anything like treatment. When the medical officer lives nearly a mile from the infirmary his responsibility and labour are much increased by the absence of a trained nurse in the sick department, whose skilled observation could determine when it is necessary to send for him in the night or at other times. It is most unfair on a doctor to expect him to treat the sick pauper under such conditions, and we look forward to the day when these Country infirmaries shall become the properly equipped hospitals of the district.

The diets are of the usual kind — boiled meat, suet puddings, vegetables, with extras for the sick ordered by the doctor. The matron told us that she sent the dying man any little thing he fancied from her table. In passing through the children's ward we noticed some cases of impetigo and eczema among them. This surely points to a poor diet. We would advise the doctor to bring this matter before his board; indeed, the food of the sick and of the children needs revision.

The closets are close to the wards, separated by a single door, and with no disconnecting lobby; commodes are provided for use at night. There is an ample supply of baths, those used by the tramps being distinct from the inmates' baths; but, though these appliances are provided, with the present style of service in the wards there is no guarantee that the baths are used, or that each patient has fresh water; indeed, we have reason to think the contrary.

The airing courts are back yards. There are extensive gardens round the house, but we did not see any seats to show that the old people were welcome there.

At the back of the building is the small infectious hospital, which appeared suitable for its purpose; it was empty at the time of our visit.

RECOMMENDATIONS.

We suggest that these 57 beds for the sick and infirm be placed under the care of a trained nurse, who shall also be a midwife; that a night nurse also be appointed. That wards for the offensive cases be provided, in communication with the rest of the sick department. That the closets be cut off from direct communication with the wards, and that the places for the outdoor exercise of the sick be improved.


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