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

LOUGHREA WORKHOUSE INFIRMARY, CO. GALWAY.

If situation could redeem the evils of the present vicious system of the Poor Law, Ireland would be exceptionally well off; its workhouses, as in tins instance, often have a situation that would be the envy of a millionaire. Standing on time borders of the lake and looking over the water to the mountains beyond, the road which skirts the lake passing the lodge, it commanded as pretty a view in the early morning light as heart could desire. But inside the gates the beauty ended.

Before describing as usual the internal arrangements we would set forth the insanitary conditions that surround the infirmary. The portion of the hospital building usually assigned to the idiots was in this case used as a place for keeping live ducks; the place was most unsavoury, having apparently never been cleansed, and without ventilation, except for the door and a small window on the same side, which was partially boarded up. The rafters are unceiled, and the room above is a sick ward. The division next to the ducks' house is used as a laundry; in it we saw tubs of dirty soapsuds standing about; the floor was uneven and sloppy, the room unventilated except by the door and small window, the rafters unceiled, and again a sick ward above. Further on, also under the sick wards, is a privy, used as a dustbin as well as for its nominal purpose. Inside ashes and soil were scattered on the floor, which was broken into holes, and the seat was covered with similar litter. Again, round the angle of the building, still under the hospital wall, was a heap of manure and filth; over this passed an outside staircase leading to the wards on the upper floor, and used for the removal of the dead. From a survey of these surroundings we passed to the infirmary.

Dr. O'Donaghue was making his rounds, and he courteously offered to take us through the wards at the same time. The ground floor wards, except two small ones near the staircase, were unoccupied; the large wards on the first floor were in use, but, as it was summer, were not, full. The structure of the wards was such as we have found in all the Irish workhouses: the roof pitched and low, the walls smooth and whitewashed; windows small, with iron frames and diamond panes, ill-fitting and not weather proof; the beds are on either side of the long narrow ward, the space between them laterally and the passage down the middle so cramped that no furniture is possible except high wooden chairs, benches, and the necessary commodes. There was a strip of carpet down time middle of each ward. The bedsteads have no redeeming feature; those in the male wards are low iron frames on which are the inevitable straw ticks; in the female wards we found our old friends the narrow "harrow" frames, also with straw ticks. We were, however, glad to find that most of the patients were provided with feather pillows. The men's ward was fairly empty, very few of the patients being in bed, and these were chiefly chronic cases. There were more women, both in the wards and in bed, hut, though many of these required careful nursing, we did not see many acute cases. The infirmary has a capacity of 80 beds, of which 45 were occupied; we noted that if the 80 beds were all in use the infirmary would be overcrowded.

The nursing is carried on by nuns, of whom three are on the staff, but the service of a fourth is actually found necessary by the mother superior. We have constantly found that the official number of nuns sanctioned by the Local Government Board is increased, the additional assistants being of course unpaid. Here the nuns have an advantage over a secular staff, since they can draw upon the resources of the community, whereas the secular nurse has no reserve of helpers, and can only do her best. There is no night nurse, the only attendance at night being such as the wardsman or woman can render. There is no midwife. The maternity ward is in the infirmary block on the ground floor, opening out of the large ward. It was empty at the time of the visit; the average number of confinements is six in the year. The patients generally appeared clean and well cared for. The imbecile and epileptic patients are scattered through the infirmary wards or find employment in the house.

The fever hospital is a temporary building of corrugated iron, placed on vacant ground at the side of, and some distance from, the infirmary block; it contains two wards and offices. There was one patient in it in charge of an inmate as attendant.

The nursery is the large barrack-like room in the body of the house usually appropriated to the infirm and aged women. Here the mothers live and sleep with their infants. There were six beds at the end and three wooden cradles. This room is quite unsuited to the purpose to which it has been assigned; the single stove is insufficient for the warming and ventilation of a place more like a barn than a living room; the two windows, oue at either end, give a mere apology for light; in short, the infants are insufficiently supplied with light, air, and warmth, and their ignorant mothers make but bad nurses.

The old women, twelve in all, are crowded into the room that is usually the female dayroom, and in this case serves the double purpose of sleeping and living room. We found the ward close, dark and dreary, the rough walls and plastered ceiling giving a comfortless aspect, which was not belied by the listless group of dirty women on benches round the room, nor by the harrow beds on each side with the straw ticks.

The aged men, of whom there were 17 in the opposite end of the building, were in the larger ward, the other being the dayroom for the able-bodied men. This ward was a little improved by the opening of two windows in the long wall, but otherwise it was as dreary and comfortless as the females' quarters. The old men, some of whom were sitting on the benches smoking round. the fire, had also a dirty, uncared-for look, suggestive of the small basin and round towel which we saw in the corner.

Not often in this tour of inspection have we turned to the probatonary wards, but the arrangements in this house are so peculiar that we paid that department a visit. The male portion is appropriated to the clerk's office, so that the one apartment on the opposite side serves as bathroom, men's dormitory, male and female refectory, and waiting-room, the women sleeping above. It is hard to conceive a more reprehensible practice, considering the low class who frequent these wards. It has, of course, been winked at by the authorities, but what can they be about to allow such a state of affairs?

In passing through the domestic offices belonging to the various departments we were struck with the neglect and want of repair evident in the machinery and appliances. The laundry boiler was out of order, so there was no hot water in the troughs; the kitchen range in the infirmary was a fairly good one, or would have been, had not the bars been falling out and the false bottom in pieces, allowing large bits of coal and cinder to fall out. There is no hot water supply in the infirmary, nor any in the house, except that heated in the main kitchen, where we saw large boilers of the famine date, each with its separate furnace.

The ambulances share in the prevailing neglect, and date from an early period of history. That for the use of the fever patients is a high four-wheeled covered van, and the other, for general patients, is a two-wheeled covered car; vehicles more unsuited for the conveyance of the sick over rough country could hardly be contrived. There is a tradition that a poor woman was found to be dead when the two-wheeled ambulance brought her to the infirmary.

RECOMMENDATIONS.

As we make our way past the files of patients lying on these narrow wooden frames we feel that they deserve their name of "harrow" beds; and when we read, as in this case, that the guardians "are of opinion that iron and wire beds are not to be recommended on the score of expense," we confess to a longing to condemn these same guardians to spend a night on these beds of little ease in the locked and unlit ward; we know that they would return to freedom sadder and wiser men. We recommend then a wider, longer, and more elastic form of bedstead and bedding; we plead also for a night nurse, so that the poor sick folk may receive attention by night as by day. We suggest further that some attention be paid to the sanitary appliances; first of all, that ordinary cleanliness should be observed, and then that proper conveniences for the aged and sick should be built adjacent to their departments. The probationary ward is nothing short of a scandal, and we marvel that the inspector of the Local Government Board has overlooked a wholly unjustifiable infringement of the proper classification of the casual wards. We learn from the guardians' report that the schoolmistress stated that "she had the children bathed every available day in the summer." So far well, but we should like to know how frequently the "available day" came round, and whether the guardians think that children are better unwashed in winter. It will be found to be the best economy to bring an adequate service of water into all departments.