THE 
SICK POOR IN WORKHOUSES. 
REPORTS 
ON THE 
NURSING AND ADMINISTRATION OF 
PROVINCIAL WORKHOUSES AND INFIRMARIES, 
By a Special Commission of the “ British Medical Journal 
WITH AN APPENDIX OF SUMMARIES OF THE ABOVE AND AN INTRODUCTION 
By ERNEST HART, D.C.L., 
EDITOR OF THE “BRITISH MEDICAL JOURNAL.” 
Ami a Statement in respect of the above made in the House of Commons 
by the Riyht Hon. E. Shaw Lefevre, M.P., President of the 
Local Government Board. 
FIRST SERIES. 
LONDON: 
SMITH, ELDER & CO., 15, WATERLOO PLACE. 
1895. 
PRICE ONE SHILLING. THE NURSING AND ADMINISTRATION 
OF PROVINCIAL WORKHOUSES 
AND INFIRMARIES. THE 
SICK POOR IN WORKHOUSES 
REPORTS 
ON THE 
NURSING AND ADMINISTRATION OF 
PROVINCIAL WORKHOUSES AND INFIRMARIES, 
By a Special Commission of the “ British Medical Journal,” 
WITH AN APPENDIX OF SUMMARIES OF THE ABOVE AND AN INTRODUCTION 
By ERNEST HART, D.C.L., 
EDITOR OF THE “BRITISH MEDICAL JOURNAL.” 
And a Statement in respect of the above made in the House of Commons 
by the Right Hon. E. Shaw Lefevre, M.P., President of the 
Local Government Board. 
FIRST SERIES. 
LONDON: 
SMITH, ELDER & CO., 15, WATERLOO PLACE. 
1895. CONTEXTS. 
PAGE 
Introduction vii 
Statement made in the House of Commons by 
the Eight Hon. E. Shaw Lefevre, M.P. ... xii 
Eeports on the Nursing and Administration of 
Provincial Workhouses and Infirmaries: 
I. Introductory 1 
II. Hatfield 4 
III. St. Albans 6 
IY. Bishop Stortford 8 
V. Haverfordwest 11 
VI. Bath 14 
VII. Bishop Auckland 18 
VIII. Chester 21 
IX. Aberystwith 23 
X. Wrexham 25 
XI. Darlington 27 
XII. Wakefield 29 
Appendix : 
Summary of the foregoing Eeporfs from the 
British Medical Journal, with Editorial 
and other Comments S3 INTRODUCTION. 
(Being an editorial article of the British Medical Journal, Aug. 25,189LJ 
In a timely article in the Westminster Revieio, Miss de Pledge, 
matron of a large metropolitan infirmary, reviews the 
present treatment and nursing of the sick poor in the 
metropolitan and some of the larger country workhouse 
infirmaries. It is delightful to find how wide is the interval 
which separates their present condition from that which 
obtained in 1865, when the inquests on Gibson in the 
Holborn Workhouse Infirmary first attracted the attention 
of Mr. Ernest Hart, when acting as the co-editor of a con- 
temporary, and led him to plan and initiate the inquiry, 
in which he subsequently obtained the assistance of Dr. 
Anstie, Dr. Eogers, and Dr. Carr. Then followed the publica 
tion of 50,000 copies of his manifesto on the “ Hospitals of the 
State; ” the formation of the Metropolitan Workhouse Infirm- 
aries Eeform Association; the great meeting at St. James’s 
Hall; the giant deputation which he introduced at the Poor 
Law Board, and of which he was spokesman, to Mr. Villiers, 
then President; and the unprecedented and rapid revolu- 
tion of public opinion which destroyed the old and bar- 
barous systems of treatment of the sick in the infirmaries, 
and culminated within eighteen months in the passing of 
Gathorne Hardy’s Act; the creation of the Metropolitan 
Asylums system; and the erection throughout the metropolis 
of separate infirmary buildings, administered as, what they 
are now admitted to be, “ hospitals of the State.” This phrase 
has since then become stereotyped in our literature: 
it represents what was then a new idea but has now become 
a commonplace. Then for the first time was accepted the 
principle of a common rate for London for sanitary purposes 
and for the sick, the first and fruitful step towards equalisa- 
tion of rates and the recognition of the unity of London—as 
a whole. 
Miss de Pledge points out with pride, and we read with a 
warm thrill of personal pleasure, the admirable conditions 
under which the great workhouse infirmaries of London are 
now administered—the kindness, the skill, and the success 
with which the sick poor within these great establishments 
are treated and nursed. No one will envy us the deep satis- 
faction with which we find it affirmed by a critical authority Viii 
INTBODtfCTIOU. 
that that great humanitarian movement, due solely to 
medical effort, quorum pars magna fui, has remained a 
permanent benefaction to the thousands of the infirm, 
sick, and helpless poor. Not only are they no longer 
neglected and made to endure cruel and unnecessary suf- 
ferings, but they are, as Miss de Pledge points out, as 
tenderly nursed and as well cared for as in the great 
metropolitan hospitals, which are the pride and glory of our 
city. It is delightful to find that an impartial critic is able 
to give such an account of these establishments as to show 
that the work then founded remains a permanent good, an i 
one which has grown and developed during the quarter of a 
century which has elapsed. It is now in most respects and 
in many places as well, in London as in some of the great 
provincial cities—Manchester, Birmingham, Cardiff, Liver- 
pool, and Newcastle—and in other large workhouse infir- 
maries scattered over England and Wales, a model for other 
countries and for other cities. It now only remains to com- 
plete the work by raising the provincial workhouse infir- 
maries generally to the same level of decency and of humanity 
in the treatment of the sick poor. 
It will no doubt have come as a painful surprise to many, 
as indped it has been to ourselves, to learn, as has been 
shown by the result of our recent inspections, and from the 
reports which we have already published and those which 
we have yet to publish, that the “straw sack” is still in use in 
some of our country infirmaries ; that the untrained matron 
of the workhouse is accepted as the head of the nursing 
department; that the “ assistant nurse ” is still to be found 
receiving her £12 per annum; that the night nurses, even the 
untrained pauper helps so-called, are few and far between ; 
that the unpaid paupers who are called nurses, and who 
wash the patients, change poultices, administer medicines, 
drugs, and have charge of the stimulants for the sick, are 
plying their task in numberless instances in the wards of 
the workhouse infirmaries. How they fulfil them, and with 
what results, the tragedies at Newton Abbot and at the 
Oldham workhouses bear illustrative testimony. We have 
found that the mixing up of the infirm, helpless imbeciles, 
and sick is the prevailing custom in the majority of these 
infirmaries. We have had twenty-eight years of further 
Poor-law inspection; but these abuses still exist, and 
few days pass but that in one country newspaper or another 
news is given of a catastrophe that has resulted from the 
want of trained nurses or proper appliances. We propose 
to make an end of them, and ask public help for the 
purpose. lNTB.ODUC.fIuN. 
It would be regrettable if, under the influence of anodyne 
reports of the great improvements which have been effected 
through the efforts of Mr. Ernest Hart and his contemporaries 
in the metropolitan workhouse infirmaries and those of the 
great cities which we have named, the public should now fold 
its hands and rest satisfied that all has been done that is 
required for the sick. The Local Government Board appears 
for a long series of years to have regarded these sad con- 
ditions and cruel neglects with silent complacency or gentle 
chidings at cases of scandal; it needs to be awakened from 
this supine satisfaction. What its inspectors have failed to 
stigmatise, and what the Board has been content not to 
know or not to alter, we are bringing weekly to public notice. 
At present, and hitherto, these strange and sad revelations, 
while happily awakening some local echoes and leading to 
partial improvements, are being received by the Board with 
silence, and by the public and the press, preoccupied with 
political anxieties, with a quietude which might be inter- 
preted as indifference. The inspectors of the Local Govern- 
ment Board have apparently been occupied largely, so far 
as they have been moved at all by the reports of our com- 
missioners, in suggesting apologies or insinuating exaggera- 
tion. We are well assured, however, that there will be a 
rude and probably a swift awakening. The public con- 
science will not be satisfied with little hole-and-corner 
reforms and local reprimands. The reports which we are 
week by week giving of the country workhouse infirmaries 
bring to light in every one of those which we have had 
visited one or more of the abuses to which we have referred 
existing in full vitality. 
Almost everything that was accomplished by Mr. Ernest 
Hart and his colleagues for the sick poor in the great cities 
remains to be done in the country, and we must work on 
knowing no pause until this result is attained. It is abso- 
lutely necessary, and we demand in the name of all that is 
dutiful and humane, that adequate standards be laid down 
for the construction, the administration, and the nursing of 
the sick poor under the charge of the State in provincial as 
in metropolitan workhouses. There must be an end of all 
this cruel, wicked story of the sick, the infirm, and the 
bedridden. We are formulating these standards tentatively 
by recommendations in each infirmary. It will be for the 
public to insist and the Poor-law Board to require that they 
are fulfilled. 
We demand—and we feel sure that the public conscience 
will support the demand—that there shall be a standard for 
the number of trained nurses in workhouses in proportion X 
to the number and the classification of the sick; that the 
necessary appliances, baths, closets, and dressing apparatus 
be provided according to a general scale'; and that the pro- 
vincial hospitals of the State be assimilated in standards of 
humanity and efficiency to those of the great cities. This 
is all the more necessary that, judging by their silence or 
their recalcitrancy, by their supineness or their obstruction, 
the legal and political gentlemen to whom, as “general 
inspectors,” the supervision of the wards, the nursing 
establishment, the supply of hospital appliances, and the 
nature of the hospital administration has hitherto been 
officially left appear to be wholly unequal to the task and 
ill equipped for the responsibility—as, indeed, without 
reproach, they might be expected to be. 
INTfiOPUCTION. 
To the question which we have now often asked—who 
shall inspect the inspectors?—there has as yet been no reply. 
To this we must now add the further question—and take care 
that sooner or later a public answer shall come—Who shall 
appoint the inspectors, under what conditions, with what 
requirements, and by whose advice ? It might be well, and 
it would be very agreeable to us as it would, we feel sure, be 
satisfactory to the public, and worthy of the Local Govern- 
ment Board, if it would now and at the present stage take 
this matter in hand on the basis of the information already 
furnished by the twelve reports which we have thus far pub- 
lished of the results of our inspection of as many workhouse 
infirmaries in the provinces, and with the aid of the further 
information contained in as many more reports which we 
have in hand, and of which we are ready at once to furnish 
to Mr. Shaw Lefevre the details. It seems to us surprising 
that this stereotyped machinery of influential deputations to 
the Local Government Board, and the public recital within 
the walls of its board room of the facts calling for inquiry 
and redress, should always be needed. It had to be gone 
through, with all the aid of public meetings and grand depu- 
tations, in order to bring about the reform of metropolitan 
workhouses. It cost our present Editor just eighteen months 
of hard work when such time could ill be spared. This was 
rewarded by the success of the effort, by much violent abuse, 
and speedy oblivion. We have just gone again through that 
ceremony, this time also with prompt and promising results 
in the case of the children of the State educated in barrack 
schools. Three months ago, when the subject of the Forest 
Gate School scandal was first brought before us and we 
began to deal energetically with this subject, the Local 
Government Board, with all its apparatus of secre- 
taries, inspectors, and clerks, appeared perfectly contented INTRODUCTION. 
wi*.h the then existing state of things. In more than 
one instance it has even refused to allow cottage homes to 
be established at the guardians’ expense, and it was on the 
eve of approving considerable additions to metropolitan bar- 
rack schools. In reply to the questions which were put in the 
House of Commons at the instance of Mr. Ernest Hart, as 
Chairman of the Parliamentary Bills Committee and as 
Editor of this Journal, concerning the Forest Gate scandals, 
and the hardly less regrettable methods and results of the 
Local Government Board inquiry, the President of the Local 
Government Board—under the advice, no doubt, of his able 
permanent officers- -gave answers indicative of nothing else 
than deprecation of any suggestion for the need of further 
inquiry, and treated the matter as a closed book. The 
advent to the Local Government Board of a great and 
influential deputation, and the printed memorandum pre- 
viously placed in the President’s hands and issued from this 
office, descriptive of the basis of demand for a full and 
ample public inquiry, first awoke Mr. Shaw Lefevre to an 
active sense of the necessity of giving something more 
than smooth and illusive replies in the House of Commons; 
and so within three months of our first raising the 
question in an individual sense it was developed into 
an urgent and organised public demand which no ad- 
ministrator could disregard. To this Mr. Shaw Lefevre, 
with a sensitive and humane instinct, has given effectual 
satisfaction by the appointment of a Committee of able 
and independent persons wholly freed from official influ- 
ences. For this act and for the complete and graceful 
manner in which it has been carried out, much thanks are 
due to him. We trust—and we feel, indeed, no small con- 
fidence—that he will meet the demands which we are now 
putting forward as to the treatment of the sick poor in 
provincial infirmaries with the like concession. The Par- 
liamentary recess is upon us, or it would certainly be 
obtained within a few weeks. Meantime Mr. Shaw 
Lefevre has time to set his house in order, and to 
agree with us—his friend and not his enemy—in the 
gate. 
We hope that it may not be necessary again to besiege the 
doors of the Local Government Board at so short an interval 
with another deputation bound on a similar errand ; but, how- 
ever it may be necessary to proceed in order to obtain the 
public object which we have in view, we must not rest 
until a similar inquiry is set on foot for the sick as is now 
to be commenced for the children. In this labour we shall 
not pause, and we feel assured that the demand which we iNTROhUClIOlt. 
are making on behalf of the public and of the sick poor is so 
just and so urgent that it cannot be resisted, and its satis- 
faction ought not to be long postponed. 
Statement made in the House of Commons by the 
Right Hon. E. Shaw Lefevre, M.P., President 
of the Local Government Board. 
In the House of Commons on Thursday, August 23rd, Mr. 
A. C. Morton asked the President of the Local Government 
Board what were the requirements of the Board for the ap- 
pointment of inspectors of the Local Government Board; 
what were the technical qualifications required; whether 
their duties included reporting on the nursing of sick poor 
in infirmaries, and the management of the hospital wards; 
how far they could be considered responsible for not having 
reported on the condition of things officially admitted to 
have existed at Oldham, Bath, and other provincial work- 
house infirmaries, which were now known to be wholly un- 
provided with trained nurses for the attendance on the sick 
and aged people at night; and whether he was cognisant of 
the reports on this subject on twelve provincial workhouses 
and infirmaries in the British Medical Journal, all of 
them described in detail as disclosing cruel and shocking 
defects in the treatment of the sick poor. 
Mr. Shaw Lefevre, in reply, said that no rules had been 
laid down as to the qualifications for the office of general 
inspector of the Local Government Board. During the last 
twenty years the officers appointed had, almost without 
exception, held office as assistant inspectors, and had thus 
obtained experience in the inspection of workhouses and 
other duties which devolve on an inspector. There were also 
two medical inspectors, one of whom acts in the provinces, 
and was associated with the inspector of the district in 
special inspection where the advice and assistance of a 
medical man was deemed desirable. It was the duty of the 
inspectors when they visited the sick wards of a workhouse 
to inquire as to their arrangements, ascertain from the 
inmates whether they had any complaints, and report to 
the Board the result of the inspection, and especially any 
matters which they considered required a communication to 
the guardians from the Board. They themselves dealt with 
many matters by direct communication with the guardians. 
He had read with great regret the reports which appeared in 
the British Medical Journal, and they were receiving his 
very careful attention. He had instructed an inspector to 
deal with them in connection with his visits to the work- 1NTHODUCTION. 
house, and when it appeared to be required a joint visit 
would be made by a medical inspector. He was aware that 
there were many unions in which the guardians still relied to 
a much greater extent than was desirable on the assistance 
given to nurses by pauper wardsmen and wardswomen, and 
the subject was one that was constantly being brought under 
the attention of boards of guardians. In several of the cases 
mentioned the nursing arrangements had been the subject of 
communications either by the board or tlieir inspectors. 
Although much remained to be done, he was very glad to be 
able to state that there had been of late years a considerable 
increase in the number of nurses, and this to a large extent 
had been secured by the influence of the board and their in- 
spectors. The importance of the questions affecting the care 
and comfort of the sick was fully realised by him, and he 
would give the whole subject his very careful consideration 
during the recess. 
Mr. A. C. Morton asked how long it took the inspectors to 
discover the cruelties practised at the Brentwood Schools. 
Mr. Shaw Lefevre said it was very difficult indeed to dis- 
cover cases of that kind unless complaint was made to them, 
and very often the children were so terrorised that they were 
afraid to make a complaint. 
Mr. A. C. Morton inquired whether the inspectors took any 
opportunity of seeing the children themselves. 
Mr. Shaw Lefevre replied in the affirmative. 
Mr. H. Hoare asked whether the inspectors ever saw the 
children after they left the schools. 
Mr. Shaw Lefevre was understood to say that that had been 
done in some cases, but even then it was not always possible 
to ascertain the facts. REPORTS 
ON 
THE NURSING AND ADMINISTRATION 
OF PROVINCIAL WORKHOUSES 
AND INFIRMARIES. 
Specially Repoexed to the “British Medical Journal.-' 
Workhouse Infirmaries 1'fiey Were.—Foundation of the Work- 
house Infirmaries' Reform Association.—The Workhouse Visit- 
ing Committee.—The Battle against Officialism.—Mr. Gathorne 
Hardy's Act.—Trained Nurses for Sick Paupers. 
I. 
In 1865 Mr. Ernest Hart, and subsequently Dr. Anstie and 
Dr. Rogers as his colleagues, initiated an investigation 
into the condition of the sick poor in the Metropolitan 
workhouse infirmaries on behalf of a great medical jour- 
nal. Two cases of grievous hardship and neglect had 
awakened the public conscience, and Mr. Hart took the 
initiative in conducting an investigation into the state of 
the pauper sick, bringing to bear on the question those 
powers of patient research that are a matter of course to 
the medical man, and also the special knowledge of the re- 
quirements of the sick gained in hospital life. The Workhouse 
Infirmaries’ Reform Association was soon after founded by 
the same gentlemen, taking as its manifesto an article in the 
Fortnightly Review by Mr. Hart on “The Hospitals of the 
State/’ of which 50,000 copies were reprinted. The labours 
of this Committee aroused the utmost interest, whilst at the 
same time it horrified by tale after tale of the greatest 
neglect, ignorance, and stupidity in the treatment of the 
sick, and of the total absence of anything like intelligence in 
their management. It was not that the country grudged the 
money necessary for the proper care of the sick, it was not 
that the guardians as a body intended the ill-treatment of 
the sick, it was not that the officials—master, matron, or 
others—were brutal or hard-hearted; the reports of the Asso- 
ciation reiterate how every facility was given by the guardians 
for the investigation, how at times they showed with pride 
an infirmary “ up to date,” as they thought, where every- 
thing nevertheless was wanting for the treatment of the sick, 
and in many cases the officials are spoken of as humane people doing their best according to their lights. It was 
ignorance, want of experience and knowledge, that was the 
cause of this neglect. In the report of the Commission are 
these words: “ The guardians are by their experience and 
their position unacquainted with the primary facts and with 
the first principles which should guide the government of a 
hospital;” and again, “The present is a system of patch- 
work ; originally no doubt the workhouses were intended for 
the sturdy vagrant and the ne’er-do-well, and partook largely 
of the nature of a prison ; the care of the sick and feeble was 
an afterthought.” 
