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

WITHINGTON, LANCASHIRE.

At Withington is the hospital for the Chorlton Union, one of the three unions for the city of Manchester, Withington itself being a suburb of Manchester. On one side of the road are the large Poor-law schools, and on the other the Chorlton Union and Withington Hospital. We were met by Dr. Rhodes, a guardian, and by the medical officer, Dr. Orchard, who accompanied us round the hospital, and gave us every assistance. The hospital buildings lie behind the workhouse, and are built to accommodate over 700 patients.

The plan is that of pavilion blocks, having at the workhouse end a communicating corridor, which forms an open air terrace on the first floor. At this end of the block are the ward kitchens, isolation wards, and charge nurse's room; at the other end, in turrets, are the bath rooms and closets, one of which is set apart as the soiled linen chamber. There are three floors in each block including the ground floor, and the upper storeys are reached by a wide open staircase and a wide landing. The pavilions vary in capacity, the wards having from thirty-three to thirty-six beds in each, with one or two single-bed wards for special cases. There are seven pavilions in all, the three middle blocks being older than the remaining four. The former were built experimentally, and the latter show many improvements in structure and arrangement, such as slow-combustion fireplaces, self-purifying gaslights, and a space at the far end of the ward partitioned off to serve as a day room. ln the older pavilions there is a wide balcony at the end which was supposed to serve as a relief to the ward, but practically it was found to be frequently useless.

Classification is on the most approved hospital methods — male and female, medical and surgical — and there is one ward for chest cases, kept at a suitable temperature. The imbeciles and fit cases are in separate blocks, quite apart from the hospital, under the care of trained attendants, who are entirely responsible for them whether sick or well. The children have a separate ward in one of the pavilions. The lock cases are treated in a small building apart, with its separate offices and staff.

The infectious hospital was at the time of our visit occupied by the little victims of an epidemic of measles. It is a self-contained building, having its own laundry and storing room under the control of the charge nurse. It is built with an outside staircase, so that the upper floor can be used if necessary for a distinct class of disease, the attendants having no cause to interfere with each other. This isolation hospital is used for intercurrent cases only. At the time of our visit the staff consisted of a charge nurse and probationer, the ground floor only being used for the patients with measles.

The lying-in ward is placed at the top of one of the hospital pavilions, and occupies the whole of the floor. The labour ward is the partitioned end, corresponding to the day room on the storey below, and the doorway admits of the bedstead being wheeled out into the larger ward. The women remain in this department from three weeks to a month, until they are quite strong. The nurse, who is a certificated midwife, has her quarters close to her ward, an exception to the rule that all the nurses shall reside in the nursing home when off duty.

In the wards, the bedsteads are placed between the windows, facing each other, some wards holding 33 and some 36 patients. Over each bed is a large card, giving particulars of patient, diagnosis, and treatment; behind is the temperature chart, and in some cases there is a second holder, containing the clinical notes of the case. We were informed by the superintendent that the temperature of every patient was taken and recorded on admission, but afterwards only by the doctor's orders. Between the beds are lockers combining seat and cupboard, the latter for personal possessions; the one we saw opened contained some books, a pipe, and some small articles of clothing. Behind the upright, forming the back of the chair, is a hook for the towel and the comb bag. We think that a pull might be placed over each bed with advantage; a large proportion of the patients are very helpless, and the pull would help the nurses in lifting. In the middle of each ward is a buffet table, in the cupboards of which are surgical dressings, ward medicines, poisons, and sundries; these are all kept locked. There is cross ventilation, carried on in the older wards by means of the upper part of the windows, in the more recent buildings by ventilators in the walls and under the beds as well. The walls are of glazed brick.

The children's ward is intended for the reception of boys and girls from the month until 16 years of age. Both medical and surgical cases are treated in it. The style and arrangements are similar to the ward above described. We were sorry to see the tube feeding bottle in use here.

The diets for the hospital are served from the house kitchen, and distributed in jacketed tins; a certain amount of sick cookery is prepared in the ward kitchens, one object being to give the nurses an opportunity of learning that important, but too often neglected, part of their duties. The diets are in the hands of the medical officers, the guardians being most liberal in this particular; a glance at some of the bed cards showed this conclusively.

The female lock wards are small wards in a separate part of the grounds; there were five patients in bed at the time of our visit, and some up in the day room. These wards are in the charge of a nurse; the building is self-contained.

The imbeciles, etc., are lodged in two separate blocks at the end of the male and female wings of the house. They are cared for by trained nurses, and provision is made for their treatment in these quarters if attacked by any acute illness. These wards are large and cheerful, and such amusements are provided for the inmates as they can enter into. The day rooms open on to small gardens for outdoor exercise. We noted with pleasure an instance of thoughtful contrivance — the iron frame of the bedsteads for the epileptics is rounded, to obviate any danger of injury from a sharp corner. Padded rooms are provided for use if necessary.

The nursery is in the house, and is under the charge of a responsible officer. The room is spacious and wholesome, and the little things seemed well cared for and on good terms with their attendants. Separate offices are attached to this department. The wisdom, to say nothing of the humanity, of the Chorlton guardians, is apparent in this provision of efficient management for these infants; it may relieve the rates of future paupers.

The whole of the washing for over 2,000 inmates is done in the one laundry in the house, except that for the infectious hospital, which has its own laundry. The laundry is fitted up with modern machinery, driven by steam power, and is capable of turning out any amount of clothing. The labour is provided by the inmates.

The sanitary appliances are of most modern construction. In the newer pavilions the closets and bathrooms are cut off by an intercepting lobby. We noticed an omission in these arrangements; there is no slop sink, therefore all the bedpans, etc., must be emptied in the closets. The urinals are emptied in a small urinal, over which there should be a flowing stream of water; but the one we saw was not flushed, and consequently not sweet. All vessels are kept in these places, and with this one exception they were perfectly wholesome.

The soiled linen is removed twice a week from the wards, unless there is need for immediate removal, when these articles are sent to the laundry daily. An improvement in the linen storage might be made by having a metal-lined hamper, or zinc box with a lid, to be kept in the soiled linen cupboard, as a linen receptacle.

In each pavilion there is a charge nurse, and on each floor there are two probationers; in the children's ward there are three probationers. At night there is one nurse for each pavilion, but this number is shortly to be doubled, and there will be two nurses on duty at night in each pavilion. The charge nurses are all fully trained, and this hospital is a large training school of Poor-law nurses. There is a trained matron responsible for the nursing of the hospital, and a resident medical officer. The nurses are lodged in the nursing home, the door to which opens on to the pavilion corridor; it is fitted up in accordance with modern requirements, the whole being placed under the charge of the home sister. The cleaning of the wards and all service is performed by the inmates, and inmates are on duty by night in each pavilion.

RECOMMENDATIONS.

It will be gathered from the report that the Withington Hospital hardly differs from some of the large voluntary hospitals, either in appointments or management, and dealing as the guardians do with an increasing population, the aid that they offer the sick poor is readily claimed. The points that struck us as capable of improvement are very few: they are, a slop sink for ward vessels, the hamper or box for the storage of soiled linen, pulls for the patients in bed, and the discarding of the tube feeding bottle in the nursery department.