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 West Derby union workhouse.


These two institutions, with the large workhouse at Walton-on-the-Hill, belong to West Derby Union, which includes within its radius a large portion of the city of Liverpool, hence they are the complement of each other. Armed with a permit from the Board, we applied for admission at the Belmont Road House. This house is called the "Test House" because in the original scheme it was used as a place of labour for the large number of vagrants that passed through the union; it is now used by the vagrants, but there is besides a certain proportion of permanent able-bodied inmates, and also infirm and old people. The Mill Road Infirmary receives all the sick who apply for medical relief, such patients as are in Belmont Road House being the cases that have occurred among the inmates or the vagrants.

The hospitals, for there are two, in blocks at opposite extremities of the building, are assigned to the inmates and the vagrants respectively. The plan of the building is a series of separate blocks standing one behind the other, connected by a covered corridor; the intersecting corridor, divided in its length, separates the blocks into male and female portions. The inmates' hospital is at the extreme end of the block and the tramps' hospital is to the front, being the next block behind the tramps' wards. The inmates' hospital block contains 36 beds for females in two wards, and 42 for males in two wards. The wards are on the first and second floors, the ground floors being used as day rooms.

The wards resemble each other in style and arrangement; they are long and narrow, lighted by windows on each side, having the nurse's sitting-room on the landing, and at the far end the waterclosets and slop-sink, and an inside stone staircase for a fire escape. The beds are placed against the long walls; they are of full width, having iron canvas-covered laths, with flock or straw beds. The wall surface is painted brick. There are two open fireplaces in each ward; wooden floors, with a strip of carpet down the middle. The ventilators are of ingenious construction; above the upper sash is a continuation of the framing with louvred apertures. When the sash is down the ventilator is in action, when closed it is pushed up into a space in the wall prepared for it. The windows are set high in the walls, giving a somewhat gloomy appearance to the wards.

The hospital was nearly empty at the time of our visit, and the bulk of the patients were in the day rooms; those who were in the wards represented the sick cases under treatment. The worst case was one of pneumonia following influenza. There was a very good temperature chart giving a record of the disease, and showing that the man had a good chance of recovery, but he had been seriously ill. A man convalescent from bronchitis, another with chronic bronchitis, one crippled with rheumatism; and, among the women, cases of old age and infirmity, which prevented them going up and down stairs. In the day room most of the women were at needlework; a few of the men were playing a game, but the larger number were in a listless group round the fire.

The tramps' hospital block is similar in plan and arrangement to that already described, but it holds a slightly larger number of beds; there are 35 for the females and 44 for the men. As its name indicates it is reserved for the treatment of all cases of sickness among the casuals, all offensive patients are placed here; the top floor on each side is set apart for the lock cases. We found many more cases of acute illness here, patients who had been exposed to chill or severe weather, skin eruptions, and cases of syphilis; the medical officer endeavours to keep them under treatment until cured, though they are often restive under the detention.

Lying-in patients are not received in this hospital; such cases as are nursed in the workhouse are sent to Walton-on-the Hill; but it is the practice in this union to urge the women to be confined at their own homes, attended by the nurses from the infirmary. Likewise there is no children's department; the children are located in the cottage homes at Fazakerly, where they have their own infirmary; such children as we saw are either detained by magistrate's order, or are on the tramp with their. parents.

Trained nurses, both male and female, are employed in the hospitals, assisted by the inmates. There is one nurse in each section by day and the same at night; also an inmate is on duty in each block at night, who sleeps in the ward by day. Three of the female nurses are also midwives, and are ready to deal with any emergency that may arise in the tramps' department. We conversed with several of the nurses and were shown the cupboards for poisons and medicines, also the temperature charts, discussed the work with them; as far as the nature of the cases permitted there was skilled nursing. The hospital is visited daily by the doctor, and if required he is fetched by messenger at night. According to the statements made to us, there appeared to be careful feeding during the night; the man with pneumonia being fed at regular intervals during the night.