This was in 1865, but, previous to that date, much prepara- 
tory work had been done. Going back fifteen years, we find 
the Workhouse Visiting Committee had by their patient 
labours gradually been letting daylight in upon these 
grievous abuses. Until that time the workhouses had been 
as fast closed to the casual visitor as the prison, and very 
great difficulty was experienced by that band of women in 
obtaining permission to visit the inmates. The name of the 
energetic secretary of that body (Miss Louisa Twining) is 
now identified with the movement then commenced, which 
had for its aim the amelioration of the condition of the sick 
poor in the workhouses, and with her must be associated the 
surgeon of the Strand Union, the late Dr. Joseph Rogers, a 
man cast in a heroic mould, who fought his battle against 
officialism, ignorance, and apathy to the last. The education of 
the public mind had been carried on by pamphlets, letters 
to the press, meetings, etc., by any means that could be de- 
vised to lay facts before it, so that when these two ghastly 
cases of neglect and hardship were brought to light, they 
were but the match to the train of powder. It seemed in- 
conceivable that such utter callousness to human suffering 
should be possible in a Christian country; that such gross 
neglect was to be discovered under the rule of men in all 
respects humane and enlightened ; but there it was in all its 
hideous nakedness, and the worst of it was that these were 
no isolated . instances, proofs of the breaking ,down of a 
system otherwise of fair utility, but that rather they were 
the result of the system of Poor-law management, and that 
similar instances could be multiplied in nearly every work- 
house in the metropolitan area. We are a proverbially slow 
nation to arouse to enthusiasm or energetic action, but when 
aroused we are in earnest. As the result of the labours of 
the Association three public inquiries were carried on at 
as many London workhouses, Mr. Hart acting as public 
prosecutor; and deputations and public meetings were 
organised, the result of which was the introduction of a 
Bill drafted by Mr. Gathorne Hardy, the then Presi- 
dent of the Poor-law Board, which is the origin of all the 
improvements that have been made in the metropolitan 
infirmaries. It provided for the erection of separate build- 
ings for the reception of the sick, and ordered the classifica- 
tion of the sick in wards apart from the lunatics, imbeciles, 
able-bodied or infectious patients. Twenty-four sick asylums 
of the metropolis, which vie in fitness of appointment and 
in the necessary machinery with many of the voluntary hos- 
pitals, are the result of that Bill. 
Whilst this agitation was at work around the pauper sick of 
London, the experiment of trained nursing for the sick in the 
workhouse infirmary was being actually tried in Liverpool; 3 
in 1865, Miss Agnes Jones, of the Nightingale Training 
School, undertook the nursing of the vast establishment of 
Brownlow Hill Infirmary. in that quaint old building, 
where everything was most rudimentary, she proved the great 
advantage of skilled nursing from all points of view; we have 
but to turn to her life, with its graphic pictures of the diffi- 
culties she encountered, the hardships she underwent, and 
the excessive strain on mind and body, to realise what the 
task was. Agnes Jones, in three short years, gave her life for 
the work she loved so well; but the cause of the sick pauper 
was practically won. 
There is one thing more wanted to make these great city 
infirmaries remunerative to the ratepayer, and that is, that 
they should be utilised as medical schools where the student 
might learn the treatment of the chronically sick—a class of 
patients which represents a large proportion of his practice, 
and of which, from the nature of his hospital training, he is 
often very ignorant. Within these walls there is an immense 
amount of teaching material that is quite out of reach, though 
the ratepayer has a more real claim on it than on the material 
placed at his disposal in the voluntary hospital. 
The above retrospect brings us to the point at which we 
now stand—a point that leaves the bulk of the country work- 
houses in the more remote districts untouched. Much has 
been done in those large centres of population that resemble 
London in their circumstances to bring the infirmaries up to 
date, but of the conditions of the sick poor in the country we 
are comparatively ignorant. 
The public conscience has recently received another shock 
from the revelations of the management of a country work- 
house, as the result of an inquiry held by the Local Government 
Board. The state of affairs therein disclosed differs in no 
particular from that found in many of the metropolitan in- 
firmaries when Mr. Hart and his colleagues made their round. 
If this be so, who is to blame ? Surely that system must 
be at fault which makes such things possible, for whilst Mr. 
Gathorne Hardy’s Act gave increased powers to those boards 
of guardians who sought for reform, it exercised no control 
over those boards who had neither the knowledge nor the 
experience to decide upon the requirements of the sick. This 
is evident to anyone who will wade through the pages of 
Glen's Consolidated Orders, wherein are many recommen- 
dations from the Local Government Board on the fitting 
management of the sick, quotations from Miss Nightingale’s 
regulations for the training of probationers, suggestions from 
the reports of medical inspectors as to the proportion of 
nurses to the sick, and indeed an elaborate series of by-laws 
concerned with the relations of the officials to the sick ; but 
the power of the Local Government Board to enforce the 
same is nil in the teeth of a non-progressive board of 
guardians. 
The old prejudice that trained nursing is extravagant still 
remains there, and will die hard; to such we could commend 
the aphorism, “That work badly done, though ever so 
cheaply, can never in the end be economicaland reiterate 
the opinion expressed after the results of the old system 
had-been ascertained, “ if, as we assert ought to be the 
case, all the infirm were medically treated, there would 
be a larger percentage of recoveries, and consequently, as 
before stated, an important saving of the rates.” II. 
HATFIE1 D. 
Hatfield is a small country tor n, which owes most of its 
importance to the junction on tha Great Northern Kail way, 
and to Hatfield House, the seat of the Marquis of Salisbury. 
The workhouse is less than a mile from the station ; it is an 
old house, and scattered in its arrangement. On the imme- 
diate right on entering the gate is the new block for the male 
infirmary; on the left are quarters for the vagrants and 
casuals; in the centre, some distance from the gate, is the 
main block of the house. The building is nowhere above two 
storeys in height. 
We were received by the Master and Matron, who most 
courteously gave us every opportunity of seeing all parts of 
the house; and Hr. Lovell Hrage, the medical officer, was 
kind enough to accompany us. 
Male Infirmary. 
The male infirmary is a comparatively modern building. 
It consists of two wards holding twelve beds each, a day 
room, and an empty ward, used for lock or other isolation 
cases. In a small lobby close to the wards is a sink for wash- 
ing up, and two fixed washing basins, over which are taps, 
but there is no water supply. Outside the entrance is the 
closet, which is on the earth principle, but there was no 
earth in it at the time of our visit; it was simply a metal 
pan to receive the evacuations, and, considering its faulty 
construction, it was a wonder it was not more unwholesome 
than we found it. The wards are bright and cheerful, and 
nearly square, about 18 or 20 feet; the bedsteads are 3 feet 
wide, and the bedding is either flock or straw, the latter 
being preferred for its cleanliness. Of those in bed, the 
only acute case wras one of phthisis ; the temperature chart 
over his bed looked very businesslike. Each patient has 
his or her bed card, with the disease, treatment, and 
diet written by the medical officer. The other two cases 
in bed were senile debility ; the linen was clean, and the beds 
comfortable. There is no bath room, nor is any hot water 
supplied to any part of the building ; we saw in one corner a 
small copper supposed to be heated by gas, but, as it was set 
quite close to an external door in a draught, it could not be 
kept alight, nor if the flame were maintained would there be 
much chance of the water being hot. There were a few 
movable baths about, but these are not on wheels; thpy have 
to be filled by kettles and baled in emptying ; to give such 
baths in an infirmary is to make a mock of bathing. The 
only fixed bath that we saw was in the tramps’ quarter, and it 
was laige enough for a good-sized child to take a comfortable 
bath. 
The female infirmary is in a line with the main block, and 
is located in some old cottages, buildings as unsuitable foi 
the purpose as can well be imagined. On the occasion of our 
visit we found about half a dozen old women huddled round 
a fire in a small room about 10 feet wide by 20 feet or less 
Female Infirmary. long. There were six beds in this ward, two of them being 
occupied by aged patients; the windows were small there 
was no cross ventilation, but sliding shutters to admit the 
fresh air. On questioning the nurse she said that the foul- 
ness of the ward after the night was excessive; the only 
possible provision for their natural wants was the commode, 
and this was not emptied until the morning. The water- 
closet attached to the female infirmary was at a little distance 
out of doors, and to this they had to make their way in all 
weathers ; moreover, this convenience was immediately 
under the window of the labour ward, and, though on the 
earth principle, was without that necessary deodoriser. This 
ward was in direct communication with the airing court, and 
the cold air easily made its way through the ill-fitting door. 
The bedsteads were the narrow 2 feet 3 inch frame, the ward 
not admitting the wider bedstead. The ward above had six 
beds in it, but at this time it was empty. The quarters for 
the nurse are in this block. The staircases are narrow and 
steep, and the impossibility of carrying a corpse down 
decently, or of bringing helpless patients out in the hurry of 
an alarm of fire, was painfully evident. 
The Lying-in Ward. 
The labour ward is a small attic about 8 feet square, with a 
proportion of the air space taken off by a sloping roof ; there 
is a small fireplace quite inadequate to maintain a sufficient 
temperature in the depth of winter, and of but little use to 
the nurse. All slops and refuse must be carried down to the 
outside closet. The bedding was in a soiled condition, but 
the matron said that she was having new bedding made as 
fast as possible, and that she had supplied the nurse with 
mackintoshes; both she and the nurse had only recently 
been appointed. The only ventilation was from the window 
opening just above the convenience above named. We can 
hardly conceive that a board of guardians would acquiesce in 
this state of things, but wherever the difficulty of reform lies 
we trust that action will soon be taken either by the medical 
officer or the inspector to have them remedied. As long as 
they stand they are a disgrace to Hatfield, and if any deaths 
result from the low temperature of the ward, the board must 
be held morally responsible for them. 
Sanitary Appliances. 
In making our round we came across another convenience, 
this time a watercloset, but without water; of course it was 
not sweet, and the matron told us that it was only by the 
liberal use of disinfectants that she was able to keep it 
even tolerably wholesome. The water that is used in the 
house and in the infirmary is pumped up by the tramps, 
though the town main passes outside the gates. 
There is one trained nurse for these thirty-six beds, there 
is no night nurse, but in the event of a patient requiring 
more attention the matron divides the work with the nurse. 
There are no means of communication with the officials at 
night except by sending a pauper across the courts to the 
master’s or the nurse’s quarters, and the male infirmary is at 
System of Nursing. 6 
some distance from either. The cleaning of the wards is done 
by the wardsmen and women ; they have not been responsible 
for the nursing since the trained nurse came; the old wards- 
man who had been infirmary attendant over twenty-five 
years had become quite skilled as a nurse. 
There were no lock cases in at the time of our visit; such 
cases are isolated in the small wards in the male infirmary, 
and the same course is pursued for the insane, attendants 
being sent in from the town to take charge until removal to 
the asylum. We saw one imbecile on the female side, but 
she was quite harmless. 
Isolation. 
Diets. 
The medical officer has a free hand in diets, and the food 
given is suitable to their condition. The doctor receives a 
salary of £30 for attendance and drugs, and there is a sepa- 
rate fee for operations. 
Sick Comforts. 
The wards on the male side were provided with comfortable 
armchairs and—most unusual sight—a sofa; on the female 
side there was no room in the wards for anything but the 
bare necessaries. In the male wards we saw some screens, 
but so cumbersome that a nurse could hardly be expected to 
cany them. The airing courts are dreary prison-like yards, 
asphalted, the garden, with its wealth of flowers, being be- 
hind the house out of sight. We are at a loss for the reason 
why the sick poor are so carefully excluded from the use of the 
gardens ; it would surely relieve the monotony of their lives 
to be allowed to walk among the flower beds. In view of the 
deficiencies disclosed, we append the following 
Recommendations. 
To build a new female infirmary contiguous to the male 
block, fitted with suitable appliances for sick nursing. The 
remodelling of the drainage and water supply. The employ- 
ment of a paid attendant in the wards at night. To provide 
a communication with the officers’ quarters for use at night. 
To build bath rooms in the infirmary, with hot and cold 
water in them. 
III. 
ST. ALBANS. 
The next house that we visited was Pt. Albans, situated at 
a little distance out of the town, and standing on a slight 
elevation, with open space all round. The inmates are drawn 
from an agricultural population, and this class is low in in- 
telligence, and enters the infirmary at an advanced age. The 
building set apart for the sick is small, crowded, and unsuit- 
able for its work, but the matron informed us that the 
guardians were contemplating the erection of the new in- 
firmary. 7 
The matron was most obliging in showing us over the in- 
firmary and in giving us every information. The wards were 
rather empty, but when all the beds are occupied there must 
be overcrowding ; they are small rooms, holding five or six 
beds and these wards serve as day rooms, the meals of those 
patients who are up being taken in them. The dinner was 
being served when we were going round; it consisted of 
boiled pork and potatoes ; it was well cooked, but the thick 
slices of fat pork could hardly be an appetising morsel for a 
sick man. Special diets are ordered by the doctor, such as 
fish, milk puddings, eggs, beef-tea : these we saw on the bed 
cards, and the matron informed us that milk and beef-tea 
was given to the sick at night, for they have their last meal at 
6 o’clock. 
At Time of Visit. 
In the infirmary there are two nurses, the senior being 
fully trained, and the assistant having had some experience 
in the infirmary work. There is no night nursing of any 
description, the usual wardsman or wardswoman sleeping in 
the ward. In the event of a patient being seriously ill, the 
watches are taken by the two nurses ; no patient dies unat- 
tended. There are fifty-eight beds in the infirmary, the 
heaviest work just now being on the male side ; the cases in- 
cluded paralysis, rheumatism, bronchitis, and several of senile 
debility. The paupers help with the bed making, and wait on 
the patients, except those serious cases which are attended to 
by the nurses themselves, who also wash the patients. 
The labour ward is small, opening out of one of the infirm 
wards ; it is not often used, and then principally for unmar- 
ried women. 
System of Nursing. 
The imbeciles are kept apart; there is no provision for 
dealing with the insane, but in the event of a patient being 
uncontrollable, paid attendants are hired to take charge of 
the insane until removal to the asylum. There were no lock 
cases in the building at the time of our visit, nor is there any 
ward for their reception; such as may require isolation are 
kept in the receiving ward. 
Classification. 
The bedsteads were the miserable 2 feet 3 inch bed with a 
flock mattress and a proper supply of bedding, but we were 
pained to see the poor old people, many of whom never 
leave their bed, condemned to lie on a bed which was almost 
too narrow to turn round on; one big woman to whom we made 
this remark said they were most uncomfortable, and more 
easy to roll out of than to lie in. The bathrooms are on 
each floor, but from the overcrowded state of the infirmary 
they were full of a miscellaneous collection of articles, 
making it evident that they could not be frequently used. 
They were supplied with hot and cold water, and there was 
a good flush in the closets. There are no slop sinks, nor 
did there appear to be any convenience for emptying water 
except in the closet. 
Wards and Offices. Isolation Hospital. 
There is an infectious hospital attached to the Union, at 
this time empty; it is provided with a disinfecting oven, but 
here we noticed that the important duty of placing the cloth- 
ing in the receptacle is entrusted to a pauper. What is the 
use of having complicated apparatus, when they are rendered 
useless, or worse than useless, by neglecting to provide a 
responsible man to see that they are properly worked ? Nor 
was the infectious hospital kept ready for the reception of 
patients ; a nurse would have to be found, a certain amount 
of lumber to be removed, and the place cleaned up. It is a 
new building, so perhaps the guardians do not yet under- 
stand the use of their possession. 
Recommendations. 
That a new infirmary be built bringing the sick of both 
sexes under one roof, thus economising the nursing staff. 
A paid attendant to be put on duty in the sick wards at 
night. The setting apart of wards for the insane and the 
lock cases. That a responsible officer be put in charge of the 
disinfecting apparatus, and that the infectious hospital be 
maintained in a state of efficiency. 
IV. 
BISHOP STORTFORD. 
Bishop Stortfobh is a country town of average size and 
standing, and is the centre of a large agricultural population ; 
the union receives its inmates from a large number of 
hamlets, over a wide area. There is no hospital nearer than 
London or Cambridge, so that the sick among the working 
class must come into the infirmary if they require nursing, 
unless the case is so grave as to be sent to either of these 
places. 
The workhouse stands well on a slight rise, and is open on 
all sides. The infirmary is a separate building, and contains 
44 beds on the male side, and 35 on the female side ; to these 
must be added 33 beds in the fever hospital, making a total of 
112. On one side the infirmary is open to a wide expanse of 
country; the wards are of varying size, the largest holding 11 
beds; they are cheerful, airy, and well ventilated, having 
cross lights, and hit-or-miss ventilators in the cornice. The 
beds are wide, and the bedding is flock, feathers, or straw 
according to the nature of the case. Water and air mattresses 
are used in the infirmary for special cases. 
Buildings. 
Class of Patients. 
The master and matron took us into every part of the 
buildings, and afforded every facility for a minute inspection. 
On the male side there were at least 8 patients who required 
careful nursing. There was a man with cancer of the jaw which 
had been operated on. The wardsman seemed to be responsible 
for his feeding and cleanliness, indeed he took quite a profes- 
sional interest in his patient. In the larger ward a man was lying with spinal disease who had no control over the sphincters ; 
in the day he could be efficiently attended to, but at night, 
being dependent on pauper help, it was impossible that the 
wardsman sincle-handed could keep him clean. The matron 
said that on the bed being opened in the morning it was 
always in an unwholesome condition ; this was inevitable 
under the conditions, and it spoke well for the care that the 
man received that he was free from bedsore ; but his condi- 
tion through the night is sad to think of. In the same ward 
was a patient recovering from bronchitis, and another 
crippled with rheumatisn, a case of senile debility, and a 
case of dementia; to these add the aged and infirm in the 
smaller wards and we have a fair idea of the class of patients 
under the care of the nurse on the male side. On the female 
side the work was not so heavy, but as the midwifery patients 
are attended to by the same nurse, at times her hands are 
over full. The infirmary is always light as the warmer 
season comes on, but in the winter every bed is full, and 
often with acute cases. 
Lying-in Ward. 
This ward opens out of one of the infirm wards. It con- 
tains 4 beds, and is attended to by an inmate who was 
midwife before the trained nurse was appointed; it has no 
separate offices, and the number of confinements is not great. 
There were no lock cases in the infirmary at the time of our 
visit; but there is provision for their isolation. We saw a 
few imbeciles scattered about among the other patients; 
r,here is a separate ward for the insane, with a padded room 
into which a violent patient can be put by the doctor’s order, 
the more harmless are watched by the inmates until removal. 
Classification. 
The infectious hospital is a wooden building quite apart, 
but it is under the charge of the workhouse master, and its 
expenses chargeable to the workhouse. The wards are a 
series of huts suitable for their purpose, but otherwise it is 
crowded. We saw no place for the storage of the food but 
the bathrooms; the absence of such conveniences ham- 
pers the working and is quite unnecessary since the 
guardians were not limited in the space at their disposal. 
