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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 Wakefield union workhouse.

WAKEFIELD.

On arriving at Wakefield, we visited the medical officer of the workhouse, hoping that he might be able to accompany us to the infirmary. Unfortunately he was out of town, but his assistant kindly telephoned to the master stating the purpose for which we wished to visit the infirmary, when an answer was immediately returned that we were welcome to do so.

The Wakefield Workhouse Infirmary is in two blocks, standing apart from but near to the main building. There is accommodation for 130 patients in all; in the main block are the general cases, and in the smaller block the offensive and lock cases are isolated. The lock patients are placed in small wards at each end of the block for offensive cases; there are 2 beds for the female and 4 beds for the male patients, having separate offices. In the general wards on the female side the bedsteads are of the full width, and the bedding is straw or flock according to the nature of the case; sometimes a water mattress is supplied to avert the danger of a bedsore. The nurse turned down such beds as we desired; they were all quite clean and were amply supplied with bedding. The wards are of various size, distributed through a two-storeyed building; they all presented a comfortable home-like appearance, with cushioned arm chairs for the old people when cut of bed; we did not see any couches. We were much pleased with the ample supply of nice handy rail-screens, some of which were shielding off a draught and others around beds whose occupants required quiet; they made a bright feature in the wards, with the coloured chintz cover neatly fastened on and easily removed. The system of ventilation is chiefly by means of the windows on the ground floors; on the upper floor there are also ventilators in the roof. We noticed that some of the beds were placed along the walls of the ward, the head of one to the foot of the other; this was allowed to economise space; but it seemed to us that the more healthy plan would be to have a bed or two less in the wards. On the male side some of the bedsteads are of the narrow width which should never be used in an infirmary; the bedding was the same as that supplied to the females.

We were not so pleased with the appearance of the wards in the isolation block; there was a look of neglect in all their appointments, as though, because these poor creatures were helpless and, in workhouse language, "dirty cases," they did not need so much care as the other patients. We were particularly struck by the beds; these were of all sizes, the foundation being laths, over which was a thin chaff or straw mattress, not by any means sufficient as a cushion for the patients to lie on all day and night. The ward also lacked the look of finish that we saw in the other wards. Is it that these poor creatures are treated as naughty children who must be punished for their infirmity as for a fault? The wards themselves were gloomy; they wanted something to brighten them up.

There is an ample allowance of sanitary appliances on each floor and to each ward for use at night; on each floor there is a fixed wash basin, hot and cold water; each set of wards has its bathroom. Here we found the wise precaution of having these kept locked, for the average pauper looks upon a bathroom as a receptacle for all rubbish and as a place where he may do any washing of clothes, etc., that pleases him. The closets have a good flush, and were clean at the time of our visit, which was about 10 A.M.

The number of nurses employed to nurse in these wards is two; one nurse has the main block, and the second nurse the isolation block. The nurse in the main block has received hospital training; the nurse in the isolation block has been trained in a lunatic asylum. The board had just engaged one night nurse; her quarters were being prepared at the time when we saw the infirmary. The nurses took us round their wards and gave us every facility of seeing their work after we had been introduced by the matron. Pauper help is largely made use of in the infirmary; each ward — and there are about sixteen in the blocks — has its wardsman or woman, and they do the nursing under the nurses; this follows as a matter of course, as it is beyond the powers of any nurse, however energetic, to attend individually upon over 90 patients. Until quite recently there was no trained night nurse; such an officer has now been appointed and will be responsible for the hundred or more patients scattered up and down in the wards. On conversing with the nurse in charge of the isolation hospital, she told us that the air of her wards when she came on duty in the morning was very foul. These poor bedridden patients being in the charge of inmates during the night, their beds were not properly cleansed, nor was the very necessary ventilation looked after by the inmates. Besides the usual duties of a nurse, each nurse has her laundry, for the working of which she is responsible.

The patients are the usual admixture of acute and infirm cases. We saw a girl up for the first time after pleurisy; her temperature chart showed an acute and somewhat prolonged attack; she had made a very good recovery. We saw a wardsman who had pleuritic effusion; we should not like to say how many pints had been taken from the chest, but his recovery was excellent; there was no perceptible flattening nor deformity, and he stood up straight, with a good physique. There were not many in bed. We saw a case of advanced phthisis, rheumatism, and heart disease (the man had lain in bed for seventeen years; his skin was quite whole); a case of pneumonia recovering, paralysis, and several bad cases of old age; speaking from recollection about six of these were charted. In the isolation block, holding 40 beds, nearly every patient was in bed, and they all required the nursing of a child.

The lying-in ward is in the house department, but the nurse of the infirmary is the midwife. She explained to us that when she is called over to this ward in the night she calls up a man and a woman for each side, and leaves them in charge whilst she is occupied with the confinement. There is accommodation in this ward for three patients, and it has a small ward attached holding two beds for convalescents. These wards have separate offices. There are no means of communication through the building for use at night; as before mentioned, there is a telephone to the doctor's house.

There is a nice ward for the children in the infirmary; at the time of our visit this was occupied by little patients with whooping-cough; they had plenty of toys and books for play. None of them were in bed.

