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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 Totnes union workhouse.

TOTNES, DEVONSHIRE.

We fancy that this house must be unique in construction. It is built on the side of one of the steep hills of this lovely country, and clambers up the slope in sections. It stands a little way out of the pretty little Devonshire town, and commands a magnificent view over the surrounding country. The grey stone of the locality, of which it is built, and the small windows, give a prison-like aspect to the exterior.

The house stands on a terrace reached by a long flight of steps. The first section contains the wards for the old and infirm; a climb up the hill takes us to the quarters for the able bodied; above this is the hospital; and a further climb will bring us to the isolation hospital, which crowns the hill. There are, in addition, two detached annexes; in the eastern one are a ward and a day room for infirm men, in the western one is the laundry. The eastern annexe opens on to the stonebreakers' yard; the other intervening spaces between the lines of building form the gardens or airing courts for the various departments.

As our visit was specially to the sick the acting matron conducted us first to the hospital. This building is set on arches, above which is a pleasant terrace round the wards. Here we found some of the patients on benches, enjoying the sunshine and perhaps the view. A few creepers and nasturtiums gave a cheerful look to the exterior. The hospital is in two detached buildings for male and female patients, 18 beds for the men and 28 for the women. In one female ward there was a patient with chronic rheumatism, another with bronchitis; in the second ward a woman with complete paralysis, another with internal tumour, a patient recovering from bronchitis, a case of old age, in all six in bed; several women were up in the day room, or out on the terrace.

The male patients were mostly in the day room or on the terrace; one man was in bed suffering from extreme weakness after bronchitis. In this block there are 9 beds in each ward, and there is less crowding than in the female ward. We found idiots all over the place; there is no classification. In the eastern block are 10 beds and a day room, the latter with its cushioned seats, table and cheerful fire, was the most comfortable room in the place. Here all the men were up. The ward is reached by three steps up from the day room; we could not discover the structural reason for thus raising the floor of the inner room, but it seriously curtailed the cubic space, as the pitched roofs of both were on a level.

The infirmary is in the first section, near the gateway, and contains male and female wards. There are 18 beds for women and 17 for men on the first floor, where also is the lying-in ward. There are no day rooms. The beds are close together, and when they are all occupied, and the weather such that the inmates cannot get out, the atmosphere must be anything but wholesome. The walls are painted and have a smooth surface. the roof is pitched, with cross beams. In the men's ward there are two open fireplaces; in the women's there is a tortoise stove and one open fireplace; there is a large boiler beside the fireplace, with pipes from it taken round the ward, to increase the warmth in winter. Gas is used for lighting throughout the buildings. There were very few armchairs in the wards; in the male hospital day room was an ancient wooden arm chair with a thin cushion on the seat.

There were three men in bed in the infirmary, one was laid up with a "bad leg;" in reply to a question, we were informed that the leg was "just bandaged." The other patients in bed were cases of senility. The usual group of listless old men was seated on benches round the fire. There was a similar group in the women's ward, and one patient in bed. The bedsteads are narrow and low, with straw or flock bedding; we did not observe any pulls with which the patients might assist themselves when in bed.

The lying-in ward is partitioned off from the end of this ward; it holds four beds. All sound must be transmitted from one ward to the other. We saw a convalescent patient with her two weeks' babe, and an old pauper in charge. There are no appliances of bath or water, and the closet is common to the lying-in ward and the infirm ward.

The nursing is divided among three, a male and two female nurses; the head female nurse is in the infirmary, and she is the midwife; the assistant female nurse is on duty in the hospital; the males nurse is responsible for all the men, sick and infirm; none of these are hospital trained. There is no night nurse. A "ward tender" is appointed to each ward, and these seemed to do much of the nursing; they are mostly old people.

The sanitary arrangements are of the old style: there is a closet for each block in the hospital, rinsed by the turning of a tap; that for the women is small and inconvenient; there is much more space on the men's side. The fixed bath on the women's side appeared to us to be most unsuitable for use by sick or old people; the raw edge of the metal, turned outwards at a right angle, is unprotected, and might be dangerous. The men's bath is movable. The water is pumped up, requiring the entire labour of one pauper. The water for the fixed bath is heated in a boiler in the hospital kitchen. In the infirmary there are movable baths; the closets are of the same style. and open immediately from the wards. We found no single closet sweet, and the urinal, also rinsed by tap, was in a foul condition. We came to the conclusion that the baths were not often used.

The isolation block holds eight beds; it was empty at the time of our visit. It is divided into four wards with whitewashed walls, and there is a small kitchen and closet. The straw bedding is destroyed after each case, though, as we saw the bedding left by the last patient, a man with itch, there seems to be some lack of promptitude in carrying out this detail. We would suggest that an old stuffed screen, offering a good soil for germs, should be added to the next bonfire.

This building is the only means of isolation. The matron informed us that when a patient is isolated "watchers" are sent from the house to take charge, or he is nursed from the infirmary.

The nursery is in the able-bodied part of the house; one little inmate was the sole occupant, in the care of a pauper. Ancient wooden cradles were in use and there was a dreariness and inattention to the needs of child life only too common in our workhouses. There are no bathing arrangements. The infants are kept here till they are three years old. The mothers feed their infants and look after them in the nursery.

The diets include meat daily, which is roasted on two days in the week; it is distributed in wooden trays with metal covers from the house kitchen.

Bells of communication ring from the wards to the master's or porter's rooms; the receiving wards in front of the building and the tramps' quarters ring to the porter's lodge. The doctor, who lives about a mile from the house, is fetched by messenger.

RECOMMENDATIONS.

We understand that the guardians propose building day rooms, with bathrooms underneath, for the infirmary block; this will be a great improvement. We would suggest that the alterations should include a new lying-in ward, at a greater distance from the old people; also that the sanitary appliances all over the house be brought more into harmony with modern ideas. We believe that there is an ample supply of water, as there is a mysterious ever-flowing spring which could doubtless be utilised. New bedsteads of a more comfortable pattern for the old people, more arm chairs, the brightening of the hospital day rooms, especially the men's, would conduce to the comfort of the inmates. Above all, a staff of trained nurses, with one on duty at night, is most essential.

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