There is a small cottage holding 8 beds and this cottage 
takes in such patients as cannot be admitted into the wards; 
it is in the charge of a pauper and his wife. In this depart- 
ment there is the oven for disinfection ; it is provided with a 
pyrometer, and the porter is responsible for bringing the 
apparatus to the right heat, but the pauper resident in the 
cottage places the clothing in the receptacle; we could not 
ascertain that the distribution of the articles inside the oven 
was supervised, and this important detail seemed to us of too 
much moment to be entrusted to a pauper. The old man 
toddled out with much pride to exhibit the oven. Another 
thing that struck us as being faulty was an open trough 
running behind the infectious block within a few yards; 
along this trough the sewage was pumped on to the land. 
Isolation Hospital. 10 
The fever hospital has a permanent nurse responsible for 
its cleanliness and preparedness, and as occasion requires 
other nurses are engaged for temporary work; as there were 
only a few cases of scarlet fever in the ward when we visited, 
the one nurse was working single handed. This nurse is 
fully trained ; she is assisted by an inmate. In the infirmary 
there is one nurse responsible for the entire nursing of the 
sick; she is trained as a midwife, and has otherwise gained 
experience in general nursing; there is no night nurse, and 
all the service that the nurse cannot give is done by the 
paupers. In reply to our question as to the course pursued 
when a patient was too ill to be left untended at night, the 
matron informed us that some of the inmates were told off to 
sit up at night, or the nurse had to take the night watching. 
The nurse’s quarters are in the infirmary, and there is a bell 
for use at night to the master’s room. 
System of Nursing. 
Pauper help is very largely used in this house, for there are 
very few officers, and indeed considering the size of the 
building, and the number of the inmates (455), it was a 
wonder that the order was so excellent; a good spirit per- 
vaded all departments, hence the officers had willing workers; 
but the matron told us that the supply of able-bodied 
women was so small that she did not know where to turn 
for inmates for the service of the house. This difficulty is 
increasing every year, and at the time we were going through 
the house all the available workers were taken up by the sick 
department. 
The utmost was made of the inmates by keeping them to the 
work to which they were most accustomed. For instance we 
saw in the wards men and women who had served them for 
several years, and knew the routine, but taken at their best 
paupers can never be made responsible, and there is no 
margin for contingencies. 
Pauper Help. 
Receiving Wards. 
These are on each side of the hall close to the main 
entrance, and receive patients before they are seen by the 
doctor and classified; that for the women is attended to by 
an inmate, and that for the men by the porter. We saw a 
tramp in bed in the receiving ward; he was supposed to be 
resting, but he looked as though he would have been the 
better for regular nursing. 
Diets. 
The sick are given such extras as the doctor orders, and on 
casting our eyes over the bed cards, we saw that extra milk 
was frequently ordered ; the extras are fish, milk puddings, 
beef tea, and stimulants, and the matron informed us that 
milk, and beef tea, are served out for the night to the feeble 
ones. The “ full diet” in the infirmary is 7 oz. of bread, £oz. 
of butter, and 1 pint of tea, for breakfast, and the same for 
tea; for dinner 5 oz. of meat—it does not state whether roast 
or boiled, or of what nature—and 12 oz. of potatoes, vegetables; 
rice or pudding ; the “low diet” is the same for 
and supper, with 4 oz. of meat, 1 pint of broth, 12 oz. of 11 
potatoes, and 4 oz. of bread; arrowroot, broth or rice-milk 
may be substituted for meat in this diet. In this diet there 
is a deficiency of the material necessary for the repair of the 
body ; the nitrogenous element is small, compared with the 
carbo-hydrates and the hydro-carbons. The same defect 
was in the children’s diet, there is a large proportion of 
porridge, and very little milk. 
Water Supply. 
The water supply seemed to be ample ; there was a good 
flush in the closets, and hot and cold water was laid on to the 
bathrooms. Each ward was provided with a closet near at 
hand for use at night; these were all sweet and clean at the 
time of our visit. 
There are cheerful airing courts attached to each side of 
the infirmary, and besides the use of these courts, the infirm 
were allowed to walk in the extensive fields and gardens that 
surround the house. 
Grounds. 
Recommendations. 
We were much struck with the efficiency of the manage- 
ment of this house, but at the same time we were convinced 
that the number of officers was too small, and we recommend 
that a paid attendant be put on at night in the infirmary, 
and that the receiving wards be under the care of a respon- 
sible officer, and that increased space be provided in the 
infectious block for the service of the same; that the sewage 
trough be diverted from the immediate neighbourhood of the 
block; that the disinfecting apparatus be put under the 
entire charge of a responsible officer. 
V. 
HAVERFORDWEST, SOUTH WALES. 
It has rarely been our lot to visit a workhouse infirmary more 
unsuited for its purpose, or more ill-provided with all that is 
necessary for the comfort of the sick. The master readily 
acceded to the request of Dr. Williams, the medical officer, 
to show us the infirmary ; but we must confess to a feeling 
of surprise that the matron, whom we only saw for a brief 
moment, did not respond to the master’s suggestion that she 
should accompany us through the female department. 
This union embraces a large extent of country, and takes 
paupers from sixty-six parishes ; the town is the centre of a 
wide district. 
The workhouse is well situated on a hill, and has extensive 
grounds around it; it is an old house, and in every part is 
quite behind the times. It is built round four courts, which 
form the airing courts of the various departments. 
There is accommodation for thirty-two sick, and 
besides a fever ward placed at the top of the house, at tf 
Buildings and Wards. present time empty. The wards are of variable size, and are 
distributed on the ground and first floors ; the largest is for 
eleven beds, and the smaller wards hold two or three beds; 
the arrangement on the male and female side is the same. 
The wards are dreary places, the walls dirty, washed over 
with dingy yellow colouring, windows on one side, only one 
fireplace at one end, looking bare of furniture for the sick. 
Th# iron bedsteads are low and on them are three planks 
held by a crosspiece, not always laid close, and on this a chaff 
mattress about three inches thick. We saw the helpless bed- 
ridden old people lying on these beds, and they must have 
found them a sorry rest for their weary bones. There are 
about four spring beds distributed in the wards, but they 
have only the chaff mattress over the springs. There is no 
means of ventilation but by the windows, and, as the fireplace 
in some of the wards is small it is hardly probable that the 
atmosphere is changed in the night. 
The system of warming is peculiar to this part of the 
country. “ Culm,” which is clay and anthracite slack kneaded 
into balls, is used in the grates; when quite alight it is 
red hot and must throw out a good heat, but it is slow in 
kindling and can hardly be of service for obtaining a fire 
quickly. 
Class op Patients. 
These are of the usual description found in the work- 
houses. On one of the spring beds there was an old woman 
with hemiplegia, helpless all but one hand and unable to turn 
herself ; in the male ward was a fine man with erysipelas in 
his leg. On inquiring as to the treatment the “ nurse” told 
us that he washed it for himself twice a day with Condy’s 
fluid, but that otherwise no dressing was used. We could 
not but think what a pity it was that more vigorous measures 
were not tried, since by a speedy curing of the leg the rates 
would be relieved of that man’s keep. He was too long for 
his bed. 
There were eight patients in bed in all’in this part of the 
infirmary, including senile debility, rheumatism, paralysis, 
chest complaints, and old age, and several very infirm men 
and women up in the wards. We were shown a small ward 
with four beds in it, all occupied; it opened immediately 
from one of the yards, it was without a fireplace, and was 
lighted by one small window. This is the tramps’ sick ward. 
We could not ascertain that any one person was responsible 
for attendance in this ward, and, if assistance was wanted in 
the night, the most able-bodied of the tramps would have to 
go some little distance before he could obtain it, as there is 
no communication bell. 
The sanitary appliances are quite rudimentary; there is 
no water laid oh to the upper floors; the only conveniences 
for the wards are commodes, of which there are a few in 
each ward; one is placed outside on each landing, intended 
for use at night, that for the men being enclosed within a 
screen, that for the women being open, it can hardly be ex- 
pected that these poor infirm folk will go outside the wards 
on a cold night, not is it well that they should. The com- 
modes in the wards are emptied after 6 in the morning. On 
going round the wards we saw some ordinary utensils about, 
Sanitary Arrangements. gome of which were unemptied. The closets are all outside; 
they are simply cesspools, and some were very unpleasant. 
The water supply is ample, and is obtained from wells in 
the courts. The pumps in each court discharge over troughs 
down which the refuse water is emptied. 
There is only one fixed bath, and that is in the tramps’ 
room; it is a small one, sunk in the floor, with a tap to 
supply hot water, but the cold has to be carried in from the 
yard. We saw no baths which could be used for the sick, 
and, as every drop of water must be carried up or down, it is 
probable that bathing is not largely practised in this infir- 
mary; indeed, the patients and their linen did not look par- 
ticularly clean at the time of our visit. 
System of Nursing. 
The “nurse” is untrained; she is solely responsible for 
the care of the sick and of midwifery cases ; there is no night 
nurse nor regular pauper help at night. On inquiring how 
the helpless patients were attended to during the night, we 
were informed that they had to obtain such assistance as 
they could from the more able-bodied paupers who slept in 
the ward. As we found that bedsores were recognised as one 
of the usuai ailments in the infirmary, it can be imagined 
how much help these paupers are able to render to each 
other. We pictured to ourselves the sad condition of these 
helpless old people, passing the long hours of the dark nights 
on their comfortless beds, uncared for, uncleansed, unfed. 
We say “ dark night ” because we have ascertained that all 
lights were removed from the wards after the patients are in 
bed, nor did we see any appliances for lighting the stair- 
cases or passages. 
The labour ward is for two beds ; it has no separate offices, 
and all refuse must be carried downstairs. 
Classification of Patients. 
There is no system of classification; we saw the imbeciles 
and “ harmless lunatics ” among the patients in the wards ; 
one half-witted boy was busy serving the dinners. There 
were no lock cases in the infirmary, and we were informed 
that there were no isolation wards for offensive cases. The 
“harmless lunatics” appeared to be straying about where 
they pleased. 
On our way round the house we passed through the 
“ nursery,” a large ill-furnished room, the floor laid down 
with paving stones; there was a large table, two benches, 
two wooden cradles, a few chairs, the latter round a fireplace 
which was most insufficient to warm the room in the winter. 
In this room the infants stay with their mothers until they 
are 2 years old. There was a baby in each cradle, one look- 
ing very ill; its mother thought it was “ sickening for some- 
thing.” There was no rug, or even a bit of sacking on which 
the infants might crawl; a more dreary place to be called a 
nursery can hardly be imagined. Though not properly 
coming within the scope of this inquiry, we mention this 
room as indicating the lack of a kindly and sympathetic 
spirit on the part of those responsible for the management of 
the house. 
Nursery. Diet. 
The dinners were being served at the time of our visit. 
It was “broth day”; the broth, made of mutton and vege- 
tables, both looked and smelt good, but it was served in 
wooden bowls which were black with age and grease. We 
tasted the bread and butter, both of which were good. We 
saw no bed cards in the wards, but the master informed us 
that the medical officer has a free hand in ordering extras, 
and that milk and beef tea are taken into the wards for the 
sick at night. As the last meal is given at 6 o’clock, and the 
first at 8 in the morning, it is necessary that the old.people 
should have something to take in the night. 
The day room on the men’s side is used for sleeping pur- 
poses ; there were four beds in it; it is also the tailor’s shop 
where the male clothing is looked over and mended. It is a 
very small room, with one window, and at the time of our 
visit the floor was piled with clothing, and the air of the 
room was quite unwholesome. On the women’s side the day 
room is not used for a sleeping room; it had one large settle 
in it, but no comfortable chairs or anything to make it 
homely. 
On passing through one of the courts we were shown the 
disinfecting apparatus. It is a small galvanised iron box, like 
a good-sized tank, the lid broken at the edges, and having 
underneath it a tray for the fire; this was standing in a shed 
close to the closets. 
Day Rooms. 
It seems hopeless to make any recommendation in the case 
of this infirmary. The building is unsuitable for its purpose, 
and the system on which it is worked is faulty in every 
particular. 
Recommendations. 
The workhouse stands outside the city on a hill surrounded 
by a large extent of ground, which is cultivated by the able- 
bodied. The infirmary, though in a separate block, is practi- 
cally under the same roof as the workhouse, there being a 
short covered communicating corridor. It is licensed for 230 
beds. The house is a very old one, the date, 1834, is inscribed 
over the door. It is built of Bath stone in the solid style of 
that part of the country, and its aspect is somewhat of a 
prison—high walls with asphalte courts. The plan of the main 
building is the shape of the letter Y, but so much has been 
added to it since it was first built that at the present time 
it is almost impossible to discern the original plan. 
VI.—BATH. 
The Infirmary. 
These buildings are of ancient date and have no appliances 
for sick nursing. It is a two-storied building ; the wards on 
the ground floor are dark and squalid in appearance; the first 
floor wards are better, but there is but little window space and 
no cross ventilation ; the top floor is the brightest and the 15 
airiest, the windows admitting of cross ventilation, but there 
is no ceiling. We can imagine the howlings of the wind, the 
draughts in those wards when a storm is raging, as it can 
rage over those hills. The water supply and system of distri- 
bution are inadequate, every drop of hot water for the in- 
firmary use has to be carried from a boiler across a court. 
The matron showed us that a new boiler was being fitted near 
the women’s quarters which she thought would be a great 
help in working the place. But when we remarked that hot 
water laid on to every floor was a necessity for a hospital she 
informed us that the objection to that was that the pipes 
would burst in the frost. Some of the closets are of the old 
pattern and some modern; they are well placed for the use of 
the helpless at night, but they are in immediate communica- 
tion with the wards, having a cross ventilation; this would, 
to a certain extent, cutoff the foul air from the wards if these 
windows are kept open by night as well as by day. The bath- 
rooms are few and far between, and have a cold water supply 
only. In one bath, that for the “ eruption ward,” the steam 
for the water is turned on for two hours thrice a week in the 
afternoon; otherwise all the hot water for the baths or for 
washing the patients is carried from the boiler by the in- 
mates, and no hot water is procurable at night except by boil- 
ing a kettle. The staircases are steep and narrow, enclosed in 
walls. The ventilation is entirely by means of windows. 
The wards are warmed by fires and lit with gas. The walls 
and ceilings are colour washed and profusely adorned with 
pictures pinned on to the walls. The whole place wanted 
cleaning, but the matron informed us that the matter was in 
hand. 
Patients and Classification. 
When going round the wards in company with the matron 
and nurse we were struck with the large number of acute cases 
under the care of the guardians as compared with other infir- 
maries of a similar size. In the twelve wards there were, 
on a rough estimate, about sixty patients in bed, and the 
nurse informed us that there were twenty-four temperatures 
to be taken that evening, of which half or more she expected 
to be above the normal. Pneumonia has been and is very 
prevalent in the neighbourhood, to quote from the medical 
officer’s report (Mr. Craddock, May 23rd): “Amongst others 
in the infirmary are 4 cases of pneumonia, 4 very bad cases 
of phthisis, 7 of heart disease, and 16 dirty cases—all re- 
quiring the most careful and tender nursing.” We most 
fully concur in this statement of the class of patients in the 
wards. Besides those above referred to, we saw a woman 
with internal cancer—ill in every sense of the word, frail and 
wasted, with a face of great suffering; a bad case of hemi- 
plegia ; a man with cardiac dropsy, with a great deal of fluid 
in the lower part of the body; several men and women with 
ulcerated legs; besides the unvarying paralysis and bed- 
ridden cases, each of whom needs the same care as an infant 
if they are to be kept in a wholesome state. In the death- 
certificate book we noticed that in May and June there had 
been 14 deaths, only 2 of which could be attributed to old age, 
and the other diseases were pneumonia, cardiac rheumatism, 
or phthisis. In the children’s wards there have been several 
cases of measles. The lock cases are treated in the ground- 
floor wards, and their wards have separate offices. The im~ 16 
beciles and idiots are in another part of the building, under 
the charge of paid attendants. In this matter and in the 
provision of separate wards for the sick children this Board 
sets an example that other boards would do well to follow. 
To speak accurately, there is no system of nursing; there 
is one fully-trained nurse to “nurse” all these patients, and 
she has to help her two assistants, one who has been in the 
workhouse one year and nine months, uncertificated; the 
other, who has had only a scrappy training at an 
infirmary, supplemented by work as a draper’s assistant, 
and a young girl, not trained, who held some other 
appointment in the house ; the nurse is also the midwife. On 
inquiring from the nurse how much time she had for actual 
nursing, she informed us that by the time she had looked at 
the serious cases, made her notes, issued her orders to her 
subordinates, filled the medicine bottles, and looked through 
the wards, the time was gone. Under these circumstances it 
did not surprise us to hear that the paupers gave the medi- 
cine, or from the medical officers that a poultice had been left 
on a pneumonic chest for twenty hours unchanged, or from 
the nurse that the hours of work for the nurses began at 
6 a.m. and ended at 10 p.m. Paupers are largely employed in 
the infirmary. Every ward has its inmate who is the wards- 
man or woman ; some of these are ancient inhabitants, well- 
meaning no doubt, but as useful in the ward as they would 
be in a glass manufactory. The patients are left in the 
charge of paupers during the night, two on the male side, 
one on the female. This latter “ night nurse” is put to bed 
in the daytime in one of the wards that she minds in the 
night. The men are not treated to such a mockery of sleep ; 
they are over in the house somewhere. The woman with 
internal cancer above referred to complains of the rough 
handling at night, but the pauper “night nurse” is not 
to blame. Such being the case, the nurse informed us 
that the assistants took it in turn to be called on alter- 
nate nights to administer the stimulants, and the doctor 
informed us that he had no guarantee that the extras 
ordered were given in the night, nor could there be any system- 
atic feeding. It must also daunt a nurse to see the vast 
amount of work around her, and to know that she cannot do 
one tithe of it properly, especially with the help that is pro- 
vided for her: we are not sui-prised to hear that the nurse has 
resigned. All the appliances for the hospital are on the same 
meagre scale; we were informed that there are three roller 
towels for the use of each ward, of about twenty-three beds ; 
these are changed three times a week; there is one comb 
somewhere about for the patients, perhaps a brush; cleanli- 
ness under these circumstances is impossible. There are two 
patients with bedsores, and, considering the nature of the 
cases and the want of system in the nursing, we are sur- 
prised that there are so few. 
System of Nursing. 
The Medical Officer’s Controversy with the 
Mr. Craddock has brought this state of things before the 
Board in the strongest and plainest terms possible, and the 
readers of this Journal will understand that any conscien- 
tious officer responsible for the treatment of the sick shrinks 
Guardians. from being a party to the continuance of such a state of 
things ; but no amount of words will undo the grievous harm 
that is being done to the sick whilst it lasts. Poulticing in 
cases of pneumonia cannot be carried on in a regular man- 
ner ; feeding in cases of typhoid fever would lack that regu- 
larity that constitutes its great value, and so on through all 
modes of treatment necessary in acute cases. We understand 
that a night nurse has been engaged by the guardians—one 
night nurse to 230 beds! She would have to be as strong as a 
donkey and as active as a flea if she is to see after that number 
of patients ; nor do we see that there is any provision for the 
complication of the two serious cases requiring attention in 
opposite ends of the building. The medical officer lives a 
mile from the infirmary, and his house is not in telephonic 
communication with the infirmary, nor are there any bells of 
communication through the building. 
