BMJ Reports on the Nursing and Administration of Irish Workhouses and Infirmaries, 1895-6.

YOUGHAL, CO. CORK.

Youghal did not look its best drowned in sea fog and drenched with the spray carried by the south-east wind over the town; but even under these unfavourable circumstances we gathered some idea of its beauty and picturesqueness. The workhouse is well placed, on a hill overlooking the town and the sea; it is quite a mile outside the boundaries. Dr. Charles Ronayne had kindly given us an introduction to the Superior, and armed with this we climbed the hill to the workhouse.

It is a large building of two blocks, a roadway dividing the male and female portions of the body of the house. It serves a large district, and is the only hospital in the neighbourhood. The convent, kitchen, and laundry form a group of low buildings between the infirmary and the main block, a distribution doubtless rendered necessary by the demand for increased accommodation, but it deprives the infirmary of light and air on one side. The dining hall and chapel connect this block with the sick department.

The infirmary is built on the usual plan; in the middle block are the night nurse's sleeping room and the maternity ward. This ward is small, and the bed appeared to us much too small for use as a labour bed. On the ground floor are the kitchen also too small, and badly ventilated, the storeroom, and the surgery. The surgery is also used as an operating room, for which purpose it must be very small and inconvenient. The two wards on the ground floor, which are devoted to surgical cases, hold each eight beds. They lead one into the other, and a locked door at the end communicates with the lunatic department. On the first floor, used for medical cases, are two wards, one with 8 beds, and a larger one with 14 beds. This arrangement of wards applies to both male and female divisions.

The wards have smooth surface walls, coloured; the floors are stained and beeswaxed; the pitched roof is plastered, and the ground floor is ceiled; the windows face each other, but are rather too small, not reaching to the cornice, and ventilation is by means of the windows only. The fireplaces are not good — wide open grates, wasteful of heat and fuel; in one ward is a boiler with a cylinder for the hot-water supply to the baths and service taps; this arrangement must cause at times an inconvenient amount of heat. There are no dayrooms, but there is a nice garden for the men; the women are not so favoured. We noticed some pictures on the walls and other decorations. A continuous shelf round the walls is a store place for medicines, and at the end of the wards was an unusual display of mugs, plates, egg cups, and tin washing bowls, clean and polished. A low stool cupboard stands between each pair of beds.

The patients numbered 92 in the infirmary, exclusive of the lunatics, the average being about 90 throughout the year. In the surgical wards on the male aide, were two cases of recent fracture, placed in splints and lying between sand bags; a fractured thigh, not recent, hip joint with extension, struma and minor surgical ailments. Above were cases of phthisis, asthma, bronchitis, heart disease, indigestion, old age and paralysis. Some of these patients were dressed, and arm chairs and other easy wooden chairs were provided for their comfort.

On the female side, which was not so full, there were, in the surgical wards, a cut head, the result of a drunken fight; ophthalmia in some children, a diseased toe, two cases of dropped wrist, for which Dr. Ronayne was trying massage, a child suffering from loss of power after fever, also being treated with massage: and minor surgical cases. In the wards above were the medical cases; several with phthisis. The smaller ward is used for the children; there were some babies in cradles — marasmus, teething trouble, deserted infants; half the space is reserved for the children.

The appearance of the patients and of the wards gave a favourable impression of the care bestowed upon them. The wards were not overcrowded, and the patients were clean and cheerful. We saw several nursing appliances, such as bronchitis kettles and inhalers, hot water bottles, air and water cushions, water mattresses and small feather pillows. The bedsteads are chiefly iron, with straw ticks; there are a few spring beds, and the fracture cases are on hair mattresses. In the female wards were some harrow frames and ticks.

The nuns are responsible for the nursing. Two employed in the infirmary have been trained by the medical officer; they have inmates as assistants, one for each ward. At night the wards are, in the charge of inmates, but they are visited by the night nurse. This nurse can also be summoned by a bell to the lunatic wards, and there are emergency bells from the sick wards to the convent. The night nurse is also the midwife. The nuns have charge of the schools and of the infirm wards as well as of the sick, but they have not yet succeeded in reforming the nursery where we noticed the usual neglect and muddling of the infants by their mothers. The old inmate in charge was of very little use; the cradles filled with straw the absence of sanitary appliances, and the want of efficient supervision are all most unsatisfactory.

The infirm wards, on the contrary, show a decided advance on most of those we have seen, for though they are crowded and lack necessary offices, the inmates looked more cared for and a few comforts, such as chairs and cushions, and a little decoration in the way of pictures and plants gave a human look to the wards. The old women are on the ground and first floors; the ground-floor room held 16 beds and the room above 20, some placed head to head in the middle of the floor. The wards are low pitched, but the lighting is good, and red quilts give them a cheerful aspect. Still so long as the sanitary system is so imperfect (soil buckets for night use and no proper washing or bathing arrangements), the provision for this class leaves much to be desired, and for the absence of these things pictures and red quilts will hardly atone. The floors are stained. We did not visit the male infirm ward.

The lunatics are in the infirmary block in their usual wards; they are chiefly harmless lunatics and epileptics, though there have been at times violent and unmanageable patients awaiting removal to the asylum. There were 8 men in 2 wards, and they were not crowded, but there is no dayroom, and only the small yard for exercise. On the female side were 17 of this class also in two wards; they were all inside owing to the bad weather, and a few of them in bed; the atmosphere was decidedly close. On each side there is an attendant (not trained), and an inmate assistant; the patients looked cared for. In one of these wards the night attendant was endeavouring to get some sleep, but with poor success.

Improved sanitation was evident in some departments. There are two baths in the infirmary, which are wisely kept locked, and the water-closets are modern, with flushing apparatus. The excreta are removed in metal covered pails, and the vessels are all cleansed daily and inspected; the night chairs—two or three in a ward—are of porcelain, and are cleansed daily. All this applies to the infirmary only. In the lunatic division, in the infirm wards, in the nursery there is no advance; there are only the outside privies. The water supply is intermittent and is supplemented by rain water.

The infirmary linen is under the care of the nuns, and their system is to keep the supply for each ward in that ward. The washing is done in the general laundry. The cooking for the sick is done in the infirmary kitchen, which, as we before remarked, is very small and has no range.

RECOMMENDATIONS.

Considering that the infirmary is the hospital for the district, it appeared to us that the nursing staff was too small. With only one nun to each side-and she, we must remember, has no hospital training — the greater part of the nursing must be in the hands of the paupers. The number and the class of patients indicate the work that is required of the nurses, for the simple attention which must be given to the patients means incessant work. The provision of day-rooms in all departments would add very much to the efficiency of the house and help in ward management. The nursery might be improved by the appointment of a paid nurse and by keeping the visits of the mothers to set times. The sanitary system, especially for the aged and for the infants, should include indoor conveniences and bathing appliances, and the former should be accessible at night. We also think that the surgery requires some alteration, or that another room for operations should be contrived for the medical officer.