The sanitary appliances are of modern construction, especially the baths. Each section has its bathroom in the corridor adjacent to the block; the bath is of porcelain set in the middle of the floor; the walls are tiled and cemented, and the floor is laid in tiles; there is no means of heating the rooms, but the matron informed us that it was not necessary. In the bathrooms for the tramps there are four baths in a room; we did not see any screens to ensure privacy. We have already noticed the slop sink in the ward lobbies, an adjunct to cleanly nursing more frequently conspicuous by its absence.

We now turned our steps to the Mill Road Infirmary. An inspection of this place was not in our brief; but the authorities were urgent on us that we should see it, assuring us that the Test House was nowhere in comparison, and so we presented our request to the medical superintendent for permission to go over the institution under his charge. Unfortunately he was out, but his place was readily taken by the matron. The infirmary is a hospital in its arrangements and in its method of working. It stands three-quarters of a mile from the Test House, and nearer the city; it occupies the place of the old hospital, part of which is incorporated in this building with extensive additions. The ground plan is that of a double H, the two side blocks being respectively male and female wards, half of the middle block being the administrative department, the rear portion having the children's wards and those for the lock cases. The building stands four storeys high, including the basement, where are wards which are only used in time of pressure. The total accommodation is for about 900 beds; this includes 150 in the Lower Hospital, reserved for the imbeciles and epileptics. This hospital is a detached building in the same enclosure at right angles to the main hospital.

The wards, of which there are 16 of 36 beds, and 4 of 32 beds, occupy the entire length of the uprights of the letter; at the near end is a day room, a ward kitchen, single ward with 2 beds, and a linen room; in the transverse portion, on the ground floor, are the receiving rooms with bath room attached, and lifts for conveying the patients to the respective floors. The upper portions of the transverse corridors are converted into recreation grounds, the iron columns from the one floor supporting the balcony above. The walls of the wards have a smooth surface painted in two colours. There are two stoves, each having one fireplace, in the middle of the ward, the flues being carried under the floor. The lighting is by numerous single gas brackets on the side walls. The windows face each other; the ventilation is by means of the upper half of the sash formed into a hopper opening. and there are besides intakes below the windows and outlets in the cornice communicating with the patent extractors in the roof by shafts in the wall. In each ward there are low cupboards for the ward necessaries — dressings, medicines, etc.; these are placed tablewise down the middle of the wards. The bedsteads have the spring mattress, on which is laid a wood-fibre mattress, and they are furnished with removable pulls. At the end of the ward, in an annexe with an intercepting lobby, are the lavatories and bath rooms; the walls are tiled in two colours and the floor laid in tiles, all set in modern style. The surgical patients are nursed in the top wards, near the small room that is used as an operating theatre.

The nursing is such as one would expect to find in so well-appointed a building; there is no pauper help of any kind. The medical superintendent has under him a trained matron with two assistants, a staff of from 60 to 70 nurses, some of whom have been trained in the infirmary, and a night superintendent. The cases are the acute sick surgical patients and operation cases, so that there is excellent material for the training of the nurses; these nurses are lodged in the home placed on the opposite side of the road, and connected by a subterranean passage with the hospital. Here are the dining and sitting rooms, a large hall useful for various purposes, 63 bedrooms for the nursing staff and other conveniences, accommodation for sick nurses, and rooms for the household servants on the top floor. A home sister is responsible for the work of the home under the matron. Each officer is responsible for her own department under the medical superintendent.

The laundry service for these two hospitals is provided for at the Test House, where a large and well-appointed laundry has been fitted up for the purpose of taking the washing from the infirmary, thus providing work for the able-bodied paupers of the union. The soiled linen is removed daily. The bread for the infirmary is also baked in the Test House.

The Guardians may feel proud of their infirmary, of which we carried away a most favourable impression. We trust that it will serve as a pioneer in the cause that we have at heart, namely, the Nursing of the sick pauper in a manner that bears a commonsense relation to his ailment, irrespective of the fact that he receives such medical relief from the rates. The guardians of West Derby Union have evidently approached the subject in an enlightened manner, and we doubt not that in course of time they will receive the indirect reward of their policy in the decrease of pauperism due to the generous bestowal of medical relief. As we made the round of the building we saw points in which there still lingered the trail of the workhouse system; but we feel sure that in time these marks will vanish, and that our best plan is to leave the matter in the hands of the Board and its advisers.

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