17 
The Bedding. 
This is chaff for the dirty cases and flock in the general 
wards ; the bedsteads are narrow, they have laths ; the mat- 
tresses that are supplied are not of sufficient thickness to 
cushion the laths ; the sheets were clean, also the blankets 
on the patients’ beds. We did not see any screens, but the 
matron informed us that they had been ordered. The 
utensils in nearly all the wards were under the beds. There 
were hardly any cupboards, and we saw the medicines on the 
window-sills. The beds in some wards were crowded so that 
the nurse would not be able to attend to her patient without 
moving them. 
This ward holds four beds; there is no labour ward, and 
when, as happened lately, several women were in labour at 
the same time, some were confined in the general ward. 
This ward is an end taken off’ a long ward. 
The Lying-in Ward. 
The isolation hospital is in a distant part of the grounds, 
almost out of sight. We did not visit this building as it was 
closed. There are, we believe, four beds in it, and it is in- 
tended for patients from the workhouse. The medical officer, 
in the report above quoted from, states that in January last a 
man suffering from typhoid fever was nursed there entirely 
by paupers. 
The Isolation Hospital. 
General Remarks. 
The rooms provided for the nurses are not good ; the only 
sitting room (of course, poor things, they never sit) is the 
surgery, redolent of drugs, and we could not ascertain that 
any separate bath room or lavatory accommodation was set 
apart for their use. There are no slopsinks ; the only place 
of that kind that we saw was a small fixed basin outside some 
of the wards, presumably for the officials to wash their hands. 
In the rooms where the wash-up for each ward was done we 
saw no convenience of sink, bowl, or other necessary. The 
matron informed us that she had five separate laundries 
under her charge for male and female, sick and able-bodied, 
and for the children ; we mention this to show how very rudi- 
mentary the arrangements are in this house. 18 
We should recommend that new infirmary buildings be 
provided; that twice as many nurses be engaged for atten- 
dance on the sick, not of necessity all fully trained; and that 
the nursing staff be put under the sole control of a matron, 
who shall also be a nurse; that the paupers be kept for the 
cleaning and the service of the infirmary; and that the 
doctor’s residence be put in telephonic communication with 
the infirmary. In no other way do we see that it would be 
possible to create a satisfactory state of things for the sick; 
the existing infirmary is crowded, both in the wards and in 
the offices, and no amount of patching and remodelling would 
overcome the stubborn facts of structure. 
VII. 
BISHOP AUCKLAND. 
Bishop Auckland is in the centre of the Durham coal 
pits, and draws its inmates almost entirely from that class 
of workers. Bishop Auckland is built over the coal pits, 
many of which are in the parish; the Bishop’s castle 
stands on the borders of the town; the town itself is a 
quiet little country place, existing only for the colliers, and, 
as it is off the main line of rail, it does not attract many 
visitors. 
The Workhouse. 
The workhouse stands on the outskirts of the town, on 
rising ground. The infirmary is a separate block behind the 
main building. The medical officer (Dr. Wardle) was unable 
to meet us when we made our visit, but his place was sup- 
plied by the master and matron, who spared no pains in 
showing us the sick wards and other parts of the house. At 
the time of our visit the drains were being relaid, and the 
closets in all parts of the house were in the course of recon- 
struction with modern appliances. The master stated that 
the water supply was intermittent; but this was due to the 
source from which the water is drawn—the river Wear—and 
not to the machinery for distribution. The water is laid on 
to all parts of the building, and there are bathrooms on every 
landing with a supply of hot and cold water. Besides the 
bathrooms there are fixed basins outside the wards, but we 
did not see any slop sinks. 
Wards. 
These are of varying size, and accommodate 115 patients, 
the average being from seventy to eighty occupied beds. The 
wards present a cheerful appearance to the visitor; they are 
adorned with pictures; there are strips of matting in the 
centre, plants, flowers, and newspapers for the inmates. In 
the large wards the fireplace is in the middle, the flue being 
enclosed ; besides the fires there are hot pipes for the winter. 
We saw Tobin ventilators (not always in use, as in one ward 
the ventilator served as a shelf for books), openings in the 
ceiling, and open windows. As the wards were of all sizes, 
cross ventilation was the exception ; some of the rooms were 
close and airless. Those on the female side are more modern- 19 
the long ward with the windows on each side and fireplaces 
at both ends; but this shape is not popular with the in- 
mates, not being home-like. The bedsteads are of varying 
width, but most commonly the full size, and there are about 
twelve that have spring mattresses ; water and air mattresses 
are used for such cases as need them. The bedding is chaff, 
and on those beds that we turned down there was an ample 
supply of blankets ; all was quite clean. In one ward—and 
to this we were taken last—we found four old women, one 
with hemiplegia, another blind, one old age, the fourth with 
heart disease; these formed a happy family; the matron, 
with a touch of humanity, had allowed them to set out their 
treasures and hang up their pictures in the room, so that it 
looked more like an almshouse than a workhouse ward ; here 
we were expected to sit down and admire the work, hear 
stories about the portraits, and bring our news from the outer 
world; these patients all helped each other, and the whole 
made a pleasing picture of the possibilities of workhouse life 
under humane management. 
But there is a darker side to this picture, and that we saw 
when walking round the wards and studying the cases in 
bed; some of them, cases requiring hospital care but being 
treated under such circumstances and in such surroundings 
is make such care impossible. There was one poor man in a 
corner of the large ward, whose days were numbered ; if he had 
been in a hospital he would have received a large share of 
the care of a trained nurse, a suitable or varied diet would 
have been given him, a resident doctor would have been at 
hand to superintend the treatment, and this routine would 
have been carried on through the night; what was the rea- 
lity ? This dying man was to all intents and purposes being 
nursed by paupers, for though there is a trained nurse, at 
this time she was far away in another part of the building, 
and as we hovered at the bed the wardsman was telling the 
matron of the progress of the case ; we did not see anything 
near at hand in the way of food or drink, and at night that 
sick man would be left to the charge of the ward, all the 
occupants of which would be in bed. In that same ward 
there was an imbecile who spent his time in twisting his 
fingers until the knuckles were rubbed into callosities; he 
was the sole care of an inmate ; the bulk of the patients in 
that ward were up where they lived as well as slept. The 
other patients in bed were a man with fistula, a severe case 
of heart disease, a man with pressure on the veins of the leg, 
consumption, paralysis, and old age ; in all there were about 
twenty cases in bed on both sides. The doctor does any 
operation that may be requisite, as there is no hospital in the 
town. We saw one man who exhibited his leg with much 
pride; it had been a case of acute necrosis soundly healed, 
and he was shortly going out. There is no separate ward for the 
children. There is a watere.lo3et close to each ward for use 
at night, and the usual lockers in the wards. 
The Patients. 
System of Nursing. 
These 70 or more patients are under the care of one trained 
nurse, who is also the midwife; the doctor lives at some 
ittle distance, and if required in the night is fetched by an 20 
aged pauper. The nurse’s quarters are in the women’s in- 
firmary, and in themselves are very comfortable. There is 
telephonic communication from the wards, and the same 
system of communication is laid on to the master’s house. 
Pauper help is largely used in this house, as indeed it must 
be if the sick are to have anything like attention, and when 
going round we formed the opinion that the matron held 
them responsible for their several charges. The nurse did 
not go round with us, nor could we see where she came in ; 
but as she had only lately come, doubtless she was new to 
the place. There is no night nurse, the wardsman or woman 
do what they can in the night, and when any patient requires 
“ watching ” an inmate is deputed for the duty. The poor 
man dying of dropsy had not reached the stage of “watch- 
ing.” In justice to the management we must say that the 
utmost was made of the inmates, they are drawn from an 
intelligent class; and we felt that, given a more generous 
system of nursing, with better appliances, the recoveries 
would bear a larger proportion, and much of the pauper help 
could be dispensed with. The lying-in ward holds four beds, 
it has separate offices, and is fairly suitable for the work ; it 
is under the care of a pauper inmate, who works under the 
nurse. 
Classification. 
As a matter of fact, there is no classification ; the imbeciles 
and idiots were scattered all up and down the wards among 
the sane patients, but each feeble-minded patient had an 
attendant inmate in charge of him or her, and it was touch- 
ing to see the interest they took in their simple-minded 
children. The lock cases are in small wards at each end of 
the infirmary, and there are separate offices for these wards. 
There is want of more dayrooms, especially on the men’s 
side ; there are dayrooms on the ground floor but not for the 
wards above. We could not judge of the airing courts, as 
they were in disorder through the drainage works. 
The dinner was being served at the time of our visit. It 
was suet pudding with sweet sauce. The pudding was nice 
and light; the people said that they liked it; some of the 
patients were having boiled beef and potatoes; this also was 
properly cooked. The doctor is responsible for the extras, 
and, to judge by the bedcards, these were milk or beef-tea; 
the matron also made lemonade for those who could take it. 
Of necessity there is no systematic feeding through the 
night, and we wondered how that poor fellow with dropsy 
would manage to get through the night without any such 
alleviation. The hours of meals, as usual, are 8 o’clock 
breakfast, 12 for dinner, 6 o’clock for tea; tea is given in the 
sick wards. 
Diets. 
Isolation Hospital. 
There is a separate block for the isolation of infectious 
patients; it appeared to us that the situation was not well 
chosen; it lies between the infirmary and the children’s 
quarters, and being a low-storeyed building, it is in a well, and 
might in the event of a prolonged epidemic become a source 
of infection. It was empty at the time of our visit, and if 
in use it is in the charge of an inmate. It is complete in 
itself. 21 
General Remarks. 
We were glad to see an ample supply of cushioned arm- 
chairs for the old people, and the women, both those in bed 
and those up, were wearing comfortable knitted hoods of a 
bright colour with flannel jackets or shawls. They are pro- 
vided with dressing gowns and slippers for use at night. 
Both the master and matron evidently bestowed all the care 
and thought possible on the sick ; the defects we noticed 
when making our round are those of the system, and not on 
the part of the officers. We would recommend that the 
guardians appoint two more nurses ; a second for the day to 
take either the male or the female side, and one for duty in 
the whole building at night; this is the very smallest amount 
of nursing requisite, even if the-infirm were separated from 
the sick and placed under the care of a paid attendant; for 
this being practically the only hospital, it receives many 
acute cases. With regard to the building, we would suggest 
that the present isolation hospital be taken for some other 
purpose—for the use of the feeble-minded, for instance—and 
that another infectious block be built in a more suitable 
situation. Altogether we were pleased with the humanity 
and care evident in the management of the house. 
VIII. 
CHESTER. 
The workhouse is about a mile outside the city, the infirmary 
buildings standing behind the main block ; these are in 
three parallel blocks connected by wide bridges. The latter 
form a pleasant airing ground for the patients, and comfort- 
able benches are placed on them. One block is set apart for 
the imbeciles and harmless lunatics; one block accom- 
modates the medical cases, the infirm patients, and the lying- 
in wards; and the third block has the surgical cases, some 
infirm patients, and the children. The male and female 
inmates are thus in each block, and a trained nurse is in 
charge of each block. The infirmary is returned as accom- 
modating 247 patients, but this includes the imbecile block ; 
the average is about 80 in each block, more or less. The 
blocks are entirely apart, there being no means of communi- 
cation except by the bridges aforementioned. 
is a mixture of the trained nurse with pauper help ; both the 
nurses whom we saw had received hospital training, but they 
could not attend upon 80 or more patients ; hence the pauper 
inmate is requisitioned to supplement them, and the style of 
the work bore out that system. At night there is one trained 
nurse for the two sick blocks, and in each block there is a 
male and female attendant besides ; these latter are paupers. 
We lay stress on these points, bearing in mind that just 
recently an inquest was held on a pauper who died under cir- 
cumstances that aroused suspicion that his death had been 
caused by the rough treatment which he had received at the 
hands of his ward attendant. The jury returned a verdict of 
manslaughter. With that verdict we have nothing to do; 
The System of Nursing but we wish to emphasise the criticism of the coroner, who 
asked, “ Is there no person here to take the night nurse’s 
place when a person is dying in another ward ? ” and the re- 
commendation of the jury that “there should be an assistant 
night nurse in the hospital in case of emergency.” When the 
nurse is in the one block she is as much away from the super- 
vision of the other block as though she were in another 
street, and in her absence and before she could be fetched 
(for there are no communicating bells) there is time for any 
such tragedies to occur, the patients being practically in the 
hands of the inmates. In plain terms, the night nurse has 
to see after 160 patients in separate blocks. Pauper help is of 
necessity largely employed in this infirmary. We saw the 
wardsman or woman in each ward ; from the evidence given 
at the inquest these inmates wash the patients “ in a bowl, 
whilst he or she is seated on a chair at the bedside.” So lax 
a system admits of accidents, and it depends entirely on the 
vigilance of the nurse to discover any mishaps which may 
have befallen the patients in her absence, unless attention is 
called to the matter by some courageous inmate. 
are small, the largest containing eleven beds; the others 
have six and four beds in them severally ; this arrangement 
applies to both blocks. The wards are comfortable and home- 
like in appearance, the bedsteads of the full width, and the 
bedding is long straw, well filled, except where the nature of 
the case requires a water mattress, which the matron in- 
formed us was then supplied. The patients are classified as 
medical and surgical, the dirty cases being distributed among 
the other patients. The lock and itch patients are in a small 
separate block containing six beds for males and the same 
for the females. The master is responsible for the male 
patients, whilst the matron visits the female side of this 
isolation block. There is a labour ward having two beds; it 
struck us that the bed used as the labour bed was incon- 
veniently small for its work. The women are convalesced in 
the larger ward. In the children’s ward, which is on the 
ground floor, we found nice modern cots, and wool mattresses ; 
these are a gift from a guardian who takes interest in the 
little ones. The ward looked cheerful and comfortable; it 
holds eleven cots, and has its separate bathroom and offices. 
There were very few children in at the time of our visit, and 
no severe case. A pauper is in charge of this ward. 
The Wards 
The Patients, 
of whom only a few were in bed, included a severe case of 
cancer of the face—this was dressed with sal alembroth wool 
and gauze—it was most offensive and required iso’ation; a 
woman in an advanced stage of internal cancer; several cases 
of ulcerated legs; a man recovering from pneumonia ; some 
cases of paralysis and of senile debility. We saw a hale old 
body whose bedcard recorded the age of 101; she was in full 
possession of her faculties, and was proud of her great age. 
The itch ward on the female side was given up to some 
children with measles; these were in the care of their 
mothers, and we could, not ascertain that they received any 
care from the nurses; we saw one child on whom the rash 
was fully out, dressed, and in its mother’s arms, the lower 23 
part of its body was exposed to any chill, and the ward was 
not very warm though the day itself was so. That child was 
not being nursed in the hospital sense of the word, and no 
precautions were being taken to keep it in one temperature. 
When the doctor is required in the night a pauper is sent to 
the master, and he sends to call the porter, who is then 
sent off to the doctor, who lives nearly two miles from the 
infirmary. 
The Sanitary Appliances. 
are not up to date; the baths are movable, and stand on the 
landings, where they are used behind screens. Hot and cold 
water is laid on for ward use, but the bath water is heated by 
geysers, which the matron informed us were quite efficient. 
The closets are also on the landings, a step or two down, and 
at a little distance from the wards, so that commodes are in 
use at night. There seemed to be a sufficient supply of 
water. The bath for the children’s ward is a fixed one. 
Gulleys are provided for the emptying of the large baths* 
There is only one day room, and that is on the men’s side ; 
the men are allowed to smoke in the wards, or on the bridges. 
The airing courts are of the usual back-yard style, but the 
bridges have to a certain extent superseded them. 
There is much in the structure of the infirmary that might 
be improved. The wards are crowded, and there is no ward 
for the separation of an offensive case or patient requiring 
isolation ; day rooms are needed to relieve the wards of the 
more convalescent patients ; bath rooms with improved 
closet accommodation are a necessity, especially in the lock 
and itch wards. Then the nursing staff is lamentably weak, 
we might almost say dangerously so, in the light of the late 
inquest. We would suggest that the pauper nurses be with- 
drawn, and that more fully-trained nurses be engaged, who 
should be assisted by a few probationers ; that one nurse at 
the least be on duty at night in each block, and that the 
wards be placed in communication with each other, and with 
the master’s quarters by means of a telephone or bells, and 
that a telephone be laid on to the doctor’s house ; that the 
isolation block should be placed under the care of the trained 
nurses, and that the whole infirmary be made into a separate 
department under a trained superintendent. 
Recommendations. 
ABERYSTWITH. 
IX. 
It was quite refreshing to turn from the dreary squalor of the 
Infirmary of Haverfordwest to the cheerful little infirmary 
attached to this workhouse. The matron took us round the 
wards, and showed the various departments with justifiable 
pride. 
Buildings and Wards. 
The workhouse is in the town of Aberystwith; it is a 
cheerful-looking place, clean and well cared for; the wards 
have eleven beds on the men’s side and seven on the women’s, 24 
The men’s wards are of a good size, the eleven beds being in 
two rooms. The women’s ward is crowded; the seven beds are 
in one room, while some of the necessary air space has been 
curtailed by the erection of a high wooden screen, so as to 
take off a passage. 
The bedsteads are the usual width; the laths are covered 
with coeoanut matting, on which is the straw bed; these are 
tilled with the long straw, and appeared to be quite comfort- 
able. The labour ward is small; it has no offices, and all 
refuse must be carried outside. There is no receiving ward. 
Classification of Patients. 
There is practically no classification, as there are no sepa- 
rate wards for the imbeciles or idiots, and it seemed to us 
that there was a possibility of the imbeciles of both sexes 
mixing together, as the nature of the building hindered com- 
plete separation. There is no machinery for dealing with a 
case of insanity except by placing the patient in the fever 
wards. These same fever wards are utilised for lock cases, 
when such are under treatment, or for infectious diseases. 
At the time of our visit there were no patients in bed on the 
women’s side and only two on the men’s. One of these was 
very ill with consumption, and the other was a case of old 
age ; there could be no doubt about the care bestowed on the 
sick as far as circumstances would admit. 
System of Nubsing. 
The nurse, whom we saw, is not trained, but she was quite 
capable for the nursing in that infirmary, as she had had 
some previous experience, and her wards looked business- 
like and clean. A midwife is engaged from the town for the 
lying-in ward; no trained nurse is employed in the fever 
wards ; the patients are placed under the care of an inmate. 
Sanitary Arrangements. 
These are quite modern; all the closets are flushed auto- 
matically, except those on the sick landings, which are done 
by hand. Hot and cold water is laid on to the wards, but 
there are no bath rooms for the sick, though there is ample 
supply in the other parts of the house. 
Diets. 
These are ordered by the medical officer, and are liberal. 
