BMJ Reports on the Nursing and Administration of Provincial Workhouses and Infirmaries, 1894-5.

BISHOP STORTFORD.

Bishop Stortford is a country town of average size and standing, and is the centre of a large agricultural population; the union receives its inmates from a large number of hamlets, over a wide area. There is no hospital nearer than London or Cambridge, so that the sick among the working class must come into the infirmary if they require nursing, unless the case is so grave as to be sent to either of these places.

The workhouse stands well on a slight rise, and is open on all sides. The infirmary is a separate building, and contains 44 beds on the male side, and 35 on the female side; to these must be added 33 beds in the fever hospital, making a total of 112. On one side the infirmary is open to a wide expanse of country; the wards are of varying size, the largest holding 11 beds; they are cheerful, airy, and well ventilated, having cross lights, and hit-or-miss ventilators in the cornice. The beds are wide, and the bedding is flock, feathers, or straw according to the nature of the case. Water and air mattresses are used in the infirmary for special cases.

The master and matron took us into every part of the buildings, and afforded every facility for a minute inspection. On the male side there were at least 8 patients who required careful nursing. There was a man with cancer of the jaw which had been operated on. The wardsman seemed to be responsible for his feeding and cleanliness, indeed he took quite a professional interest in his patient. In the larger ward a man was lying with spinal disease who had no control over the sphincters; in the day he could be efficiently attended to, but at night, being dependent on pauper help, it was impossible that the wardsman single-handed could keep him clean. The matron said that on the bed being opened in the morning it was always in an unwholesome condition; this was inevitable under the conditions, and it spoke well for the care that the man received that he was free from bedsore; but his condition through the night is sad to think of. In the same ward was a patient recovering from bronchitis, and another crippled with rheumatism, a case of senile debility, and a case of dementia; to these add the aged and infirm in the smaller wards and we have a fair idea of the class of patients under the care of the nurse on the male side. On the female side the work was not so heavy, but as the midwifery patients are attended to by the same nurse, at times her hands are over full. The infirmary is always light as the warmer season comes on, but in the winter every bed is full, and often with acute cases.

The lying-in ward opens out of one of the infirm wards. It contains 4 beds, and is attended to by an inmate who was midwife before the trained nurse was appointed; it has no separate offices, and the number of confinements is not great.

There were no lock cases in the infirmary at the time of our visit; but there is provision for their isolation. We saw a few imbeciles scattered about among the other patients; there is a separate ward for the insane, with a padded room into which a violent patient can be put by the doctor's order, the more harmless are watched by the inmates until removal.

The infectious hospital is a wooden building quite apart, but it is under the charge of the workhouse master, and its expenses chargeable to the workhouse. The wards are a series of huts suitable for their purpose, but otherwise it is crowded. We saw no place for the storage of the food but the bathrooms; the absence of such conveniences hampers the working and is quite unnecessary since the guardians were not limited in the space at their disposal. There is a small cottage holding 8 beds and this cottage takes in such patients as cannot be admitted into the wards; it is in the charge of a pauper and his wife. In this department there is the oven for disinfection; it is provided with a pyrometer, and the porter is responsible for bringing the apparatus to the right heat, but the pauper resident in the cottage places the clothing in the receptacle; we could not ascertain that the distribution of the articles inside the oven was supervised, and this important detail seemed to us of too much moment to be entrusted to a pauper. The old man toddled out with much pride to exhibit the oven. Another thing that struck us as being faulty was an open trough running behind the infectious block within a few yards; along this trough the age was pumped on to the land.

The fever hospital has a permanent nurse responsible for its cleanliness and preparedness, and as occasion requires other nurses are engaged for temporary work; as there were only a few cases of scarlet fever in the ward when we visited, the one nurse was working single handed. This nurse is fully trained; she is assisted by an inmate. In the infirmary there is one nurse responsible for the entire nursing of the sick; she is trained as a midwife, and has otherwise gained experience in general nursing; there is no night nurse, and all the service that the nurse cannot give is done by the paupers. In reply to our question as to the course pursued when a patient was too ill to be left untended at night, the matron informed us that some of the inmates were told off to sit up at night, or the nurse had to take the night watching. The nurse's quarters are in the infirmary, and there is a bell for use at night to the master's room.

Pauper help is very largely used in this house, for there are very few officers, and indeed considering the size of the building, and the number of the inmates (455), it was a wonder that the order was so excellent; a good spirit pervaded all departments, hence the officers had willing workers; but the matron told us that the supply of able-bodied women was so small that she did not know where to turn for inmates for the service of the house. This difficulty is increasing every year, and at the time we were going through the house all the available workers were taken up by the sick department. The utmost was made of the inmates by keeping them to the work to which they were most accustomed. For instance we saw in the wards men and women who had served them for several years, and knew the routine, but taken at their best paupers can never be made responsible, and there is no margin for contingencies.

The receiving wards are on each side of the hall close to the main entrance, and receive patients before they are seen by the doctor and classified; that for the women is attended to by an inmate, and that for the men by the porter. We saw a tramp in bed in the receiving ward; he was supposed to be resting, but he looked as though he would have been the better for regular nursing.

The sick are given such extras as the doctor orders, and on casting our eyes over the bed cards, we saw that extra milk was frequently ordered; the extras are fish, milk puddings, beef tea, and stimulants, and the matron informed us that milk, and beef tea, are served out for the night to the feeble ones. The "full diet" in the infirmary is 7 oz. of bread, ½ oz. of butter, and 1 pint of tea, for breakfast, and the same for tea; for dinner 5 oz. of meat — it does not state whether roast or boiled, or of what nature — and 12oz. of potatoes, vegetables, rice or pudding; the "low diet" is the same for breakfast and supper, with 4 oz. of meat, 1 pint of broth, 12 oz. of potatoes, and 4 oz. of bread; arrowroot, broth or rice-milk may be substituted for meat in this diet. In this diet there is a deficiency of the material necessary for the repair of the body; the nitrogenous element is small, compared with the carbohydrates and the hydro-carbons. The same defect was in the children's diet, there is a large proportion of porridge, and very little milk.

The water supply seemed to be ample; there was a good flush in the closets, and hot and cold water was laid on to the bathrooms. Each ward was provided with a closet near at hand for use at night; these were all sweet and clean at the time of our visit.

There are cheerful airing courts attached to each side of the infirmary, and besides the use of these courts, the infirm were allowed to walk in the extensive fields and gardens that surround the house.

RECOMMENDATIONS.

We were much struck with the efficiency of the management of this house, but at the same time we were convinced that the number of officers was too small, and we recommend that a paid attendant be put on at night in the infirmary, and that the receiving wards be under the care of a responsible officer, and that increased space be provided in the infectious block for the service of the same; that the sewage trough be diverted from the immediate neighbourhood of the block; that the disinfecting apparatus be put under the entire charge of a responsible officer.