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

TRURO.

The visit of our Commissioner to Truro coincided with the meeting of the board of guardians; being advised to make request for permission to visit direct to the chairman, our Commissioner received from him a courteous invitation to take a seat at the board whilst the guardians transacted their business. The board having met us so cordially, and having most freely placed themselves and their officers at our service, we trust that such criticism of the arrangements for the sick poor which we may feel to be necessary will be accepted by them in the same friendly spirit.

The workhouse stands about two miles from the city. It is a large building, licensed for 500 inmates. The structure is old, and in many ways quite behind the times, but capable of improvement within existing limits. The matron accompanied us round the infirmary, two of the guardians kindly introducing us, and authorising her to give us all the information which we might require.

The infirmary is in a separate building at the back of the main part of the house. It accommodates 78 patients. The appearance of the wards is dreary; the whitewashed walls have a rough surface, which is objectionable from a sanitary point of view, as it affords so many resting places for dust and the germs of disease, while the whitewash is wearying to the eyes of the sick. The matron and the nurse had fastened up pictures from the illustrated papers to relieve the monotony of the bare walls, and some of the inmates had decorated the private corners round their beds with their own treasured pictures.

The wards are all small, holding 6 or 7 beds each, and are distributed on the ground and first floors; the patients are scattered among them without much attempt at classification. There are no day rooms, so the men, if they smoke, smoke in the wards; the matron says they do not smoke at night. They are supplied with the old-fashioned narrow bedstead, rather low; the beds are mostly of straw, with a few of mill puff; there is one water mattress. There did not appear to be any provision for drying the straw; when we asked the matron how it was ascertained that the straw was properly dried, she told us that it was always dry. Macintoshes are not used in the infants' cradles, for we saw a stream trickling from beneath one cot, and the matron told us that the moisture drained through. so we may be pardoned if we doubt the invariable dryness of the straw. On one of the beds turned down for our inspection there was a stain on the "tie," or, as we should say, the tick, as though some moisture had thus "drained away." There was the usual scarcity of arm chairs in the wards, the few that we saw not being sufficient for the patients that were up; there were no couches.

The patients were of the usual type that is found in the workhouse ward. On the female side there were about twelve in bed; a rather bad case of heart disease, paralysis, fits, hysteria, old age, and several with bad legs. In a separate ward an old married couple, both bedridden, were ending their days; both suffering from incontinence. The room had a strong odour of ammonia, which the matron explained by informing us that the man was supplied with a urine bottle, which he was always upsetting in the bed; his clothing appeared soaked with urine. An old pauper woman was in charge of these married quarters, and probably she did her best, but it is evident that she was not able to do all that was necessary for the helpless man. On the male side we saw nine patients in bed; a man who had had a severe fit was in a state of helpless incoherency; another had dropsy, a bad case of phthisis, paralysis in its various phases, and senile debility; the other patients were infirm and aged.

The nurse is not trained, she has been at the work for some time and was evidently interested in her patients. The doctor had instructed her in midwifery, and she now attends the natural labours. On questioning her as to the treatment of the leg cases, she said that they were washed with carbolic lotion, but that no particular ointment was used; some of the patients did their own legs; doubtless it was an occupation. There is no night nurse. In answer to an inquiry as to what course would be pursued if a case required systematic poulticing, we were told that a poultice would be applied before the nurse went to bed, and be changed as the first duty of the morning's work. There is no night feeding, but milk would be left beside a patient for whom it was ordered. The nurse informed us that when the infirmary is full in the winter she might be called up three or four times in the week. The washing of the patients and the bed making is done by the paupers: this is the inevitable result of one "nurse" to 78 beds, more especially as those beds are in several small wards on two floors. The nurse's quarters are situated between the male and female sides.

An ancient pauper who boasted to us that he was 89 years old, was wardsman in one of the wards; he was well set up for his years; the other wardsmen were all venerable, far above that 40 years limit, beyond which no candidate, however otherwise eligible, can be appointed to the post of nurse in the hospitals and infirmaries under the Local Government Board. On the female side the wardswomen are either women of bad character, or of the type of the ancient dame who was "nursing" the bed-ridden couple. One can hardly expect tenderness from the one or activity from the other.

The labour ward has seven beds. There is no labour bed, nor is their any means, except by the use of screens, for concealing the progress of the labour from the other inmates of the ward, all child-bearing women who are either expecting their own trial or have but just endured it. The screens are cumbersome frames, over which canvas is stretched; they are unwashable, and not easy of porterage. The ward was tenanted by a patient with a fortnight old baby. The ward was provided with a separate closet, but there was no bath room.

The sanitary appliances are of the old type; in some the water flush was good; they are easy of access from the wards, but where they open directly out of the ward there is no means of cutting off the air, though we observed that it was possible to make ample cross ventilation in the lobby. There is one bath room for the whole infirmary, and that is under the stairs on the women's side; from its littered appearance we judge that it is not frequently used. It was supplied with cold water only. There is no hot water laid on; the only supply is from a copper in the infirmary laundry, out of which the hot water has to be baled when required. On the upper floors there is a trough over which is a cold water tap; this trough serves to carry off the waste. The ventilation is by means of the windows, the upper part of which has coarse perforated gauze on the outside, but it seemed possible to close up the sash; there were also brick holes in the walls of each ward.

The infectious hospital which was empty at the time of our visit, is quite remote from the infirmary, standing in the same grounds. It is self-contained, but has no bath room, only a large moveable bath and only such hot water as could be obtained from the copper. It is modern, and the walls are smooth cement. The itch ward, attached to the infirmary, is a small ward opening immediately on the court, with an open roof, a small fireplace, and no other conveniences — a ward that ought to be condemned at once. The ward tenanted by the old couple is the lock ward, but the matron stated that there are small wards that might be used.

Bells from the infirmary communicate with the master's block and also ring into the nurse's room from the wards. The doctor, who lives about a mile and three-quarters away, has to be fetched at night by the porter.

The diets, the nurse informed us, were fair. We saw jacketed tins in the passage in which the food had been brought over from the kitchen, but she informed us that they were never filled with hot water. Again, we could not receive any satisfactory reply to our query as to whether the food was prepared in any special way for the toothless old people, or whether they could eat their meat when not so prepared.

The infants were in the charge of an old pauper, assisted by an imbecile. We saw about six of various ages in the nursery; one looked very sickly, and the matron said that it had been so from its birth. The objectionable tube bottle was in use. It was here that we saw the pool under the bassinette. It is always sad to see the unchildlike aspect of these unfortunate babes "mothered" by an old pauper, enduring a tolerated existence without any of the usual care bestowed on helpless infancy. The airing courts are better than usual, that for the men having grass and flowers, surpassing the women's in this particular. As we entered the infirmary we passed through a pretty bit of garden where we thought that some seats would be comfortable for the old people.

RECOMMENDATIONS.

Structures are stubborn things to deal with and that at Truro Workhouse is no exception. It is very unsuitable for infirmary work, with its small wards, many staircases, and rough walls. The latter should be cemented and washed in two shades of some pretty colour, the labour ward might be improved by taking in a piece of the adjoining dispensary. The closets might be built out with a disconnecting lobby. and bathrooms added with a hot water supply. With regard to the nursing we should advise an increased staff; there should be at least one on the male and one on the female side, and a night nurse. But even this would not be sufficient to do away with the necessity of employing the paupers to some extent as nurses, and as long as this is so we cannot be satisfied that the sick are properly nursed.