We saw milk on the bed cards, and the sick are allowed as 
varied a food as possible. The last meal is at 6 p.m., and the 
first at 8 a.m., which represents a long interval for sick 
people. 
Day Rooms. 
There are no day rooms for the sick, nor are the airing 
courts available for them ; this is especially hard for the men, 
who must either smoke in the ward—a dangerous and un- 
healthy custom—or go into the able-bodied part of the house. 
The infirm on both sides are placed on the ground floor, and 
have dayrooms off their bedrooms. The garden at the back of 
the house is of very little use for the sick, as there is no 
means of keeping the sexes apart. 
Recommendations. 
The infirmary requires to be enlarged to give more space 
in the wards, especially for the women, and to provide wards 
for isolation. 25 
Separate quarters for the imbeciles and idiots, and a safe 
ward for the detention of insane patients until their removal. 
The provision of bathrooms attached to the wards. 
A new lying-in ward, if possible further away from the 
living part of the house. 
The employment of trained nurses for the fever cases. 
The employment of a paid attendant in the sick wards dur- 
ing the night. 
X. 
WREXHAM. 
The Wrexham Union is in the midst of a populous district; 
though the number of square miles is not large, the 
number of parishes grouped in the union is nearly as 
high as any in Wales. We were therefore not surprised 
to find a large workhouse with its separate infirmary and 
nursing staff. An introduction from the medical officer of 
the workhouse, Dr. Davis, secured us a cordial welcome and 
ready co-operation on the part of the master and matron, 
who took us over the house with pardonable pride in its 
cleanliness and humane management. 
Infirmary Buildings. 
The infirmary is in a separate block, two storeys high, 
standing open all round, the wards extending like wings, 
having windows on each side, thus securing ample light 
and ventilation, and the cheerful aspect that goes with these 
prime necessities for the sick. The wards vary in size; the 
larger, on the first and second floors, hold as many as twenty- 
six beds ; the smaller, twelve, six, or three. There are no day 
rooms for the sick or the infirm. On the ground floor we saw 
some imbeciles and idiots in a day room, but on the upper 
floors such patient s as were up were grouped round the fires, 
or were sitting by the bedsides. There is an ample water 
supply, hot and cold water laid on to every floor, with water- 
closets, sinks, and bathrooms, all of which were wholesome 
and clean at the time of our visit. 
The large wards are arranged with beds on either side, 
having a strip of matting down the middle of the ward; there 
are lockers, pictures, plants, and armchairs ; we thought the 
supply of the latter rather scanty, as a large proportion of 
the inmates are infirm old people; but the whole appearance 
of the wards was comfortable, and betokened wise and 
humane management. The bedsteads vary in width; the 
bedding used is long straw. Those we turned up were quite 
clean and amply supplied with blankets. 
At this time of the year the wards are not full; there are 
sixty-two beds on the male side, and sixty on the female 
side, with about sixteen isolation beds in various parts of the 
infirmary. Each group of wards seemed to have a separate 
ward attached for isolation, which is used for any offensive 
case ; in one such ward we saw a man with cancer in" the 
mouth, kept apart because of the effluvia. On another occa- 
Wards and Patients. sion these wards might be used for the controlling of an un- 
ruly patient, and besides the small wards there is a padded 
room, where a patient would be kept, guarded by inmates 
until removal. 
We saw about ten inmates in bed; a woman with cancer of 
the breast, which was washed with boracic lotion, and 
dressed with the same ointment; another woman, who 
looked very ill, reported to have “ some internal complica- 
tion ; ” a case of rheumatism, a case of fits in a padded bed, 
paralysis and old age completing the number. 
The lying-in ward is apart from the other wards, and has 
its separate offices; it is close to the nurse’s quarters. The 
wards are warmed by coal fires and lit by gas. 
There are two paid nurses, one on the male and one on the 
female side. The latter is a fully-trained nurse, and is the 
midwiie; the former, though not hospital-trained, has had 
long experience in the work, and was reported to us by the 
matron as very capable in the management of her wards and 
patients; certainly in appearance her wards compare very 
favourably with the other side. There is no night nurse, nor 
as a rule are any inmates told off to sit up in the wards at 
night. The matron informed us that, when necessary, special 
paupers were employed as watchers; they had rest in the 
daytime, and some little extra tea or tobacco; the nurses 
were called up in the night if necessary. We asked what 
system was employed in the distribution of the paupers 
among the wards; the matron replied that when she found 
that an inmate was doing the work of the wards well, he or 
she was kept there unless proved guilty of unkindness to- 
wards the patients, in which case they were sent into the 
main building. 
Such patients as can do so make use of the night stool or 
closet on the landing; the others are helped by the wards- 
man or woman. The paupers make the beds, help with the 
washing of the patients, wait on them, and do the cleaning. 
We saw a card over each bed, and temperature charts were 
in use; the card, probably that issued by the Board, was 
hardly precise enough in its arrangement; there was very 
little space for the diagnosis, treatment, or result; it could 
not serve as a record of the case. 
System of Nubsing. 
The imbeciles, idiots, and cases of fits are on the ground 
floor, the sick on the first floor, and tbe infirm on the top 
floor. We did not see any separate wards for the treatment 
of children, and to the best of our recollection we saw some 
infants on the lower floors. It does not follow that they were 
with the idiots, but the nursery quarters were not up to the 
mark, as there was no reponsible attendant to look after 
them. Lock cases and patients with offensive disease are 
placed in the small wards off the larger ones. 
Classification. 
Diets. 
The diets for the sick include soup, broth, rice puddings, 
and such extras as are ordered by the doctor; and milk or 
beef tea is left in the wards at night. We went the round at 
dinner time, when soup and bread were being served. The matron informed us that she endeavoured to give the 
sick in bed such food as they could take, and they had tea 
extra in the afternoon for those who could take it. 
The tone and management of this house impressed us very 
favourably; the officers seemed to regard their charges as 
human beings to be cared and planned for. We would never- 
theless recommend : 
An increased staff of nurses for the sick, the employment of 
a night nurse, and the exclusion of pauper help in the actual 
nursing. The separation of the infants from the adults, the 
provision of special accommodation for them when sick, and 
of a paid official to take care of them. A paid attendant for 
the fit cases and imbeciles. Improved airing courts for the 
infirm ; those now used are too much like back yards. More 
arm chairs and couches for the sick and infirm wards. 
Recommendations. 
XI. 
DARLINGTON. 
The workhouse stands on the edge of the busy town, tall 
chimneys and whirling mills all around it. It draws its 
inmates principally from the town, with a small sprinkling 
from the country. The operatives are employed in weaving, 
which is the chief industry of the place; and also in the coal 
pits of the locality. The operative or skilled artisan is a very 
different inmate to the agricultural labourer, and the work 
that he does in the house is that of a skilled workman. In 
going round the workhouse we were struck with the greater 
intelligence of the faces of the inmates, especially of the 
men ; among the women, the type of face, while indicating a 
higher order of intellect, betrayed coarseness and hardness of 
character. Having an introduction from the vice-chairman 
of the board, our request to see the infirmary department was 
readily acceded to by the master. We were sorry that the 
the absence of the matron deprived us of the advantage of 
her escort. 
Buileing and Wards. 
The infirmary is a detached block, standing only the width 
of a roadway from the main building ; this entails the loss of 
a certain amount of light and air. The distribution of the 
wards is two long wards, holding 18 beds each, male and 
female, with smaller wards for four or six beds; the wards 
are on the ground and first floor. They have windows on each 
side, and the beds are ranged facing each other between the 
windows; the wards had a bright and cheerful appearance, 
with pictures, flowers, and other ornaments, the work, as we 
were informed, of the Ladies’ Committee. At the time of our 
visit, which was in the afternoon, we found the wards rather 
empty, this being the slack time of the year in workhouse 
life. In the large female ward there were four patients in 
bed; one a child in a cot in the centre, suffering with gan- 
grene of both legs, an offensive case for which iodoform was 
used ; a pauper inmate was straightening the bed as we entered the ward, and there was an unpleasant effluvium from 
it; a patient with consumption, whose temperature was taken 
night and morning, and charted ; a woman with fits ; and a 
case of senile debility. About three other women were in 
the ward, but the rest were in the day-room. On the men’s 
side there were two cases of “ bad legs,” and one of old age, 
and the other patients were in the day-room. 
The bedsteads are of the full width, the bedding is a cocoa- 
nut mat over the laths, and beds of flock or chaff, with an 
ample supply of blankets ; such beds as we saw were clean 
and fit. 
There are no wards for isolation, but there is a separate 
block called the isolation hospital, which we were told is con- 
demned ; it is not kept in a state of readiness for use, but the 
master Informed us that a bad lock case would be placed in 
this hospital, and be nursed by the nurse of the infirmary. 
It has a complete set of separate offices, and it struck us that 
a little soap and water would soon make it serviceable; a 
tramp was in one of the rooms infected with itch. 
System of Nursing. 
The infirmary is licensed for 72 beds ; that includes 12 in 
isolation hospital; there is one trained nurse, who is also 
the midwife ; the nurse whom we saw had only been a week 
in the department, having succeeded a trained nurse who 
has left; she has pauper help—a wardsman or woman to each 
ward. During the night the inmates are supposed to help 
each other and such of them who can go out to the closets 
on the landings are supposed to do so. We did not see any 
provision of dressing gown or slippers for this nocturnal 
walk. One or more paupers would be told off to watch 
beside a patient seriously ill, or the nurse would be called 
up. The tramp isolated with the itch would be his own 
warder in the night. There did not seem to be any means of 
communication with the nurse’s quarters, nor with the re- 
sponsible officers for night use. 
Classification. 
In answer to inquiries, we were informed by the master 
that the only means of isolation was the separate hospital 
mentioned above ; it is condemned, and therefore not put in 
order for the reception of patients. Besides this building, 
there is no means for the keeping apart of the lock cases; 
there are small wards in the infirmary, but we could not 
ascertain that the patients were classified in them. The 
imbeciles and idiots were among the patients in both the 
large and small wards. We did not see any ward for sick 
children ; the child with gangrene referred to above was in a 
cot in the large ward. There is a lying-in ward of six her) s 
with separate offices, where the mothers can remain until 
quite convalescent. 
The Infants. 
The infants are lodged in rooms close to the women’s 
quarters ; the nursery is a small room, rather bare of furni- 
ture, but warm and comfortable. There were six infants in 
the room—three in cradles and three running about. They 
were in the care of an inmate, but the management seemed 
faulty, for their mothers could have access to them as they 
came to and from their quarters, and there was no means of knowing whether the infants were properly and systematic- 
ally fed. At night they slept with their mothers in small 
bedsteads. No bathrooms or separate offices were provided 
for the nursery. The poor little things looked as if they 
would do better under the care of a paid nurse. This depart- 
ment is supervised by the trainer, but her time is fully occu- 
pied with the care of the older children. 
Diets. 
The diets are under the direction of the medical officer, but 
on analysing the dietary for the sick we were surprised to 
see how very little milk was allowed. On the “ milk diet ” 
the amount was 2f pints for the males, 2f for the females, 
and 2|- for the children ; this diet does not include pudding. 
On the “ milk and beef-tea diet,” 2 pints of milk and J pint 
of beef-tea per male, the same for the females, and 2} pints 
of milk and J pint of beef-tea for the children. The adults 
have a pint of tea and a pint of coffee besides, with 6 or 7 
ounces of bread at breakfast or supper. In this diet there is 
not much to make or repair the human frame, especially in 
the case of the sick ; but, though it does not appear on the 
dietary, the doctor can doubtless order extra milk for the 
night. 
Gevebal Abbangbments. 
The water supply is ample ; hot and cold are laid on 
to the ward landings and bath rooms; the fittings of the 
waterclosets are old, and the flush did not appear to be suffi- 
cient. There is the usual difficulty in keeping the paupers 
from soiling the baths. We saw some litter in some of the 
bath rooms, and the nurse complained of the wilful want of 
cleanliness on their part. 
The wards are ventilated by means of windows ; the 
ventilation of the ward where the gangrene patient lay was 
defective. There always is a difficulty in keeping sweet 
wards where there are a number of old people. The wards 
look bright with strips of brick-red linoleum down the 
middle, and there seemed a fair supply of arm chairs. The 
airing courts are yards with turf in the centre and a few 
bushes at the sides. 
Recommendations. 
The structure of the infirmary leaves little to be desired, but 
we would recommend: An increase of the nursing staff for 
the day, and the appointment of a night nurse ; the separa- 
tion of the idiots and imbeciles from among the sick and 
infirm ; provision for the isolation of the offensive and lock 
cases ; a paid attendant for the infants, and the provision of 
sleeping cots for them at night; bath room and separate 
offices for the nursery department; improvement of the venti- 
lation of the wards by Tobin tubes or other similar method. 
XII. 
WAKEFIELD. 
On arriving at Wakefield, we visited the medical officer of 
the workhouse, hoping that he might be able to accompany 
us to the infirmary. Unfortunately he was out of town, but his assistant kindly telephoned to the master stating the 
purpose for which we wished to visit the infirmary, when 
an answer was immediately returned that we were welcome 
to do so. 
Infirmary Arrangement. 
The Wakefield Workhouse Infirmary is in two bloeks, 
standing apart from but near to the main building. There 
is accommodation for 130 patients in all; in the main block 
are the general cases, and in the smaller block the offensive 
and lock cases are isolated. The lock patients are placed 
in small wards at each end of the block for offensive cases ; 
there are 2 beds for the female and 4 beds for the male 
patients, having separate offices. In the general wards on 
the female side the bedsteads are of the full width, and the 
bedding is straw or flock according to the nature of the case ; 
sometimes a water mattress is supplied to avert the danger 
of a bedsore. The nurse turned down such beds as we 
desired ; they were all quite clean and were amply supplied 
with bedding. The wards are of various size, distributed 
through a two-storeyed building ; they all presented a com- 
fortable lionie-like appearance, with cushioned arm-chairs 
for the old people when out of bed; we did not see any 
couches. We were much pleased with the ample supply of 
nice handy rail-screens, some of which were shielding off a 
draught and others around beds whose occupants required 
quiet; they made a bright feature in the wards, with the 
coloured chintz cover neatly fastened on and easily removed. 
The system of ventilation is chiefly by means of the windows 
on the ground floors ; on the upper floor there are also venti- 
lators in the roof. We noticed that some of the beds were 
placed along the walls of the ward, the head of one to the 
foot of the other ; this was allowed to economise space; but 
it seemed to us that the more healthy plan would be to have 
a bed or two less in the wards. On the male side some of 
the bedsteads are of the narrow width which should never 
be used in an infirmary; the bedding was the same as that 
supplied to the females. 
We were not so pleased with the appearance of these wards; 
there was a look of neglect in all their appointments, as 
though, because these poor creatures were helpless and, in 
workhouse language, “ dirty cases,” they did not need so 
much care as the other patients. We were particularly struck 
by the beds ; these were of all sizes, the foundation being laths, 
over which was a thin chaff or straw mattress, not by any 
means sufficient as a cushion for the patients to lie on all day 
and night. The ward also lacked the look of finish that we 
saw in the other wards. Is it that these poor creatures are 
treated as naughty children who must be punished for their 
infirmity as for a fault ? The wards themselves were gloomy; 
they wanted something to brighten them up. 
Isolation Block. 
Sanitaby Appliances. 
Of these there is an ample allowance on each floor and to 
each ward for use at night; on each floor there is a fixed 
wash basin, hot and cold water; each set of wards has its 
bathroom. Here we found the wise precaution of having 
these kept locked, for the average pauper looks upon a bath- 31 
room as a receptacle for all rubbish and as a place where he 
may do any washing of clothes, etc., that pleases him. The 
closets have a good flush, and were clean at the time of our 
visit, which was about 10 a.m. 
employed to nurse in these wards is two ; one nurse has the 
main block, and the second nurse the isolation block. The 
nurse in the main block has received hospital training; the 
nurse in the isolation block has been trained in a lunatic 
asylum. The board had just engaged one night nurse ; her 
quarters were being prepared at the time when we saw the 
infirmary. The nurses took us round their wards and gave 
us every facility of seeing their work after we had been in- 
troduced by the matron. Pauper help is largely made use of 
in the infirmary; each ward—and there are about sixteen in 
the blocks—has its wardsman or woman, and they do the 
nursing under the nurses ; this follows as a matter of course, 
as it is beyond the powers of any nurse, however energetic, 
to attend individually upon over 90 patients. Until quite 
recently there was no trained night nurse; such an officer has 
now been appointed and will be responsible for the hundred 
or more patients scattered up and down in the wards. On con- 
versing with the nurse in charge of the isolation hospital, 
she told us that the air of her wards when she came on duty 
in the morning was very foul. These poor bedridden patients 
being in the charge of inmates during the night, their beds 
were not properly cleansed, nor was the very necessary ven- 
tilation looked after by the inmates. Besides the usual 
duties of a nurse, each nurse has her laundry, for the working 
of which she is responsible. 
The Number oe Nurses 
are the usual admixture of acute and infirm cases. We saw a 
girl up for the first time after pleurisy; her temperature 
chart showed an acute and somewhat prolonged attack; 
she had made a veiy good recoveiy. We saw a wardsman 
who had pleuritic effusion; we should not like to say how 
many pints had been taken from the chest, but his recovery 
was excellent; there was no perceptible flattening nor 
deformity, and he stood up straight, with a good physique. 
There were not many in bed. We saw a case of advanced 
phthisis, rheumatism, and heart disease (the man had lain in 
bed for seventeen years ; his skin was quite whole); a case of 
pneumonia recovering, paralysis, and several bad cases of old 
age; speaking from recollection about six of these were 
charted. In the isolation block, holding 40 beds, nearly 
every patient was in bed, and they all required the nursing of 
a child. 
The Patients 
Lying-in Wahid. 
This ward is in the house department, hnt the nurse of the 
infirmary is the midwife. She explained to us that when 
she is called over to this ward in the night she calls up a man 
and a woman for each side, and leaves them in charge whilst 
she is occupied with the confinement. There is accommoda- 
tion in this ward for three patients, and it has a small ward 
attached holding two beds for convalescents. These wards 
have separate offices. There are no means of communication 
through the building for use at night; as before mentioned, 
there is a telephone to the doctor’s house. Children’s and Imbecile Wards. 
There is a nice ward for the children in the infirmary ; at 
the time of our visit this was occupied by little patients 
with whooping-cough ; they had plenty of toys and books for 
play. None of them were in bed. 
The imbeciles are kept apart in a separate ward on the 
male and female side, but the communication between these 
and the other wards was quite easy. 
There are no day rooms in the infirmaiy ; the airing courts 
are of the nature of back yards; the patients are not allowed 
in the garden. We always feel great pity for the patients 
whom time after time we find kept to these dreary courts for 
their recreation ; four brick or stone walls, a few benches, the 
fiky above them, and the asphalte beneath them; how can they 
be any the better for fresh air thus doled out ? 
Day Rooms and Airing Courts. 
We have here a sick department as large as some of our 
smaller hospitals, with three nurses as the nursing staff. We 
recommend that the staff be doubled at the least, and that 
the infirmary be made use of for training purposes for proba- 
tioners ; that the paupers be used for the ward service only. 
