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 Downham Market union workhouse.


The workhouse stands in the middle of the little country town of the same name, and harmonises well with its surroundings; it is a flint building of irregular outline, with casement windows. It is approached by a drive, bordered by gay and well-kept flower beds. As in so many of these Norfolk districts, the population of the neighbourhood has declined, or has improved in circumstances, so that the number of beds in the workhouse greatly exceeds the demand. The house is licensed for about 250, and at the time of our visit the inmates numbered 70. Twenty-eight beds are set apart for the sick.

The infirmary is part of the house; the whole building is very old, and in many ways quite unsuited for its work. We visited the day-rooms first, and the old people were called in from the yards by the master and matron to see us.

The day-rooms are fairly comfortable, with benches placed on either side of the fireplace, and they are made cheerful with plants and pictures; but it struck us as a grave defect that these day-rooms are approached from the yards by five or six steep stone steps, which form a serious barrier to the infirm old people. Nor were there any easy chairs; nothing but the hard benches. All the female patients were up; one woman was both blind and deaf, and sadly isolated from her fellows; another woman, who had all the appearance and manner of having been in a much superior position, was deaf; another had a paralysed hand and arm; the rest, six in all, were cases of old age.

The sick-ward was above this room, and was reached by a narrow, steep, stone staircase opening out of the day-room. The steps were worn quite hollow, and we wondered whether the guardians ever went up or down them. If so they would hardly be left in this dangerous state — dangerous even to the active, but much more so when used by the infirm. Must some poor inmate break his or her leg before these steps are condemned? At the top of this perilous ascent is a long ward, having casement windows on both sides, and a pitched roof with ventilators in it; there is a strip of matting down the middle, the beds, thirteen in this ward, are ranged down either side, and there is a fireplace at one end. The master showed us with commendable pride a contrivance by which he could screen off two beds at one end of the ward, so as to make two cubicles; these beds are intended for an offensive, a noisy, or a dying patient, and answer the purpose satisfactorily. There were no patients in bed.

The male ward is on the same level, with a locked door of communication for the nurse's use. It is in all respects similar to the female ward, except that it holds only 10 beds. The bedsteads in both wards are low and of the ordinary width of a single bed; the bedding is various, either long straw or flock, the one or the other being used, according to the case; and a water mattress when required. In this ward we found a bedridden old man suffering from asthma and heart disease. The master told us that until thus laid aside he was the useful and handy man of the place. He was the solitary tenant of the ward, but was a cheerful and contented old man. and beautifully clean. The other inmates, seven in number, were in the day room below.

A descent down another worn stone stair brought us to the men's day-room, similar in all respects to that provided for the women. Again we plead for arm chairs for the old folks, just to make them a little more comfortable. The old gentlemen hobbled up the stone steps from the yard to be introduced to us. An old man with double cataract could yet distinguish between the light and the dark parts of our clothing, much to his joy; he and another man with defective vision were to be sent to a neighbouring town to see an oculist, and they were planning the ways and means with the master with evident anticipation of the benefit to be derived from the visit. Another man was an imbecile, with a deformed foot; he had a surgical boot. The other patients were in various degrees of old age.

The lying-in ward is across a landing on the same floor as the female ward; it has two beds. The matron told us that it is very seldom used; the nurse is not a midwife; the medical officer, Dr. Wales, lives quite close, and he is responsible for the midwifery cases.

There is a bathroom for the women, with hot and cold water, outside the ward; the men's bathroom is on the ground floor. The closets, having a water flush, are outside each ward on the first floor; they are of the old style, and were littered and dirty, as is so frequently the case; for it is difficult to teach paupers cleanly habits. There were a few commodes in the ward.

Isolation when necessary can be carried out in the small unoccupied wards in the infirmary department; the medical officer stated that they seldom, if ever, had a lock case; that if such did occur they would be placed apart. The only provision for the care of the insane would be by using the receiving wards, and setting apart special inmates as watchers, or by procuring such from the town.

The attendant who is responsible for the care of the sick has been four years in the work, in which time she must have gained considerable experience; but when a doctor has only untrained assistance much more work must devolve on him, with increased responsibility. There are pauper attenddants at night, and the same act as wardsmen or women by day. The nurse whom we saw at her duties impressed us very favourably.

The matron invited us into the kitchen department to see the dinners served: these consisted of suet dumpling, currant dumpling, vegetables, meat, and broth; the portions were suet pudding and vegetables, meat and vegetables, currant pudding, or broth. Each portion was weighed by the master, and despatched quickly to the part of the house for which it was intended; we saw no hot water tins for the transit, so that if the food was to reach the inmate warm, it, required to he expeditiously served. In the winter time we doubt if it be possible to keep the food warm in transit. We were again struck by the junks of meat that were carved for some of the patients, old people who must find a difficulty in mastication. The food was well cooked, the puddings light and well mixed, the vegetables well strained; the meat, beef, was boiled.

The workhouse grounds are extensive, including flower and kitchen garden in front and at the sides of the building, and behind there are small gardens, which are the airing courts for the infirm and the sick. The old people are taken into the flower or kitchen gardens by the master or matron, but we must confess that we should like to see them disposed about the grounds at all times, the men with their pipes, the women with their knitting or their bit of work; feel sure that the permission would be appreciated by the inmates, and could hardly be abused.


We sympathise with the guardians, who have such an unmanageable structure for their infirmary. Still the difficulties are hardly insuperable, and we would suggest that some other part of the house might perhaps be adapted to infirmary work at a comparatively small cost. The worn out steps can be turned or replaced, and this is a matter that demands immediate attention, unless the Board is prepared for a possible coroner's inquest, with its damaging verdict of culpable negligence. Then with regard to the nursing, while admitting most fully the merits of the present attendant for the sick, we cannot feel that the best is done for them until they have a trained nurse, who should be also a midwife. In the small infirmaries this question bristles with difficulties; but even a year's training in a hospital or infirmary, and the course in a lying-in hospital, would be an immense gain in the service that is rendered to the sick and infirm. We have already referred to the need for some small addition to the comforts for the infirm old people.

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