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

DURHAM.

The workhouse in Durham is a large one, but the infirmary department is small. According to the official returns, there is accommodation for 49 patients, with a separate fever hospital having 21 beds; this was not occupied at the time of our visit. The infirmary buildings are of a more recent date than the house; the drainage has lately been remodelled, and there is an ample supply of water. The buildings stand high on the outskirts of the city, having a free space all round.

Having an introduction to the master, we were courteously received and every facility given for the purpose of our visit. Indeed, the master observed that he thought it the duty of every ratepayer to visit the workhouse. The wards are distributed on the ground and first floors, the first floors being set apart for the sick and the lower floors for the infirm. They extend as two wings, having the administration block in the centre. There are both large and small wards; they are lighted with windows on the one side, with ventilators in the upper part of the window. The appearance of the wards was cheerful and bright, with armchairs, pictures, and a few flowers. The bedsteads provided for the sick are spring with hair mattresses, whilst those for the infirm are of varying width, laths covered with cocoanut matting and straw beds; they were clean and well made. There are no wards for the separation of the lock or offensive cases; the idiots, imbeciles, and "fit" cases are with the sick or infirm, and there did not appear to be any means by which an insane patient could be under control until removal. We were surprised to see that there are no bathrooms attached to the sick wards; on each landing outside the wards there is a supply of hot and cold water, but no means for emptying baths except by baling. The lying-in ward is a continuation of the long female ward; it has separate offices; it holds four beds, and at the time of our visit a woman with her babe was doing quarantine on account of suspicion of some infection. In the event of any epidemic occurring in either the main or the lying-in ward there would be grave danger to the patients. There is no ward for the sick children. There are no day rooms for the sick, but there are day rooms for the infirm.

At the time of our visit the wards were comparatively empty; on the female side there was a patient "with fits" in bed, a woman with phthisis, one paralysed, one recovering from bronchitis, and a case of senile debility; on the male side a man who had injured his spine, a case of heart disease, and others in bed with old age; there were about twelve altogether, while in the lower wards were several patients very infirm. Each bed was provided with a bed card.

The system of nursing is by the employment of attendants; there are three such for the infirmary — a man and his wife, who have been there for about fifteen years — and the other nurse, who was appointed about two months ago. The two female nurses at present take day and night duty each alternate month. About a year ago a trained nurse was appointed for the night, but she only stayed six or eight months. We are not surprised to learn this; a trained nurse cannot work as one of a staff in which the other officials are untrained; this attempt at patching makes the rent bigger. There is some misapprehension in this infirmary in the application of the word "trained" as applied to the nursing staff; and as we had not the opportunity of seeing the medical officer, we have been at the pains to ascertain from him the exact status of those who are employed in this infirmary as nurses. Under these circumstances the services of the inmates must still be retained in the nursing of the patients; but as we did not see the "nurses" we were not able to ascertain to what extent they made use of the inmates in nursing the sick.

We were surprised to note so many defects in a building of a comparatively recent date. First, there is the want of bathrooms above spoken of. It is difficult to understand that any institution intended for the reception of any number of sick people should not include one or more bathrooms. The water-closets are not on a level with the wards but are on a lower landing, obliging the aged and weakly to go up and down stairs, or adding to the work of the nurses by giving them additional steps. The wards themselves admit of no classification except that of infirm or sick. Then the labour ward is only a piece taken off the main ward, and, in the event of any epidemic, isolation would be almost impossible; it is also too small for its work. No separate wards for children is a mistake, especially in this house, where there seemed to be a large number of children, and where the management of the children's department in other particulars appeared to be enlightened and liberal. We saw no slop sinks, or, indeed, any place for the emptying of vessels other than the closets. Hot and cold water is laid on outside the wards.

The infirmary buildings look on to a garden, in which the master informed us the patients are permitted to sit when the weather is suitable. There are also airing courts for the male and female patients. The receiving wards are near the gate, and the master can admit any patient to the infirmary from these wards if in his opinion necessary, reporting the same to the medical officer. The infirmary is in telephonic communication with the master's quarters; the medical officer lives at some little distance from the workhouse; one of the nurses is the midwife.

The dinner, which was being served at the time of our visit, was meat and potatoes for those able to eat it, and broth for the more sickly. The matron informed us that the medical officer ordered such extras as he judged necessary, such as milk, beef-tea, and puddings, and that food was given to the patients at night. The meat was boiled neck of mutton, or some other form of boiled mutton.

RECOMMENDATIONS.

We advise that a new infirmary be built with all necessary appliances for the nursing of the sick, bathrooms, slop sinks, closets of easy access for the sick and helpless, separate wards for the children and for the offensive cases, and a proper lying-in ward. The nurses' quarters under the same roof. That the infirmary and the isolation hospital be made into a separate department under the head nurse. That the existing infirmary be utilised for the imbeciles, idiots, and "fit" cases, the same to be in the charge of a responsible attendant. When the infirmary has been remodelled, we suggest as the top stone that a complete staff of trained nurses be placed in charge, the entire sick department be taken from under the control of the workhouse officials.