We heard that the board is purposing to build a new infir- 
mary; in this case, in all probability, it will be their intention 
to increase the nursing staff, and we hope that they will make 
the1 hospital into a separate department under its trained 
matron; for with the amount of acute cases that are ad- 
mitted in the year there would be ample material for the 
training of probationers in the first part of their duties. 
Recommendations. 33 
APPENDIX. 
SUMMARIES OF THE FOREGOING REPORTS FROM 
THE “BRITISH MEDICAL JOURNAL,” 
TOGETHER WITH EDITORIAL AND OTHER COMMENTS. 
Moved by the recent disclosures of still continuing scandals 
and defects in the treatment of the sick poor in certain pro- 
vincial workhouses and infirmaries, the Editor of the British 
Medical Journal—Mr. Ernest Hart—has set on foot an in- 
vestigation, by a specially appointed Commission, into the 
nursing and administration of some of the smaller institu- 
tions. Since the investigation of Mr. Hart and his colleagues, 
Dr. Anstie and Dr. Rogers, in 1866, which led to the creation 
of the Metropolitan Asylums and the reorganisation of the 
workhouse system of treatment of sick poor, there has been 
an extensive and progressive reform in these respects, not 
only in the metropolis, but throughout the country, and 
many of the great provincial woikhouse infirmaries are 
models of comfort and good management. But evidently 
there are others—as at Newton Abbot—where much remains 
to be done before the requirements of humanity can be held 
to be fulfilled. Beginning near home, our Commissioner re- 
ports this week as to the Hatfield Workhouse Infirmary. The 
first impression is nearly always pleasing, and Hatfield was 
no exception. The bright flowers, the neat walks and well- 
swept approach, polished brass handle and knocker, give an 
idea of cleanliness and attention to detail, and a step across 
the threshold confirms this idea; there is the common ap- 
pearance of official cleanliness characteristic of an institution. 
Turning aside from the main entrance to the infirmary de- 
partment, the men are found lodged in a modern block near 
the gate; the females are at some distance in makeshift 
quarters of three old cottages. This at the outset struck us 
as faulty in management, for the one nurse responsible for 
the sick nursing cannot be with the men and in reach of the 
women, or vice versa; and as it is impossible to guarantee 
that the one sex shall not interfere with the nursing of the 
other, the nurse, presuming that she is anxious to do her 
utmost for the sick committed to her care, at times will be 
oistracted at the hopelessness of the task before her. Taking 
into consideration that all the help at the disposal of the 
nurse is such as can be given by the inmares, this system of 
nursing may break down at any minute; it can bear no strain. 
On looking in the so-called women’s infirmary we were dis- 
mayed at finding it draughty, crowded, ill-ventilated, aud 
The Sick Poor at Hatfield. 34 
quite unprovided with the necessaries of sick nursing. In 
the lower room, about 20 feet by 12 feet, there were six beds, a 
table, a few chairs, and a night stool; two women were in 
bed and four huddled round a small fireplace; the door, an 
ill-fitting one, opened on to the court, the windows, such as 
are seen in small cottages. Up a narrow stair a similar ward 
above. It might be necessary to escape from an alarm of fire 
down that stair or there might be a corpse to be brought 
down; the aged sick could not safely be brought down, 
and a dead body could not be handled decently. The 
lying-in ward was a disgrace to the infirmary, a miserable 
attic without any conveniences, a small fireplace, a small 
window, and no appliances for the nursing of such cases. All 
sanitary arrangements were quite elementary. We saw earth 
closets without earth, waterclosets without water, these all 
being outside, a sanitary precaution which was their only re- 
deeming point, only we wondered what befel the infirm or 
sick in inclement weather or at night. The only apparatus 
for heating water (the heat being gas) was, with an amusing 
innocence, placed in a lobby close to an external door fre- 
quently opened, and was a small boiler sufficient for one 
bath of moderate capacity. We are not pointing out these 
defects in a captious critical spirit, but with the sincere hope 
that the public will look into these matters themselves, so that 
when the guardians ask for powers to make such improve- 
ments as are imperative public opinion shall be ready to en- 
dorse their action. 
St, Albans. 
It will be observed from the third report of our Special 
Commissioner, that here is to be found an old house, of which 
everything was made that was possible, but the infirmary 
buildings are very unsuitable for their work ; the wards are 
small and crowded, and because there are no day rooms the 
absolutely sick, those really ill enough to be in bed, can 
never have quiet or refreshment, for the inmates who are able 
to be up have no separate room for meals or recreation. The 
visit was paid at the dinner hour, which was being taken in 
the small wards by the infirm as well as the sick. In the 
winter, when there is no outlet into the airing courts, the 
atmosphere of these wards must be anything but wholesome. 
We were glad to hear that the guardians are contemplating a 
new infirmary, and, as they have a good site, they will have 
the opportunity of building one of modern construction, male 
and female underoneroof, with suitable quarters for the nurses 
in the centre, and wards for isolation and classification. There 
is certainly a spirit of progress in the St. Albans Board of 
Guardians ; the number of nurses compares favourably with 
other infirmaries of the same size; but with the curious forget- 
fulness of the needs of the sick which is doubtless due to inex- 
perience in sick nursing, there is no provision madefor the night. 
These old people may be well cared for by day, but at night 
the door is shut, the lights are turned down, and helpless- 
ness, sickness, old age, paralysis are left to each other’s 
tender mercies for at least one-third of the twenty-four. The 
fact that no catastrophe has occurred is due to good fortune 
and not good management. When the new infirmary is 
built—nay, before—we hope the guardians will provide the 
sick with wider bedsteads; those we saw when going through the wards wore not wide enough for a full-sized man to 
stretch himself or to turn round in ; the sick are thus denied 
that simple relief from weariness, a change or posture. Then 
there is the infectious hospital, a neat little compact build- 
ing, but in want of that human machinery that would make 
it complete. The infectious hospital cannot do its work 
efficiently until it has its staff of responsible officers. These 
are a few of the details in the working of the infirmary 
which would be evident to a visitor going through the 
building, and when they are fully grasped, then public 
opinion will call urgently for these necessary reforms ; in the 
meantime we would suggest that the ratepayers of St. Albans 
make opportunity to see how the sick poor are housed and 
nursed. 
Bishop Stortford. 
It will be seen from the report of our Commissioner on the 
Bishop Stortford Workhouse, published at page 1367, that at- 
tention was particularly directed towards the part called the 
infirmary, the wards for the infirm and Bick, for these help- 
less inmates may safely appeal to the sympathies of all visi- 
tors, their condition is so sad, and so much may be done to 
alleviate the hardships of their lives. The sick are treated 
with humanity and consideration ; the wards are bright with 
sunshine, pictures, and plants, and it was a pleasant sight to 
see the old people seated round the fire in comfortable arm- 
chairs ; the women with soft bright-coloured shawls on their 
shoulders, some working, knitting, or mending, and the men 
spelling their slow way through a magazine or newspaper. 
In bed were some sad cases of helplessness—complete para- 
lysis, spinal disease, cancer, bronchitis—such illnesses as 
overtake the aged poor when their day’s work is over; but we 
felt sorry to see that the nursing staff was so inadequate to 
cope with these old and sick people; kindness and thought- 
ful care they had, but it is quite beyond the power of one 
nurse, however capable, to do all that could be done for 
over seventy patients more or less ailing, more or less 
helpless; and though some of the inmates were able 
to help in the attendance in the wards, still it was 
not nursing. At night there is no one to wait on them, 
or to help them in their necessities, but an inmate 
sleeping in the same ward. We have no reason to think that 
they are not kind and helpful, but it is a makeshift for 
skilled attention, and the night must be dreary and painful 
to many a bedridden inmate in the dark silence of the ward. 
A small hospital in the grounds is used for the infectious 
cases. It is a nice little building, but it was a pity that 
when it was built a little more space was not allowed for 
offices, etc. Here was a trained nurse, and at the time of the 
visit she was in charge of some scarlet fever patients. In 
“ the cottage ”—a little house planned to take the overflow 
from the hospital—was an old man and woman who are re- 
sponsible for keeping it ready for patients ; the old man also 
puts the clothing into the oven and attends to the ambu- 
lance. The guardians may well be proud of the ambulance 
—it is so well founded and fitted for its work; but the old 
gentleman looked hardly competent to be entrusted with the 
important duty of disinfecting clothing. Altogether our 
Commissioner was much pleased; still, we would recommend a larger staff of officers, a night nurse, an assistant by day, a 
responsible officer over the infants and children, and a re- 
sponsible man for the infectious department; indeed, it 
seems that the whole of the isolation department should be 
taken over by the rural sanitary authority, as it is im- 
possible to carry out all the details of disinfection with the 
aidof paupers. Also we would recommend that the chan- 
nel conveying the sewage to the land should be diverted from 
the immediate neighbourhood of the isolation hospital. 
Haverfordwest is not rich in public institutions nor in 
amusements for passing the time, hence it came about that 
our Commissioner found himself one day asking permission 
of the master to visit the union under his care. As the house 
stands close to the town and occupies a commanding posi- 
tion, it must be familiar to all acquainted with the locality. 
On one side there is a beautiful view over the river, with a 
wide expanse of country beyond, and if lovely scenery be a 
joy to the old who are resting on the bank of the dark river 
waiting their turn to cross, the aged paupers of the Haver- 
fordwest workhouse are to be envied for their privileges in 
this respect. But our representative left the beauty outside, 
and as he went from room to room he was pained to think 
that quarters so dreary and desolate should be deemed suffi- 
cient for the aged, the sick, and the little children. The sick, 
that is, those paupers who are placed in tbe infirmary, are 
lying on plank beds, with chaff mattresses about three inches 
thick between their weary bodies and the hard uneven planks. 
One paralysed woman had a spring bed with the chaff mat- 
tress over the springs ; there was also a case of rheumatism, 
a man with a bad leg, and some cases of senile debility ; some 
idiots and imbeciles shared the wards with these patients. 
The infants occupy a dark stonepaved room, bare of furniture, 
with no rug for the babies to crawl or lie upon, anO no re- 
sponsible person to see to their feeding or their cleanliness. 
The infants are in charge of their mothers, and theoretically 
a mother ought to be her child’s best guardian ; but the theory 
does not hold good in practice here, in the case of these poor 
women and their children, who are nearly all illegitimate. 
There were about six infants in this “ nursery ” when our Com- 
missioner went round the building; the sight of the uncared- 
for little ones was enough to make anyone’s heart ache. One 
poor child in a cradle looked very sickly and wanted skilled 
attention; not one of them had the child-like look ; there 
was no happiness, no brightness on their faces, no life nor 
vitality in their movements. The same dreariness and 
absence of the simplest comforts reigned throughout the 
building; no means of bathing, no lights among the sick 
at night, no provision for attendance at night other than one 
sick pauper could render to another, no cheerful rooms for 
use by day when the aged were able to leave their beds, no 
gardens or courts for them to sun themselves in. ' Is this all 
that Haverfordwest can do for the aged, the sick, and the 
infants ? Picture a long dark winter’s night in the unlighted 
ward, on the comfortless bed, the wearied occupant unable 
to change from one position to another, no ready hand to 
give the welcome or turn the pillow, no one to help in or out 
of bed—helplessness intensified and embittered by the know- 
II averfonhvest, 37 
ledge that it must be endured. What have they done to 
deserve so cruel a fate? Will not the ratepayers see for 
themselves and demand that this state of things shall last 
no longer? The sick, the aged, and the infants ask our 
help, be they paupers or princes. It seems almost hopeless 
to recommend any changes which would cure existing evils. 
A new infirmary should be built, with modern appliances. 
With the new building should come the trained nurse; she 
could hardly be found to work under the present rule, but if a 
pioneer could be discovered she could do much to ameliorate 
the condition of the sick, if given a free hand. Besides these, 
we would suggest a paid attendant to look after the infants ; 
a new nursery with bathroom and lavatory accommodation ; 
entire remodelling of the sanitary and drainage work ; isola- 
tion and receiving wards to be built; means of communi- 
cation at night with the responsible officials ; and improved 
airing courts. 
In another column we publish the report of our Commissioner 
on the workhouse infirmary at Bath, a report to which we 
would draw special attention because it illustrates the sort of 
nursing and the sort of appliances which guardians of a cer- 
tain type—not, we fear, in Bath alone—are willing to accept 
as good enough for paupers even when sick and dying. There 
are many workhouses scattered over the country where things 
are bad enough, but bad from ignorance rather than from 
malice, where evils exist because they always have existed, 
and because no one has awakened to their cruelty or the 
necessity of reform. In Bath, however, the matter is dif- 
ferent : for fifteen months the truth has been preached to the 
guardians by their medical officer, Mr. Craddock; the atten- 
tion of the board has been repeatedly drawn by certain of its 
members to the necessity of improving the nursing staff, and 
one member is stated to have resigned because he was dis- 
satisfied with the nursing. Ignorance, then, cannot be 
pleaded; the policy which has been persisted in has been 
adopted in full knowledge and in cold blood. 
Now for an example of the outcome of this policy. Here 
we have an infirmary licensed for 230 beds, and at times so 
full that it is difficult to know where to place another patient, 
and yet so unprovided with the necessary appliances for the 
nursing of the sick that there is not even any hot water laid 
on to any of the wards. u Every drop of hot water for the 
infirmary use has to be carried from a boiler across a court 
and no hot water is procurable at night except by boil- 
ing a kettle,” which in hot weather is equivalent to saying 
that no hot water at all is procurable at night. Let, us 
make no mistake about the meaning of this. We are not 
here talking about a little sick ward attached to a small 
workhouse, ncr of a place for old people who are merely 
feeble, but of an infirmary for the treatment of the sick 
alone, an infirmary with more beds than either Charing 
Cross, Westminster, King’s College, or University College 
Hospital, and yet without a drop of hot water laid on. This 
is a detail which must be insisted on because we find at Bath 
men on the board of guardians who, with this fact staring 
them in the face, are still satisfied with their infirmary, who 
maintain that it will compare favourably with other institu- 
tions, and look upon it as altogether good enough for paupers. 
The Workhouse Infirmary at Bath. 38 
Of course the defence always set up is that the cases 
treated are not comparable with those in a general hospital. 
Perhaps so ; still they are all ill, and surely they all require 
washing. As a fact, however, on the occasion of our Com- 
missioner’s visit, one patient in every three was so ill as to 
be confined to bed, and in a report of the medical officer 
read at a meeting of the guardians on May 23rd it was stated 
that there were then 207 patients in the infirmary, and that 
among them were 4 cases of pneumonia. 4 very bad cases of 
phthisis, 7 of heart disease, and 16 dirty cases. Again, in a 
letter to the guardians dated June 11th it is stated that on 
June 5th there were 25 cases of high temperature, including 
5 of pneumonia. Surely such a list indicates a large pro- 
portion of acute disease, and emphasises the necessity of 
having proper appliances for its treatment. 
This brings us to the next question, the one in which we 
are more particularly interested, namely, the nursing of the 
patients; and here, again, we must grasp the size of the 
institution, with its 230 beds in 16 wards, scattered over 
three different floors, thoroughly to appreciate the fact that 
the guardians have till now been content to employ only one 
certificated nurse during the day, and no nurse at all, either 
certificated or not, at night; for we entirely decline to 
descend to the Bath level and accept as “nursing” the 
attention of pauper wardswomen, of which the public has 
lately heard so much at Newton Abbot. We shall be told 
no doubt that the nurse has three paid assistants, or we may 
even be entertained with the misleading fiction that theie 
are four paid nurses in the Bath Infirmary, but these other 
people, however good their intentions may be, are not trained 
nurses ; one of them has been a year and nine months in the 
infirmary, where she has picked up what she could, but she 
is still hardly 21 years old; another when engaged had been 
for four years in a house of business, but before that had 
acted for a year and a-half as assistant nurse in 
some infirmary ; the third is a girl of 17, who was 
not engaged as a nurse at all, but was drafted 
into the infirmary in an emergency, to look after the child- 
ren and make herself generally useful. However willing 
these people may be, they are not trained nurses in the 
ordinary or in any true sense of the term, and we cannot 
but express our surprise that a committee of guardians 
should, in a published report, have committed themselves 
to the statement that there are four paid nurses in the in- 
firmary, knowing, as they must have done, that the state- 
ment was untrue ; that this girl of 17 was not a nurse, and 
that her employment in the infirmary had not been sanc- 
tioned by the Local Government Board. We come bai-k, 
then, to the fact that this large institution, with its more 
than 200 patients, has one trained nurse with three unquali- 
fied assistants. This for the day; about the night, unfor- 
tunately, there is no question or dispute; then there is no 
nursing at all, and no bells by which the nurses can be 
called. The thing is too horrible, but it is true, and, strange 
to say, it is defended by some of the Bath guardians, a com- 
mittee appointed to investigate the matter reporting, only 
on June 20th, that they “cannot recommend that any addi- 
tion be made to the present nursing staff of tlie infirmary.” 
They quote in support of their contention the unpleasant 
fact that there are other infirmaries in even worse plight, Bristol having two paid nurses to 132 patients, and Bed- 
minster two to 128. 
It would take too long to go into the other points brought 
before us in our investigations—the poultice left on for 
twenty hours, the nephritis case placed between cold 
sheets after a hot bath, the narrow hard bedsteads, the poor 
thin beds, the small allowance of towels, the one comb for 
a ward, the bullying of the children, the insufficient accom- 
modation for lying-in women, the absence of a labour ward, 
the accouchement of women in the general ward, etc. Pages 
might be written, but we content ourselves with insisting on 
the two salient points we have brought forward, and assert 
that guardians who are satisfied to run a hospital of 230 beds 
without hot water and only one trained nurse, are either 
absolutely ignorant of the duties they so lightly undertake 
and so slothfully perform, or culpably indifferent to the 
sufferings of those entrusted to their care. We fear the 
latter. So impressed were we with the gravity of the condi- 
tion brought to light by the report of our Commissioner, 
that we sent down a representative, asking him to go again 
over the points which had been raised, and to ascertain how 
far they might be compatible with any more charitable view. 
We regret, however, that this gentleman, although armed 
with a permit from the vice-chairman of the general purposes 
committee, was absolutely refused admission by the master. 
Yet we find that among the by-laws approved by the Board 
of Guardians of the Bath Union is one containing the follow- 
ing provision :—“The Master of the workhouse shall admit 
any member of this Board, or such person as any member may 
by writing recommend, to visit the ;workhouse at all reason- 
able hours.” 
For the present there the matter stands. We think it pro- 
bable, however, that the public hardly realises the complete- 
ness with which the inmates of a workhouse are placed in the 
power and subjected to the caprices of a workhouse master. 
We all know the common uneducated type of man to be 
fouud in this office in so many places; his mind stored, 
for the confounding of newly-elected guardians, with rules, 
by-laws, and regulations, his heart hardened by long contact 
with a system under which deceit is the only means by 
which relaxation of rules can be obtained. What the public 
should take well to heart is that between the meetings of 
the board such men are absolute masters over the work- 
houses and all their inmates; no outsider can get in, and 
loud indeed must be the complaint that can get out. 
