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

CLONES UNION, CO. MONAGHAN.

This is a second class house, but as is the case with so many workhouses it is more than half empty; the number all told on the day when we made application to go over the house was only 80, and we were informed that of late years the number of inmates had not exceeded 100; of these 80 inmates more than half are either helpless or children. The union stands close to the town of the same name.

Th infirmary, to which part of the house we directed our steps first, is a two-storeyed building stated to hold 40 beds, and has an average of 25 patients under treatment. Structurally it compares favourably with other houses lately visited; the walls have a smooth surface, a dado of grey colour is painted behind the beds for about 4 feet from the floor, the rest being whitewashed, the ceilings and pitched roof are plastered and whitewashed. Here, however, the improvement ends; the windows are small and ill-fitting, placed on one side only; small square apertures in the opposite wall do duty for windows, the fireplaces are old and inadequate, and the wards generally destitute of comforts for the patients. The wards occupy both floors, but that for males on the first floor was in the hands of the workmen, consequently that on the lower floor was more crowded than usual. Small wards for isolation have been taken off the ground-floor wards; they are cell-like structures, holding 1 or 2 beds; indeed, they appear to have been the idiots' quarters before a door was opened in the party wall. This construction makes the whole ward practically one, hence the use of these wards for isolation must be very limited. We found the same arrangement on the female side. The harrow beds are used throughout the infirmary, with straw ticks and pillows. We were informed that some hair mattresses are ordered for use on these frames, but the introduction of the hair mattress on this old frame will not add to the width or the length. Between the beds is a tier of shelves divided in the middle to hold mug, medicine bottle, or personal possessions; there were a few armchairs for the patients, and the inevitable bench.

The patients also in their appearance and in that of their beds contrasted favourably with some houses we had visited; they looked cleaner and more tidy, but when we went into detail we found the nursing was sufficient neither in quantity nor quality. The one nurse is untrained, and she has for assistance mostly women with illegitimate children; these pauper nurses are described by the medical officer in his report to the guardians "as ignorant and indifferent;" there is no night nurse, and, to quote from the same authority, "the patients on the male side are locked up without a light, and with such help as a fellow-patient can render them." On the female side, also, the wards are left without a light through the night; the only light for the long . winter evenings in the wards is a paraffin lamp. As we walked through the wards we noticed a case of fracture of the neck of the femur, fracture of the radius, cystitis, rheumatism, a burn — the patient having fallen into the fire in a fit — bronchitis, phthisis, and other chronic cases; an unruly man, a case of rheumatism, was placed apart in the small room by the stairs called the dayroom. From this list our readers will see that there are several patients requiring skilled nursing; one would rather not think too minutely of their condition, locked up at night in the dark, dependent on each other for assistance, say to the fractured femur or the rheumatic patient. We noticed, in traversing the wards, some utensils left unemptied by the beds, and, as the wards are locked during the night, the pails and buckets must remain so until the morning. The patients have no change from the wards, nor have the wards any relief from the patients, as there are no day rooms, but such as are taken for other purposes, and, even if not so appropriated, they are hardly suitable for use by sick or convalescents, being dreary, dark, and bare. That on the female side has a flagged floor, and is made use of as the infirmary kitchen. Here the cooking is done by the nurse, or, to speak more accurately, by an inmate under her supervision. There is no range, simply an open wide-mouthed fireplace, and the kitchen was very bare of cooking utensils, or of the means of serving the food to the patients. The diet consists principally of milk, bread, tea, and broth. We were glad to see that the day's supply of milk was kept in a cupboard, and the bread in a box in the kitchen. The deficiency in the kitchen is in process of being remedied, as we read in the last report that the guardians have authorised the placing of a range in this little kitchen, and the providing of cooking utensils, plates, knives, and forks. We are sure that this step on the part of the guardians will soon repay itself in greater economy in the preparation of the food and its distribution, both sources of great waste in these institutions.

The fever hospital has not been occupied for several years, and it is entirely dismantled. It is of the usual construction, and has its kitchen and laundry, with separate apartments for the nurse.

The infirm wards provide accommodation for about 18 men and the same number of women, and are situated in the wings of the body of the house; they were not more than half full when we saw them. The men were all out either at work or in the yard. The women, of whom about 6 are feeble-minded, were in their ward, under the charge of one of their number, who, as we entered the ward, was scolding and arguing with one of the feeble-minded in a loud, angry voice, justly drawing on herself the correction of the matron; but, as we noted the incident, we saw how unfit this inmate was to be placed in authority over helpless or imbecile paupers. The wards are badly lighted and ventilated, having one window at each end of a long room. The walls are rough and whitewashed, unrelieved by pictures or colouring, open rafters, narrow beds down each side, benches, one old fireplace, and evidence of the one paraffin lamp during the dark winter evenings. We saw one basin, over which hung a roller towel for common use, changed, so we were informed, twice a week. The men have a boarded floor dayroom adjoining the ward; that for the females has been appropriated to the nursery, and, by order of the authorities, the old women may not go into this day room.

The nursery, a flagged room, large, dark, and unfurnished, was tenanted by a mother and her child. A room adjacent is the maternity ward. It is quite small, holding one bed for the patient and another for the pauper in attendance on the confinement; the confinements average from six to eight in the year. The dormitory over the nursery is appropriated to the nursing mothers.

The laundry is rather better found in the way of apparatus; we saw a wringer and a mangle; but the drying room requires enlargement and ventilation. A disused Turkish bath, or rather hot-air bath, has been turned into a drying room, in which is placed a small ironing stove; it has no ventilation or outlet for the steam, so that the clothes dry very slowly, nor is the space nearly large enough for the number of clothes that pass through the laundry. The workhouse kitchen exhibits the primitive arrangements of a past date; the coppers are practically of no use, having been superseded by a stove and a portable cauldron, which at the present time suffices for the simple diets of the inmates.

Baths and water supply are non-existent; there is one movable bath for the hospital, which when required can be filled and emptied by hand labour only. No water is laid on, either hot or cold; there are no indoor conveniences, and those outside are privies, on the waggon system; the absence of indoor closets involves the insanitary practice of using open pails and buckets. In the body of the house there is a fixed bath for the children's use with a cold water supply only. As we were passing through the yards to see the outside places. we noticed that most of the airing courts were overgrown with rank grass, and that no seats were provided for use out of doors.

RECOMMENDATIONS.

It is evident that the two improvements most urgently required are in the nursing of the patients and the provision of healthy sanitary appliances, and to these points we should endeavour to draw the attention of the guardians; but when we turn to the report of the medical officer placed before this Board in obedience to the instruction of the Local Government Board, we read that the committee appointed to inquire into the condition of the hospital "would not recommend any alteration in the system of nursing or the sanitary arrangements!" This Board, then, must be left to the central authority, and we trust that the sword of vengeance will soon fall.