The imbeciles are kept apart in a separate ward on the male and female side, but the communication between these and the other wards was quite easy.

There are no day rooms in the infirmary; the airing courts are of the nature of back yards; the patients are not allowed in the garden. We always feel great pity for the patients whom time after time we find kept to these dreary courts for their recreation; four brick or stone walls, a few benches, the sky above them, and the asphalte beneath them; how can they be any the better for fresh air thus doled out?

RECOMMENDATIONS.

We have here a sick department as large as some of our smaller hospitals, with three nurses as the nursing staff. We recommend that the staff be doubled at the least, and that the infirmary be made use of for training purposes for probationers; that the paupers be used for the ward service only. We heard that the board is purposing to build a new infirmary; in this case, is all probability, it will be their intention to increase the nursing staff, and we hope that they will make the hospital into a separate department under its trained matron; for with the amount of acute cases that are admitted in the year there would be ample material for the training of probationers in the first part of their duties.


The BMJ subsequently published an account of a meeting of the Wakefield Board of Guardians at which its commissioner's report had been discussed:

WAKEFIELD: A CORRECTION.

Mr. Kennedy, the Local Government Board Inspector of Workhouses, attended, and we have before us a report of his address. He is described as having spoken with much warmth, and said he considered it his duty to make certain explanations to the Board. He had taken the report very much to heart, and other gentlemen connected with that Board had done the same thing. We can only say that it is a matter of great satisfaction that Mr. Kennedy has taken the report to heart, and we take it as a good omen for future reforms.

We could wish that his explanations had been more satisfactory and dealt with what was really the main matter of the report, instead of somewhat hotly and captiously questioning minor points.

The chief charge which we bring against the Wakefield Infirmary is the insufficiency of the nursing arrangements. Mr. Kennedy has not one word to say in contravention of the statements that there are but two nurses by day for the patients — whose number he himself, after making some deduction, puts at 113 — and that pauper help is very largely used. He prefers to insist rather on the fact that a single night nurse has recently been added to the infirmary staff. We congratulate the board on a step in the right direction, but we cannot agree that the nursing staff is yet sufficient. Does Mr. Kennedy seriously contend that the nursing is in any way adequate to the needs of these patients? If not, we must call his attention to the fact that he has really failed even to touch the main charge.

Then as to the isolation block which we condemned. Mr. Kennedy makes the lame excuse that between 10 and 11 o'clock in the morning, when the beds were being made and the rooms were being cleaned, was the worst time for making a visit to the house. Our Commissioner was a person peculiarly well able to make the necessary allowances in this matter. Mr. Kennedy observes that the arrangements were not as complete as desirable. Our contention is that this ward is a disgrace and that it needs to be condemned. We are inclined to suppose that "incomplete arrangements" may be Mr. Kennedy's euphemism for this state of things. It is one which we cannot admit and which we contend it is contrary to his duty to employ. We have no doubt that Mr. Kennedy is conscious of some of the difficulties of this place, and we are glad to learn that one or both of the buildings are likely to be pulled down; but we very much doubt whether he is an adequate judge of what is needed in nursing and what is proper for the construction and administration of isolation wards.

Touching upon our statement that the patients were not allowed in the garden, Mr. Kennedy "alluded to the danger of a deep and dangerous cutting on to the railway at the top of the workhouse garden, which inmates, especially imbeciles, were likely to get over if left to themselves in the garden."

It is hardly possible to find a better example of the official excuse for doing nothing. If the guardians omit to put a proper fence at the top of the cutting, or if they omit to have someone to watch the inmates, "especially imbeciles," who is to blame? and why does Mr. Kennedy think it his duty to hotly make excuses for not doing what is proper, instead of pointing out the means of doing it?

As to the overcrowding of the wards, according to the inspector's reckoning they contain each 7,000 cubic feet (35 feet by 20 feet, by 10 feet high). This gives 700 cubic feet to each patient, which is below even the Local Government Board minimum. If the beds had been placed with the head to the wall, the passage would have been too narrow, and the excuse that they were so placed to prevent patients from falling out of bed cannot be accepted.

It would be waste of time to go through the minor corrections which Mr. Kennedy makes, most of them incorrectly. We are satisfied with his practical admission that the isolation ward is what we describe it, and that the nursing arrangements are inadequate.

Mr. Kennedy may be of opinion that 33 inches is sufficient width for the bed of a bedridden patient, especially a male patient. We are of the opposite opinion.

We may remark, finally, that we did not mention Mr. Kennedy, and made no attack upon him, or charge against him; but he now places himself in a very invidious position, and we can only ask the Local Government Board to supply Mr. Kennedy with the eyes and knowledge which he apparently does not adequately possess, by sending down a medical inspector to examine this place, and to make necessary recommendations. It is not at all a question of amour propre; it is the treatment of the sick poor. We have no doubt that this officer is well intentioned, and that both he and the guardians are open to conviction, and willing to do their duty in that case. More knowledge is required, and Mr. Kennedy should supplement technical deficiency by applying for the assistance of a medical colleague.


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