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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 Bedford union workhouse.


The workhouse stands on the outskirts of the town, surrounded by extensive grounds, part of which is garden and part kept for hay. On approaching the building, there is nothing to indicate the workhouse, nor is there the porter's lodge to guard the entrance — indeed, ingress and egress on the part of anyone would be quite easy. The building itself is of ancient date. We were informed that it was built some time in the last century, and is one of the old houses of industry of that period. Within we found the lofty rooms and large windows that marked this period, before the cramped and squalid style of the early part of this century came into favour, when the window tax prohibited the entrance of light and air into the homes of the poor. The guardians having given ready assent to our request to go round the wards, Dr. Prior, medical officer to the house, most courteously placed himself at our disposal.

The sick wards, as we expected, though of lofty construction and having an ample supply of light and air through the large windows which faced each other, are antiquated in their appointments and arrangements. The beds, facing each other round the walls, are of good width; some of them have spring mattresses; on the remaining beds there are flock beds, and straw is used for special cases. We found the usual deficiency of comfortable chairs for the inmates; some wooden armchairs without cushions, plain chairs or benches, a deal table, and a table-locker between the beds completed the ward furniture. The wards are warmed by open fireplaces, one or more according to the requirements of the room; fresh air is admitted through the open upper sash, which, as Dr. Prior said, is excellent in theory but defective in practice when the doctor's back is turned. The number of sick is difficult to arrive at, as the aged and the sick are mixed up together; but as far as we could make out there were beds for between 60 and 70 patients, and these are distributed in two wings on the first and second floor.

On the first floor is a Ward of 13 beds, and above a similar ward for the sick, and adjacent a ward of 16 beds for the aged men or women; this latter ward looked crowded, the beds being close, but as there was no statement of cubic area on the door we were not able to verify our suspicion. On the female side on the second floor is a small room containing three beds used for lying-in cases, and another ward now used as a workroom. This appeared to be the only classification. There are no children's wards; when sick the children are placed with the adults. Those cases which have to be isolated, such as lock patients, itch, or erysipelas, are placed in small dreary wards in an isolation block at the back of the building. The females are attended to by the nurse on the female side, the males by the porter; as both these officers are occupied with their respective duties in other parts of the building this attention must be nominal only.

There is, besides, a block for quarantining, containing two wards, these were tenantless and dreary at the time of our visit. The matron informed us that there was no regular system of nursing of the patients consigned to this block, it was sometimes done by an inmate and sometimes an outside nurse might be engaged.

The nursing is divided between two nurses, one for the males and one for the females, with the usual pauper helps, and there is no night nurse. The nurse on the female side appears to be an assistant to the matron, as she has to leave the wards to see the materials for the dumplings weighed out; she also has to superintend the bathing of the able-bodied women and to superintend the women who may be at work in the workroom that is adjacent to the wards. Those who have apportioned these duties must have done so in ignorance of the requirements of the sick; the nurse may be wanted in two places at once, but of course an inmate can nurse the sick or deliver the parturient woman whilst the nurse is weighing out dumplings. We said there is no night nurse, and what that means to the inmates can be arrived at only by making a survey of the patients in bed at the time of our visit.

Among the women there was a case of haemoptysis complicating rheumatic neuralgia, a case of fibrous tumour lately operated on, another whose leg had been broken, now united, suffering with varicose veins, hemiplegia, swelled legs, paralysis, and the ordinary cases of infirmity and old age. On the men's side there was a bad case of anemia, a case of emaciation, who looked as if he needed scientific feeding by night as well as day, a man suffering from pressure on the veins of the legs, he was up; the cases on the male side not being so severe at the present time.

We found, to attend upon these people at night, on the female side, a young woman suffering from skin affection; that is to say, she slept in the ward, and was expected to rise when any attention was needed. We asked the nurse in what state she found her wards when she came on duty; her silence, accompanied with an expressive look, warned us that we had better not inquire further. On the male side there is an ancient pauper who attends on the sick during the night in the same way. We inquired whether the nurses were called in the night, and were told that these inmates were very careful in calling them when they were wanted. The nurse on the women's side is untrained, but she has had experience in workhouse nursing. On the men's side the nurse has been trained; she has been a long time in the work.

There were two women recently confined in the lying-in ward; there is no labour bed, nor did we see any screens or means to secure privacy in a small room. There is a separate lavatory for this ward placed alongside of it.

The nursery is a miserable little room on the ground floor; the door that gives access to it opens directly off a court, and has no screen or porch to break the draught; it faces another door, and to the left hand is the fireplace. Here we found six or more infants in the care of an old pauper assisted by one or two younger women. There is no proper lavatory attached to this ward, nor any bathing accommodation other than a movable bath, A few commode chairs were standing in a recess behind the door. The infants themselves were a sorry, sickly lot, evidencing that they do not receive skilled care or attention. There were no toys, but then that hardly mattered, for there was no space for play. The appearance of the children reminded one of the slum children in our London courts; they looked as if they and the gorgeous sun then flooding the garden had little to say to each other. It is a great pity that these infants are denied a fair start in life; no one seemed to understand them. The nurse on the female side is supposed to be responsible for them, but her duties are so manifold that she can give but a small fraction of attention to each. The infants leave the nursery at the early age of 2 years. At first we were prepared to regret that they were sent into the schools so young; bat doubtless it is wise to transfer them to more sympathetic surroundings. At night the infants are with their mothers.

The dinner was being served in the wards at the time of our visit. Some patients were having rice pudding; this was nicely cooked. The woman with haemoptysis had a mug of hot beef-tea beside her, standing in close proximity to a spittoon into which she had been vomiting blood. At the table we saw the old women served with portions of fat and bone, among which there were minute streaks of meat, and a few potatoes, many of which were bad. As we looked on, the thought crossed our mind, Where are some of those fine vegetables that we saw in the garden? The rations are cut up in the kitchen and sent on open wooden trays to the wards. In the male ward the dinner was finished, and a pauper was washing the plates in a bucket of water placed on a chair — a primitive arrangement indicating that there is no wash-up sink.

The impression that we carried away was that the Bedford guardians are possessed of ample resources in the way of building and of space for the treatment of the sick and the rearing of the infants, but that for some cause or other neither of these results was accomplished. The sick are not nursed in the full sense of the word; by that we mean that there did not appear to be any energy in the carrying out of treatment ordered; but then how can it be otherwise when the patients are only nursed for twelve out of the twenty-four hours that go to make a hospital day, and when this duty is entrusted to women who have more patients to look after than they can nurse, whose patients, moreover, are scattered, and whose range of duty include many offices that of necessity take them away from their wards?

As for the infants, the less said about them the better; they are no credit, and they represent a grievous waste of opportunity, and therefore of public money. Again we say, Why are the old people not out in their own grounds? As we walked up the drive about 11 A.M. on that glorious June morning there were no inmates abroad but those who were working in the garden; we saw no seats, no pleasantly-planned corners for the old men or women, and as there are no dayrooms there is the more need for the change which going out of doors gives the paupers. What means is there of getting them down from the wards into the garden? Are they welcome when they get there? Does it never strike the guardians as they walk to and fro that to the old inmates, most of whom have been accustomed to entire freedom of going and coming, this is neither more nor less than a prison. We make these remarks in no captious spirit, but it would be a poor return to the guardians for their kindness in allowing us to see over the house if we did not try, in a friendly manner, to bring out those points which struck us, and into which they, as busy men and women, have not leisure to investigate for themselves. We are sure that they have the good of these poor people as much at heart as we have, and when they have grasped the fact that their lot might be improved by attention to detail, they will not rest satisfied until these matters are looked into.

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