APPENDIX VIII. ASSOCIATION FOR TRAINED NURSING IN WORKHOUSE INFIRMARIES President. H.R.H. PRINCESS MARY ADELAIDE, DUCHESS OF TECK. General Committee. Dr. ACLAND. Lady CAMILLA FORTESCUE. Mrs. HENRY GRENFELL. PROMOTING S. BENTON, Esq. Hon. Mrs. VAUGHAN JOHNSON. Mrs. FREDERICK PAGET. Lady MAUDE Seymour. Rev. Canon SPENCE, Vicar of St. Lady SARAH SPENCER. Dowager Lady STANLEY of ALDER LEY. Working Committee. Lady JANE TAYLOR. Dr. E. SYMES THOMPSON. Rev. W. T. THORNHILL Webber. Hon. Mrs. HARDCASTLE. THIAN. Miss PALMER. Lady HENRY SCOTT. Hon. Sec. Miss LOUISA TWINING, 20, Queen Square, W.C. IN proposing to form a plan for promoting trained nursing in workhouse infirmaries and asylums, we wish it to be distinctly understood that we are endeavouring to assist a movement which has already begun, and has P made considerable progress in the right direction, at least as far as the sick asylums and separated infirmaries are concerned. These institutions, which during the last ten years have been set apart for the sick poor, are treated and considered as hospitals, and the Central Board has the power of enforcing the rule that paupers, or unpaid women, should not be employed, at least in the capacity of nursing the inmates. So far, we thankfully acknowledge the great step in advance that has been taken; and it is hardly surprising that more has not been done, when we consider it is only recently that the reform of nursing in hospitals has claimed the attention which it deserves. It may be well, however, to state-1. Those points which we consider still require improvement, and then2. How we propose to act in our endeavours to amend them. I. No one will deny that there is a considerable difficulty in procuring a sufficient supply of good nurses for all institutions, and also that workhouses, until quite recently, offered less attraction and interest to trained women than hospitals. The rule for their employment at present is, that a year of service in some institution established for the care of the sick, is required before their admission into poor law asylums and infirmaries. But this may mean merely a training in some workhouse where the sick are not separated, and there is no skilled or trained person to teach them. This, probably, all will admit, is a mode of training which is capable of improve ment. Many of these institutions, now separated from the workhouses, so-called, are managed on a plan which leaves little to be desired, with efficient superintendents, and enlightened managers; and with these two elements of improvement, we may be content to leave them in their hands. There are at present three sick asylums (which only differ from the infirmaries by consisting of several unions which send their sick poor to one building), the whole number, including sick asylums and separated infirmaries, being twenty. Four metropolitan unions are still without a separate place for the sick, who are in the workhouse with the rest of the inmates, and in great measure nursed by pauper women. Then there are also several unions where the provision made for the sick does not suffice for the whole number of bedridden and incurable persons, a portion of whom are consequently still in the wards of the workhouses. Is there not room, therefore, for improvement here amongst this large number of suffering, aged, or bedridden patients, as well as in the infirmaries for the sick? So much has been written and said during the last twenty years concerning pauper nurses, that it cannot be necessary to repeat it; we would only say that all which has ever been expressed about them is now true with tenfold force; for the able-bodied population of workhouses consists mainly of those who enter through infirmity or loss of character, and in neither case ought such to be employed in offices of trust, either in the care of adults or children, where their influence must be injurious. So far we have been speaking of the metropolitan district only, but we do not intend to confine our observations to this region alone. We can tell of many country and town workhouses which require still more urgently improvements and assistance; and that we may not be thought to exaggerate the evils which yet remain, we will state the case of a workhouse in a distant and populous town. The infirmary consists of 20 wards, and contains about 150 sick and infirm inmates. There is one matron over the whole workhouse, which holds about 400 inmates. Under her are two paid nurses, both previously untrained ; under these are pauper women, of more or less bad character, and many of whom cannot read or write. The men are nursed by pauper men, and there is no paid supervision at night. Yet all the incurables from the excellent town or county hospital are sent there to end their days, or linger out years of suffering, contrasting the present with the past; for there are no asylums or homes for incurables within reach. When the Workhouse Visiting Society issued its "Plea for Destitute Incurables" in 1861, it was stated that there were 80,000 such persons in the workhouses of England and Wales. It is well known that the worst cases cannot get the help they so urgently require, unless they bribe the pauper women. We are sometimes told that such things are now of the past, and no longer exist; but this statement applies to the present time, and it is true in many other instances also. Can we say, then, that there is no room for help and improvement, or for the suggestion of some other means of providing fit and proper nurses for the sick in our great public institutions all over the country? This brings us to the second point, viz. as to the help which we would offer or suggest. 2. As to the means already existing for training women The two institutions which have chiefly done as nurses. this work are the Nightingale Fund at St. Thomas's Hospital, and St. John's House at King's College Hospital, but other hospitals now admit women for training.* Both those institutions have supplied nurses for workhouse infirmaries, and are willing to do so again. The first improvement that took place in workhouse nursing was at Liverpool, when, in 1865, Agnes Jones (who was trained at the Nightingale Fund School, St. Thomas's Hospital) was engaged by the Vestry of Liverpool to introduce trained nursing into the infirmary attached to their immense workhouse. Commencing with a staff of twelve trained nurses (also from the same school), and with the charge of a section only of the wards, she had succeeded by the year 1868, when she died, in establishing trained nursing throughout the infirmary, containing upwards of 1200 patients, and in initiating a training school. The organization thus begun-a most noble work—has since been continued by the vestry upon the same basis of trained nurses under a trained superintendent. The Council of the Nightingale Fund had also the gratification (for such we think it must have been to all who are interested in the cause) of supplying the entire staff for the new infirmary at Highgate, occupied by several of the London unions in 1870, and it was hoped that a permanent nursing school would have been established there for the supply of workhouse infirmary nurses. This admirable arrangement was carried out with entire *The sick at Hampstead Workhouse Infirmary are nursed by the British Nursing Association, Cambridge Place, Paddington, which trains at the Royal Free Hospital, Gray's Inn Road. |