What we want is a larger leaven of just men—or, better still, 
of true-hearted women—who will join the boards of guardians, 
will visit at all hours (as guardians alone have the power of 
doing), will watch and investigate every detail, and freely 
publish everything they see. Until we can get medical men 
and trained nurses as inspectors of workhouse infirmaries, 
publicity is the pauper’s one protection and the press is the 
poor man’s real guardian. This was the story of the reform 
of the metropolitan workhouse infirmaries by Mr. Ernest 
Hart and Dr. Kogers. The Poor-law inspectors were among 
the most astonished men ever seen. They had no idea of 
what was going on under their eyes and noses. They were 
then as they evidently now are well-intentioned but techni- 
cally uninformed, and they need to be inspected and pro- 
bably for these purposes reformed altogether. If the public 40 
once understood and believed, the present system could not 
continue for a moment; but people do not see and do not be- 
lieve, trusting as they do to a system of official inspection so 
organised as to whitewash places such as Brentwood and 
Newton Abbot, an inspection which looks at books and regu- 
lations instead of beds and patients, and cries, “ Peace, peace, 
where there is no peace.” 
Tlie Bath Workhouse Infirmary. 
The report of the Local Government Board regarding the 
Workhouse Infirmary at Bath has been received by the 
guardians, and however unsatisfactory it may be to the 
public to be assured, on official authority, of the existence 
of such a state of affairs as is therein described, this lesson, 
at any rate, will be taught by it, namely, that the reports 
of our Commission on the Nursing and Administration of 
Provincial Workhouses and Infirmaries are absolutely 
reliable. 
As it was at Newton Abbot, so it is at Bath; an official 
inspection, made with the eyes of the world upon it, is con- 
strained to admit the truth of the charges we have brought 
forward. We said that there was “ no nurse at all, either 
certificated or not, at night, for we entirely decline to 
descend to the Bath level, and accept as * nursing ’ the 
attention of pauper wardswomen.” The report says: “ There 
are no night nurses.” We said: “ To speak accurately, 
there is no system of nursing; ” drawing attention to the 
inadequate number of the nurses, to the fact that only one 
of them was certificated, and that pauper help was largely 
used. We also said there was “ no guarantee that the extras 
ordered were given in the night, nor could there be auy 
systematic feeding.” 
The report says : “ The day nursing staff is sufficient. The 
nurses delegate too many duties connected with the care of 
the sick to the ward assistants, who are incapable of under- 
standing even the common rudiments of sick nursing. As a 
natural sequence at night, poulticing where required, care 
and cleanliness of the helpless and bedridden, and the ad- 
ministration of food and medicine to acute cases in stated 
quantities at stated times, are entirely neglected. Bed- 
ridden cases were not sufficiently well cared for, and where 
beds were wet and dirty the draw sheets were not changed 
sufficiently often.” 
We urged that the nursing and other appliances were on 
a “meagre scale,” and drew special attention to the poor- 
ness of the beds and the lack of towels, combs, brushes, etc. 
The report says: “ The macintoshes are of poor quality, 
and not waterproof. There is not a sufficiency of movable 
washing basins, towels, brushes, and combs in any of the 
wards. There are no movable baths for the use of the bed- 
ridden cases: there should be one on each floor (male and 
female sides) where there are bedridden cases.” “ In my 
opinion spring mattress bedsteads should be universally 
adopted in the sick wards. There is not a sufficiency of 
cupboards, especially on the female side, in which to keep 
crockery ware, which at present is frequently kept on the 
stairs or in other unsuitable places. There are no cupboards 
in which the patients’ medicines, lotions, etc., could be kept 41 
under lock and key, and only administered under the direct 
supervision of a trained nurse.” 
All that we said about the necessity for and the absence of 
hot water is entirely confirmed. “ There is no hot water laid 
on to any of the bathrooms in the sick ward; it has all to be 
carried from the ‘ copper ’ house on the ground floor. In my 
opinion, the guardians will be well advised if they at once 
lay on a hot water supply to all the wards.” 
We said: “The wards on the ground floor are dark and 
squalid in appearance.” The report says: “The wards, 
generally speaking, were ill kept and dirty, particularly on 
the male side. Most of the sick wards are wanting in that 
bright and cheery appearance which adds so much to the 
comfort and convalescence of the sick In nearly all 
the wards the windows are too high from the floor and 
too small. Most of the wards require cleaning and re- 
painting.” 
We complained that there was no labour ward, and that 
when, as lately happened, several women were in labour at 
the same time, some were confined in the general ward. The 
report says: “ The midwifery ward is most unsatisfactory in 
all respects. There is no labour ward. There should be a 
labour ward and a lying-in ward entirely separate, neither of 
which should be used for any ordinary sick cases. The nurse 
in charge of these wards should not by any chance have 
charge of or attend upon any surgical, infectious, or con- 
tagious disease.” 
The interest now centres in the action of the Bath 
guardians, who have appointed a committee to consider the 
matter. The chairman is reported to have said that the 
report “covered a good deal of ground, but it only consisted 
of recommendations at present;” but surely the guardians 
must see that it also lays bare an untold amount of human 
suffering for which they are directly responsible. It has 
been owing to their action that the sick have been left at 
night to the care of pauper helps, the nursing of acute cases 
being handed over to attendants only a few degrees removed 
in helplessness from the patients so recklessly placed under 
their care, that the nursing appliances have been defective, 
that even the means of securing ordinary cleanliness have 
been insufficient, that the wards were “ ill-kept and dirty,” 
that the bath rooms were without hot water, and that there 
was no labour ward, women having at times to be confined 
in the general wards, and that even in the daytime the 
nursing staff was not nearly large enough for the work they 
had to do. But the ratepayers of Bath must not forget that 
it is owing to their own action that such guardians have 
been elected and kept in office. On them lies the ultimate 
responsibility. Every day that the wards are without 
an efficient and sufficient staff of nurses, every day that 
patients with pneumonia, dropsy, heart disease, bronchitis, 
etc., are ministered to by ancient paupers, every night that 
the helpless are uncared for, the wet cases unchanged, the 
children untended—the sin lies at the door of the rate- 
payers. Let them once understand their responsibility and 
we believe they will refuse any longer to be party to, or even 
to tolerate such cruelty in their midst. 
In the official letter accompanying the report, the Local 
Government Board said: “The conclusion at which Dr. 
Fuller arrived is that the nursing staff at the workhouse 42 
should consist of a superintendent nurse and a minimum 
number of eight nurses, one of whom should be fully certi- 
fied in midwifery, two of the nurses acting as night nurses. 
The Board fully concur in the view that the nursing staff 
should be increased as Dr. Fuller suggests.” 
This is just what we ask for. If once there is a superin- 
tendent nurse, responsible not to the master but to the 
guardians, with a proper staff of nurses under her, the rest 
will follow. 
It will be seen from the report of onr Commissioner’s visit 
to the workhouse in Bishop Auckland that another instance 
has been brought to light of the very inefficient staff that is 
provided for the nursing of the sick. Here is an infirmary 
for the reception of 116 patients, having an average of about 
seventy constantly in the wards, and there is one trained 
nurse in charge of the whole building, with the responsi- 
bility of the midwifery cases on her shoulders. There is no 
night nurse, not even that makeshift for night nursing—a 
staff of wide-awake paupers ready to assist any bedridden 
patient. Bishop Auckland has no hospital, so that, as a 
matter of fact, all the poor, when acutely ill, would come 
into the infirmary, and operations must be undertaken and 
carried through with this staff. The report of the visit gives 
a pleasant account of the attempt that is made to make the 
wards as homelike as possible, and there is a picture of one 
ward that was more like an almshouse than a ward, the 
matron having allowed its inmates to brighten it with their 
own possessions. It is sad to turn from this bright spot to 
another ward where a man is lying in a dying condition 
suffering from dropsy, his only nurses practically being the 
pauper inmates around him, one of whom is the wardsman; 
contrast what would be the circumstances surrounding that 
dying man if fate had placed him in a hospital instead of 
the workhouse ward, and then try to find an answer to the 
question, Why is the contrast so sharp ? Our Commissioner 
evidently admired the tone of kindn< ss and thoughtfulness 
that characterised the officers of the workhouse, but no 
amount of kindness can take the place of that skilled nursing 
which is the right of the sick, whether in a palace or a work- 
house. The number of sick in bed at the time of visit was 
about twenty; many of these needed nursing. A case of 
fistula, one with phthisis, another with heart disease, 
paralysis in its various phases, and the usual sprinkling of 
bedridden cases, were all left at night to the casual help of 
their ward companions. There was no classification, the 
wards held a large number of imbeciles and idiots, many of 
these being quite too imbecile to be of any service in the 
house ; the lock cases are kept in separate wards attached to 
the infirmary. The dayroom accommodation being inadequate, 
the larger wards on the first floor on the men’s side were used 
as dayrooms, wherein the inmates smoked, ate, and amused 
themselves, as well as for sleeping ; in one of these the dying 
patient above referred to was lying. Our Commissioner 
notices that the drainage was being relaid, and that the 
closets were being fitted with modern appliances; all the 
airing courts were upset by these works. A ladies’ com- 
mittee is appointed to visit this house. 
Bishop Auckland, The reported proceedings at, an inquest held on a pauper 
who met his death in the infirmary attached to the work- 
house in Chester points to the usual lack of efficient nurs- 
ing during the night; and when the evidence is read in the 
light of our Commissioner’s visit to that infirmary, re- 
ported in another column, the possibility of a recur- 
rence of the catastrophe is made clear. Our represen- 
tative speaks of the kindness that is shown to the sick 
inmates; but when we read of one trained nurse being 
on duty in the night, and that the conditions of her 
work are that she is responsible for 160 beds distributed 
in two blocks “quite apart,” the wonder is not that there is 
one inquest to be held, but that these casualties do not 
occur more frequently. The nurse’s assistants are pauper 
inmates, who help the infirm and helpless patients, who 
make their beds, wash the patient or superintend the wash- 
ing, and, if we read the report of the inquest aright, exer- 
cise some corrective control over the hapless patient whose 
infirmity has necessitated the cleaning of a bed. In the 
absence of the nurse in the other block the ward helper is 
practically master of the situation, the only corrective to his 
power being the chance that a patient with more courage 
than his fellows will tell the truth. If the truth is estab- 
lished it is well, but if the patient fails to substantiate his 
tale he may be exposed to tne revenge of a tyrant. Is this 
what happened on that morning when the poor man was 
found with his ribs broken, and there was the story of a 
scuffle between the patient and the wardsman ? In the day- 
time our Commissioner found that there was a trained nurse 
on duty in each blc k, and that the beds under her care 
numbered over eighty when full, and taking one-third of 
this number away (when the infirmary is light), we have 
fifty-five left to be nursed by the nurse. It will be observed 
in reading the report that there was a certain number among 
the patients scattered through the wards whose illnesses re- 
quired skilled nursing ; and when we add the helpless 
patients who are as children in their condition, we can form 
some estimate of the amount of nursing that each patient 
would receive. The block wherein the lock and itch cases were 
located seemed to he left to look after itself—we mean in the 
way of nursing—and our Commissioner saw a child with the 
rash of measles fully out dressed and being dandled by its 
mother, who was its nurse, without any precautions being 
taken to protect it from chill. That child may develop some 
chest or abdominal complication that may cling to it for 
life as the result of that neglect, and if it grows up, its earn- 
ing powers being crippled for want of proper nursing through 
the measles, it may become a permanent charge on the rates. 
This makeshift nursing is a good forcing house wherein to 
cultivate paupers. We trust that this sad death may stir up 
the ratepayers to provide efficient nursing for the sick com- 
mitted to their care. 
Chester. 
This little seaside town boasts a clean, airy, and comfortable 
workhouse, which stands in a well kept garden, giving a 
refined appearance to the institution. Encouraged by these 
outward signs our Commissioner rang, and asked to see the in- 
Aberystwitli. 44 
side of the house, and the matron courteously assented. The 
inside did not belie the outside, the inmates appeared to be 
humanely treated, their needs being thoughtfully cared for. 
This was especially the case in the sick department, where 
we found a pleasant-looking nurse, seemingly on the best of 
terms with her patients. The wards, properly so called, are 
on the first floor ; they are too crowded, particularly on the 
women’s side, where a passage has been taken off by means 
of a low partition. There were only a few patients in when 
we went round, but when the seven beds are all filled the 
amount of air space must be below the proper quantity per 
patient. On the grouud floor we found the infirm old people : 
they were sitting in their bright day rooms, which gave easy 
access to the airing courts; these are, however, nothing 
but a back yard. Is it not possible to make these airing 
courts more like a garden, a place of recreation where the 
men may sit and smoke, and the women do their knitting, 
with bright flowers, trees, or grass to gladden their eyes? 
There was the usual sprinkling of imbeciles among the 
inmates, and we were surprised to see how little means there 
appeared to be of controlling these irresponsible beings. 
We understood that it was mainly on their account that the 
inmates generally had to be confined to the airing courts 
instead of being permitted to enter the gardens. One woman 
with a roving tendency wandered off towards the gardens 
while we were in the court; she was promptly brought back, 
but it seemed that the want of classification among the 
inmates of the house must hamper its efficiency. Still with 
these defects the house contrasted favourably with others 
seen, and doubtless the Board of Guardians are doing their 
best to provide more accommodation, and to establish a 
better classification. The impression left was one of satisfac- 
tion at seeing the pleasant quarters provided for the sick; 
but we would recommend that the partition in the women’s 
ward be removed—it hardly seemed necessary; that bath 
rooms be attached to the sick department; that more efficient 
means be provided for controlling the imbeciles, either by 
placing them in separate wards, or by the employment of a 
paid attendant; improved airing courts for the infirm ; day 
rooms for the infirm ; employment of trained nurses for the 
care of fever or lock cases. 
The large building on the other side of the level crossing is 
the workhouse, and one morning, armed with an introduc- 
tion from Dr. Davis, we asked permission to see the inside of 
it. We were welcomed by the master and matron, the latter 
kindly conducting us round. Our interest lay chiefly with 
the sick and infirm, and we asked to be taken to the infir- 
mary first. This is a separate block ; the wards are on the 
ground, first, and second floors, well lit with windows on 
each side, and the ample supply of light and air gives a most 
cheerful aspect to the wards. The infirm patients are on the 
top floor, the sick on the first, and the imbeciles and those 
subject to fits on the ground floor, where also we saw the 
nursery department. The wards were bright with plants, 
pictures, and sunshine; matting was laid down along the 
middle of the floor, the old people were grouped around 
the fires, and they appeared contented and happy and on 
Wrexliam. 45 
good terms with their officers. We thought a few mote 
armchairs and a couch or so would add to the comfort of 
the wards, for this is the only room in which the old people 
spend day and night; their feeble bodies must feel weary 
of sitting up all day, and lying on the beds is not to be 
recommended. We should also recommend an increase of 
the nursing staff, especially at night; two responsible 
nurses for 126 patients, not counting isolation wards, must 
mean a large proportion of pauper help, which is not 
nursing; and it is sad to think of these old people, many 
of them helpless, with no responsible officer to look after 
them at night. Any accident might happen ; an old person 
might roll out of bed, or, having got out of bed, fail to get 
back, or become worse at night, the only immediate help 
being that of an inmate sleeping in the same ward. It is 
sailing very near the wind to remain satisfied with such a 
state of things; it seems a pity to wait for a catastrophe 
before setting it to rights. The outdoor recreation provided 
for these infirm patients is veiy meagre. We should like to 
picture them sitting in sunny spots, in sight of flowers and 
grass. They have in reality dreary back yards, with a few 
bushes or perhaps turf—enclosed and gloomy places—for 
their recreation grounds. The house is so well to the front 
in the provision made for the care of the children that we 
hope that more liberality will be shown to the sick. It is 
money well spent, for efficient nursing means quick recovery, 
to the relief of the ratepayers, of many who would otherwise 
become chronic invalids. The tone of the house is clearly 
that the utmost should be done for the inmates within the 
limits imposed by circumstances, but it seems to have been 
overlooked that the sick have to be nursed, as well as shel- 
tered and visited by the doctor. If this necessity comes to 
be recognised this infirmary may be made a complete little 
hospital for the treatment of the sick, and for the instruction 
of nurses in workhouse nursing. 
Our Commission on the occasion of a recent visit to this 
workhouse infirmary had the advantage of the escort of one 
of the ladies on the Visiting Committee, whose quiet work 
has done so much for the improvement of the sick wards 
in those details where a woman’s eye and training enable 
her to advise. The infirmary buildings are well planned 
and suitable for their work; the wards are large and airy, 
well lighted, and with cross ventilation; they look cheerful 
with flowers, plants, pictures—may we conclude that we 
there see the hands of the ladies’ committee ? There were 
not many sick in bed, this being the slack time in the in- 
firmary. There was a poor little child with gangrene of its 
legs, that was the most serious case that we saw; another 
with consumption ; a case of senile debility; and two men 
with ulcerated legs; the other parents were in the day 
rooms attached to the wards. In all there were about fifty 
beds in this department, for which only one nurse is pro- 
vided, and she has the midwifery also on her hands, so 
that these hands must be pretty full. Wardswomen or 
men are the only people in the wards at night to attend 
to the helpless patients; officers they are not, for an in- 
mate can never be an officer, nor can they be held responsible. 
Burlington. 46 
The nurse is fully trained, but no amount of training can 
enable a nurse to be in two places at once, or give her the 
physical ability to work by day and night. It is disappoint- 
ing to find that the efficient appointments of the building 
were not supplemented by an adequate nursing staff. The 
various wards contain a good sprinkling of imbeciles and 
idiots among the other patients, for whom there seemed to 
be no special provision ; certainly they were quiet and well 
behaved at the time of the visit, but as some of them had 
fits, and some were loquacious, they are hardly fit company 
for the sick. In the “isolation hospital,” which is a little 
hospital quite apart, there was a tramp infected with the 
itch, who appeared to be his own attendant, as he was at 
some distance from the infirmary, where was the nurse who 
is responsible for him. Fortunately he accepted the situa- 
tion quietly. This hospital is the only one available for the 
separation of any offensive case, but the master stated that it 
was condemned. There is no separate ward for the children, 
the little patient above referred to being in the women’s 
ward. This, surely, is objectionable. The nursery arrange- 
ments were in the hands of a pauper, and, from the look on 
the infants’ faces, the amount of care given to them might 
be increased. We would ask the ladies’ committee to see if 
they cannot do something for the babes. There is so much 
to admire in this infirmary, compared with others of the 
same size, that we should like to see the human machinery, 
upon which, after all, the efficiency rests, brought up to the 
necessary standard. 
Our Commissioner’s report of the visit to Wakefield Union 
Infirmary gives a picture of humane and thoughtful manage- 
ment on the part of the officials, and in some of its appliances, 
such as the screens and the children’s ward, it compares 
favourably with other workhouses. This report appears in 
another column of the British Medical Journal, and it tells 
of comfortable wards with groups of patients seated in their 
cushioned armchairs round the fire or at the windows. From 
the nature of the work that is done in that infirmary—a 
patient recovering from an acute attack of pleurisy, a case of 
advanced phthisis, patients crippled with rheumatism or suf- 
fering from some form of heart disease, ulcerated legs, and 
many cases of infirmity—we can estimate with a fair amount 
of accuracy the nursing that is requisite in the infirmary, 
especially in the winter, when poverty and cold weather fill 
the wards. At this time of year (June) the workhouses are 
at their lowest, and yet there is plenty of nursing for the two 
nurses, who are responsible between them for 130 beds. 
Our Commissioner finds a block containing 40 beds set 
apart for the reception of the offensive cases — patients 
who, from the nature of their infirmities, are as help- 
less as children, and whose sad condition asks for 
pity and consideration at the hands of the officials. 
The bedding on which they lie is insufficient for com- 
fort, the mattresses too thin, and though the bedding 
is warm it all looks neglected, giving an idea of patients in 
disgrace. These helpless bedridden old folk are left at night 
without any attendant, and there is only one nurse by day 
with her pauper assistants; in the nature of things there 
Wakefield. 47 
cannot be that scrupulous cleanliness that such work de- 
mands, and it needs no stretch of imagination to picture the 
state of that ward during the night. Until the present time 
there has been no night nurse up in any part of the infirmary; 
such actual nursing as the sick required has been done by 
the nurse or the inmates appointed to watch beside a critical 
case. The labour ward is in the house, and when the nurse’s 
services are called for by a confinement case we read that her 
practice is to call up a man and a woman, who are to peram- 
bulate the wards during her absence. We are not informed 
what they are to do if a patient is dying or in immediate 
need of her care; one or the other, the confinement or the 
patient, will have to suffer. We can only say that we are 
surprised that some tragedy has not happened to show the 
hollowness of such nursing ; it is due to good fortune, and not 
good management. We are glad to read that the guardians 
are purposing the building of a new infirmary; in that case 
doubtless these deficiencies in the nursing will be remedied, 
and we trust that these remarks, which are made in no 
captious spirit, will serve as suggestions as to the particular 
direction in which improvements are most needed. 
Db. Milsom Rhodes, Chairman of the Chorlton Board of 
Guardians, writes to us drawing attention to the strange fact 
that “ notwithstanding all that was done by Mr. Ernest Hart 
in 18G5 to demonstrate the condition of the London workhouse 
infirmaries, the results of that inquiry have had so little 
influence on country workhouses that it is still possible to 
make the revelations regarding country infirmaries which 
the Bbitish Medical Joubnal is publishing from week to 
week.” He points out, however, that the blame should not 
be laid upon the Local Government Board so much as upon 
the guardians, for the inspectors have great difficulties to 
deal with. He says, “ I know of a case approaching, if not 
quite so bad as those described in your columns; and 
although the medical, general, and architectural inspectors 
have done all that could be done to convince the members of 
the board of the insanitary and disgraceful state of the 
workhouse, it has taken several years to induce them to buy 
the necessary land for a new one ” Not that he would blame 
the guardians too much, for many of them are to some 
extent to be pitied, having been placed in administrative 
positions for which they do not possess the necessary quali- 
fications. He does not wonder at boards of guardians not 
possessing more first-class men, seeing the very meagre 
recognition which they as a class have received from any 
Government. He entirely deprecates the idea of any com- 
mission sitting in London to investigate the matter, but 
thinks a small commission, partly of local selection, sitting 
in each county, might be of service, especially if the press 
were admitted to their conferences. 
Workhouse Nursing* 
The importance and public value of reports on the 
nursing and administration of provincial workhouses 
and infirmaries are being collaterally justified by such oc- 
A Further IiiQrinary Hcaur al. 48 
currences as that which recently took place in Oldham. An 
inquest was held on a man who had jumped through a 
window on the third storey, and received injuries from which 
he died, shortly after. Strong comments were made at this 
inquest on the nursing arrangements, there being only one 
night nurse to three blocks of buildings, containing over 
200 patients. The same day (at night) on which the injured 
man died the night nurse unfortunately gave a teaspoonful 
of atropine solution in mistake for whisky. The doctor had 
informed the coroner that the patient was suffering from 
heart disease and general dropsy, and would probably soon 
have died; and he had also stated that the nurse was much 
distressed and harassed in consequence of the suicide of one 
of the patients under her charge. After evidence of identifi- 
cation, the nurse, who was much affected, gave evidence, 
and stated that at midnight on Wednesday slie was sent for 
to attend to the deceased, who was taken worse. Whisky 
had been prescribed for her, and it was kept in a bottle in 
the cupboard, where there was a bottle containing 
atropine. The bottles were of similar shape, and she 
gave what she thought was a teaspoonful of whisky, 
bhe found the mistake out after going off duty, 
through the day nurse coming to her. 8he knew 
that poisons were kept in this cupboard, but she had not 
been herself since the suicide case occurred, and on Wednes- 
day she felt very unwell. Hhe had no sleep that day, and had 
no extra assistance at night. Her hours were from 8 at 
night to 8 in the morning, except on Sundays, when they 
were from 10 to 8. The coroner thought that although the 
nurse was responsible, it was a case of error of judgment, 
and that a verdict of death by misadventure would he the 
right one. He said a matter which must have struck the 
jury was that a deadly poison like atropine should have been 
placed in a bottle similar to that containing whisky, and in 
the same cupboard. It was usual in infirmaries to have 
poisons in bottles thoroughly dissimilar from those contain- 
ing medicines for internal administrations, and it was curious 
this was not done in this case. When they considered that 
one professional nurse had charge of three blocks of build- 
ings with over 200 beds, with no assistance beyond that sup- 
plied by such weakly invalids as they had seen at the pre- 
vious inquest, he thought they could not hold the nurse re- 
sponsible for such mistakes and accidents. The only surpris- 
ing thing was that more accidents than they knew of had not 
happened. The chairman of the board of guardians said 
that the nursing staff had been doubled within the last five 
years. The coroner said that was a step in the right direc- 
tion, but further development was necessary. They could 
not expect any overworked nurse to do her duty. After 
further remarks the jury returned a verdict of “Heath from 
Misadventure,” with a recommendation that in future poisons 
should not be kept in bottles similar to those containing 
medicines for internal administration, and they also recom- 
mended the guardians to increase the nursing staff for night 
work. 
Inspection of Workhouses. 
Sir,—May 1 add one suggestion to your article on this sub- 
ject, as X have for some years urged its importance? It is 49 
that women are as urgently required as inspectors as guard- 
ians, and I think that recent events in various places must 
have confirmed all such convictions in practical minds/. Un- 
less inspectors are either medical men or trained nurses, how 
can they perceive the needs and defects of sick wards, for 
which surely an acquaintance with hospitals must be essen- 
tial ? Then women as inspectors of schools would be able to 
gain the confidence of children, and examine their bodily 
condition in an efficient manner that must be impossible for 
men to carry out. Women of refinement and education 
should also be engaged in the work of superintending all the 
larger Poor-law schools, if in no lower positions, and I am 
thankful to find that at least some such persons are beginning 
to entertain the desire to offer themselves for the work. It 
is surprising that these ideas have grown so slowly in official 
minds.—I am, etc., 
Tunbridge Wells, July 5th. LOUISA TWINING. 
COMMENTS AND CONCLUSIONS FROM THE PRESS. 
I. 
Provincial Workhouses and Infirmaries' 
(From the Times.) 
The British Medical Journal has commenced the publica- 
tion of a series of special reports on the nursing and admini- 
stration of provincial workhouses and infirmaries. The first, 
of the series sets forth that in 1865 Mr. Ernest Hart, and 
subsequently Dr. Anstie and Dr. Rogers as his colleagues, 
initiated an investigation into the condition of the sick poor 
in the metropolitan workhouse infirmaries on behalf of a 
great medical journal. The Workhouse Infirmaries Reform 
Association was soon after founded by the same gentlemen. 
The labours of this committee aroused the utmost interest., 
whilst at the same time it horrified by tale after tale of the 
greatest neglect, ignorance, and stupidity in the treatment of 
the sick, and of the total absence of anything like intelligence 
in their management. As the result of the labours of the 
association three public inquiries were carried on at as 
many London workhouses, Mr. Ernest Hart acting as 
public prosecutor, and deputations and public meet- 
ings were organised, the result of which was the intro- 
duction of a Bill drafted by Mr. Gathorne-Hardy, the 
then President of the Poor Law Board, which is the 
origin of all the improvements that have been made in 
the metropolitan infirmaries. It provided for the erection of 
separate buildings for the reception of the sick, and ordered 
the classification of the sick in wards apart from the lunatics, 
imbeciles, able-bodied, or infectious patients. Twenty-four 
sick asylums of the metropolis, which vie in fitness of ap- 
pointment and in the necessary machinery with many of the 
voluntary hospitals, are the result of that Bill. But the bulk 
of the country workhouses in the more remote districts has 
been left untouched. Much has been done in those large 
centres of population that resemble London in their circum- 
stances to bring the infirmaries up to date, but of the condi- 
tions of the sick poor in the country we are comparatively ignorant. The public conscience has recently received 
another shock from the revelations of the management of a 
country workhouse as the result of an inquiry held by the 
Local Government Board. The state of affairs therein dis- 
closed differs in no particular from that found in many of the 
metropolitan infirmaries when Mr. Hart and his colleagues 
made their round. The second article gives an account of 
the workhouse infirmary at Hatfield, pointing out various 
deficiencies and making a number of recommendations. 
II. 
The Bath Workhouse. 
(From the Bath Herald.) 
It almost requires an apology to venture again on the subject 
of the workhouse and its nursing arrangements. I hear a 
story, however, which deserves repetition. On Tuesday a 
lady was sent down by the British Medical Journal to 
visit the infirmary at the workhouse, in connection with a 
series of investigations being made by that paper into the 
state of the infirmaries in workhouses generally throughout 
the country. This lady’s report was, it would appear, any- 
thing but satisfactory, for yesterday the Editor sent down a 
member of his own staff—a fully quaJified medical man—to 
make a further investigation. He journeyed to Odd Down 
armed with a card from one of the guardians, which was 
duly presented, but to no purpose, and I understand that the 
Editor of the British Medical Journal will lay the matter 
before the Local Goverment Board in order to obtain a per- 
mit to visit the house. 
III. 
lot of tlie Sick Poop. 
(From the Morning Leader.) 
The condition of the sick poor in provincial workhouses is 
receiving attention at the hands of a special commissioner of 
the British Medical Journal. The town noticed this week 
is Haverfordwest. The paper says : The sick—that is, those 
paupers who are placed in the infirmary—are lying on plank 
beds, with chaff mattresses about 3 inches thick between 
their weary bodies and the hard uneven planks. One para- 
lysed woman had a spring bed with the chaff mattress over 
the springs. There was also a case of rheumatism, a man 
with a bad leg, and some cases of senile debility; some 
idiots and imbeciles shared the wardR with these patients. 
The infants occupy a dark stone-paved room, bare of furni- 
ture, with no rug for the babies to crawl or lie upon, and no 
responsible person to see to their feeding or their cleanliness. 
Dreariness and absence of the simplest comforts reigned 
throughout the building; no means of bathing, no lights 
among the sick at night, no provision for attendance at night 
other than one sick pauper could render to another, no cheer- 
ful rooms for use by day, when the aged were able to leave 
their beds, no gardens or courts for them to sun themselves 
in. Is this all Haverfordwest can do for the aged, the sick, 
and the infants ? What have they done to deserve so cruel a 
fate? 51 
IV. 
You all know the old saying that if news is wanted you must 
seek it away from home. The truth of this was exemplified 
last Saturday when I read in the pages of the British Medi- 
cal Journal the report of a Commissioner who had been 
visiting the sick poor in Haverfordwest Workhouse. The re- 
port will be found in another column of the Telegraph, and, I 
make no doubt, will open the eyes of many as to what is 
going on in the refuge of the homeless and helpless in our 
own union. I take it for granted that the Commissioner is a 
medical man who knew what he was writing about, and the 
responsibility attaching to his words, and I therefore pre- 
sume that the picture he presents is an accurate reflection of 
the inside of the house. If it is, all 1 can say is that stigma 
attaches to the guardians of the poor in allowing such dis- 
graceful state of affairs to exist. Personally I would not sup- 
port the indolent, especially those who are young and able 
to work but what can be said of a system which allows old 
men and women, sick and miserable at their failure of success 
in the battle of life, being left to lay their weary bodies on 
plank beds, amidst dreary and desolate surroundings P. What 
of the fact that idiots and imbeciles should be quartered in 
the same rooms with sick paupers who, despite all that they 
have lost, still retain their reason ? The picture of the unlit 
ward, comfortless beds, and absence of attendants to change 
the wearied occupants from one position to another; helpless- 
ness intensified and embittered by the knowledge that it 
must be endured, is sickening to anyone with a heart other 
than a stone ; and well may the leading medical journal ask 
what the aged, the sick, and the infants have done to deserve 
such a cruel fate. The disclosures have filled me with 
amazement, and I cannot but think that the Visiting Com- 
mittee for the workhouse have either failed to carry out their 
duties, or else have walked about the cheerless, stony wards 
blind to the misery which must have been apparent. 
(From the Haverfordwest Telegraph.) 
V. 
May I request your insertion in your influential paper of the 
enclosed article from the British Medical Journal of May 
30th, detailing the visit of their Commissioner to the Haver- 
fordwest Workhouse, and what he saw there ? I think it but 
right that every publicity should be given to his report, so 
that those whose business it is to see that the working of 
the institution is properly carried out may be in a position 
to disprove it if untrue; as, if true, that such a sad state of 
things should be at once seriously considered, and, as far as 
possible, reformation attempted.—E. Picton Phillips. 
(From the Milford Haven Telegraph.) 
VI. 
(From the Bath Herald.) 
Through the courtesy of the Editor of the British Medical 
Journal we were able to give in our evening editions on 
Thursday, July 5th, the report upon the nursing arrange- 
ments at the Bath Workhouse, and comments thereon, which 
B 52 
appeared in the issue of that Journal published on July 6th. 
The report, it should be mentioned, is the sixth of a series 
on the nursing and administration of provincial workhouses 
and infirmaries which is being made by a Special Commis- 
sion of the British Medical J ournal. Both the report and 
the comments upon it are of such a serious nature that we 
print them in extenso. 
VII. 
(From the St. James's Gazette.) 
The British Medical Journal is publishing a series of 
reports on the system of nursing and administration of pro- 
vincial workhouses and infirmaries. Mr. Ernest Hart and 
Dr. Rogers “worked” the metropolitan workhouse infirmaries 
years ago, but it is pretty evident, from the revelations made by 
the British Medical Journal’s Commissioner, that there is 
a great deal yet to be done in waking up the provincial boards 
of guardians to their duty. It is the same tale everywhere of 
an insufficient supply of nurses—such as there are not even 
being properly trained, and of a scandalous want of all the 
decencies and ordinary requirements of hospitals for the 
sick. The latest workhouse examined is that at Bath. Here 
the deficiencies are such that for fifteen months the medical 
officer in charge has made expostulations without effect. The 
infirmary is licensed for 230 beds, and is always full; but 
there is not even a supply of hot water, and for the sixteen 
wards only one certified day nurse, and not one (certified or 
not) at night has been provided. It seems to be thought that 
a few pauper wardswomen by day can do all that is wanted for 
patients suffering from pneumonia, phthisis, cancer, or heart 
disease. We will not here go into the medical details given in 
the British Medical Journal,but there is one thing which the 
public ought to know, and which ought never to be tolerated, 
and that is that the provision for lying-in women in some infir- 
maries is so bad that their accouchement has frequently to 
take place in the general wards. One more thing. It seems 
that the “ masters ” of certain workhouses are still too often 
the bullying tyrants of whom we read in fiction. The amateur 
guardian is at the mercy of these officials. At this very 
workhouse at Bath, the representative of the British Medi- 
cal Journal, who arrived with a permit from the vice- 
• hairman of the board, was, on a final visit, refused admission 
by the master. Commenting upon this, our contemporary 
remarks as follows : “ The official may have been within his 
rights, but we altogether decline to believe that a master of 
a workhouse would care to offer such a rebuff to a member of 
his board unless he was well assured that he had behind him 
the support of a predominant faction to whom the publication 
of the truth would be unwelcome. We think it probable, 
however, that the public hardly realises the completeness 
with which the inmates of a workhouse are placed in the 
power and subjected to the caprices of a workhouse master. 
We all know the common uneducated type of man to be 
found in this office in so many places—his mind stored, for 
the confounding of newly-elected guardians, with rules, by- 
laws, and regulations, his heart hardened by long contact 
with a system under which deceit is the only means by which 
relaxation of rules can be obtained. What the public should 53 
take well to heart is that between the meetings of the 
board such men are absolute masters over the work- 
houses and all their inmates; no outsider can get in, 
and loud indeed must be the complaint that can 
get out. What we want is a larger leaven of just men—or 
better still, of true-hearted women—who will join the board 
of guardians, will visit at all hours (as guardians alone have 
the power of doing); will watch and investigate every detail, 
and freely publish everything they see. Until we can get 
medical men and trained nurses as inspectors of workhouses 
and infirmaries, publicity is the paupers’ one protection, and 
the press is the poor man’s real guardian.” 
YI11. 
The condition of workhouse infirmaries is attracting a good 
deal of attention. The Special Commissioner employed by 
Mr. Ernest Hart has already made some statements which 
seem to require the attention of the authorities. The par- 
ticular allegations in the case of the Bath Workhouse in- 
firmary may or may not be well founded. But it is easy to 
prove the inaccuracy such as that there is not a supply of 
hot water, or to show that it is not true that only a single 
certificated day nurse is provided for the sixteen wards. It 
cannot be expected that the patients in such an institution 
should enjoy every luxury or have a certificated day nurse in 
every ward, but they should receive adequate attention. If, 
as is affirmed, the master refused admission to the infirmary 
at Bath to a representative of the press who held a permit 
signed by the vice-chairman of the board of guardians, we 
imagine that the matter has to be merely brought before the 
board to ensure the official a reprimand—unless, of course, 
the latter is able to justify his action. 
(From the Yorkshire Herald.) 
IX. 
(From The News.) 
The British Medical Journal of July 12th publishes a 
series of reports on the system of nursing and administration 
of provincial workhouses and infirmaries. It is the same 
tale everywhere of an insufficient supply of nurses—such as 
there are not even being properly trained—and of a scan- 
dalous want of all the decencies and ordinary requirements 
of hospitals for the sick. The latest workhouse examined is 
that at Bath. Here the deficiencies are such that for fifteen 
months the medical officer in charge has made expostulations 
without effect. The infirmary is licensed for 230 beds, and 
is always full. But there is not even a supply of hot water; 
and for the sixteen wards only one certificated day nurse, and 
not one (certificated or not) at night has been provided. It 
seems to be thought that a few pauper wards women by day 
can do all that is wanted for patients suffering from pneu- 
monia, phthisis, cancer, or heart disease. We need not go 
into the medical details, but some things recorded ought not 
for a moment to be tolerated by common humanity. What 
have the Bath authorities to say in reply ? The Collective Investigation Record. 
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