and generally to report as to the cause of the mortality, and the means most likely to arrest its further progress, I proceeded to Lurgan upon the morning of the 10th February, and upon the following morning met at the workhouse Lord Lurgan and two or three other members of the Board of Guardians.
With reference to the first and second subjects of investigation mentioned above, I subjoin a Table, which shows the names and ages of the 95 patients who died within the week ending February 6, 1847, the duration of their stay in the house previous to their death, their state upon admission, and the nature of the disease of which they died; from which it appears that:
| 9. were above 60. |
| 9. were between 40 and 60. |
| 2. were between 15 and 20. |
| 8. were between 10 and 15. |
| 12. were between 20 and 40. |
| 17. were between 5 and 10. |
| 38. were between a few days and 5. |
Of these 95, 52 were healthy at the time of their admission into the workhouse; 8 had dysentery; 19 were stated by the physican to have been labouring under bowel complaints, accompanying denitition; 10 had fever; 2 were in consumption; 1 paralytic; 1 bronchitis; 1 anasarca and diarrhœa, and 1 caries of the spine.
Of the 52 who were healthy at their time of their being admitted into the house, 27 died of dysentery, 8 of diarrhea accompanying measles; 14 of diarrhea accompanying dentition, 1 of cerebral disease (nature not stated), and 2 of fevers. The duration of their stay in the workhouse previous to the commencement of their illness, and also the duration of the disease of which they died, are given as follows:
| No. | Period in the House before Illness. | Duration of the Illness. | No. | Period in the House before Illness. | Duration of the Illness. |
| 1 | 13 Days | 13 Days | 27 | 7 Days | 13 Days |
| 2 | 7 Weeks (nearly) | 23 Days | 28 | 11 Days | 16 Days |
| 3 | 11 Months (nearly) | 7 Days | 29 | 26 Days | 22 Days |
| 4 | 7 Weeks (nearly) | 11 Days | 30 | 29 Days | 19 Days |
| 5 | 5 Weeks | 15 Days | 31 | 5 Weeks (nearly) | 1 Month |
| 6 | 7 Months | 19 Days | 32 | 2 Days | 23 Days |
| 7 | 5 Months | 1 Month | 33 | 1 Week | 14 Days |
| 8 | 14 Days | 1 Month | 34 | 1 Months | 20 Days |
| 9 | 8½ Months (nearly) | 27 Days | 35 | 5 Weeks | 10 Days |
| 10 | 3 Weeks (nearly) | 8 Days | 36 | 9 Weeks (nearly) | 23 Days |
| 11 | 2½ Years | 12 Days | 37 | 4 Months | 16 Days |
| 12 | 12½ Months | 14 Days | 38 | 4½ Months | 3 Days |
| 13 | 6 Days | 12 Days | 39 | 8 Days | 21 Days |
| 14 | 7 Weeks | 14 Days | 40 | 9 Weeks (nearly) | 16 Days |
| 15 | 7 Weeks (nearly) | 13 Days | 41 | 12 Months | 17 Days |
| 16 | 3 Weeks | 9 Days | 42 | 5 Weeks | 20 Days |
| 17 | 8½ Months (nearly) | 14 Days | 43 | 6 Weeks | 18 Days |
| 18 | 7 Weeks | 21 Days | 44 | 1 Month | 24 Days |
| 19 | 17 Days | 9 Days | 45 | 1 Month (nearly) | 25 Days |
| 20 | 3 Weeks | 17 Days | 46 | 2 Years (nearly) | 19 Days |
| 21 | 3 Weeks | 14 Days | 47 | 7 Days | 19 Days |
| 22 | 1 Week | 16 Days | 48 | 3 Months | 22 Days |
| 23 | 1 Week | 16 Days | 49 | 2½ Months | 19 Days |
| 24 | 1 Month | 19 Days | 50 | 2½ Months | 21 Days |
| 25 | 8 Days | 3 Days | 51 | 6 Weeks (nearly) | 11 Days |
| 26 | 13 Days | 10 Days | 52 | 10 Months (nearly) | 22 Days |
With respect to the remaining 43 who were ill at the time of their admission into the workhouse, the following Table gives the period which elapsed between the date of their admission and the time of their death:
| No. | Period from Date of Admission to Date of Death. | No. | Period from Date of Admission to Date of Death. |
| 1 | 3 Days | 23 | 27 Days |
| 2 | 29 Days | 24 | 6 Days |
| 3 | 11 Days | 25 | 8 Days |
| 4 | 11 Days | 26 | 2 Days |
| 5 | 11 Days | 27 | 23 Days |
| 6 | 10 days | 28 | 15 Days |
| 7 | 27 Days | 29 | 6 Weeks |
| 8 | 25 Days | 30 | 6 Weeks |
| 9 | 25 Days | 31 | 3 Months |
| 10 | 25 Days | 32 | 8 Weeks |
| 11 | 13 Days | 33 | 15 Days |
| 12 | 5 Weeks | 34 | 2 Days |
| 13 | 10 Days | 35 | 19 Days |
| 14 | 11 Days | 36 | 24 Days |
| 15 | 19 Days | 37 | 6 Days |
| 16 | 8 Days | 38 | 36 Days |
| 17 | 13 Days | 39 | 7 Weeks |
| 18 | 11 Days | 40 | 22 Days |
| 19 | 13 Days | 41 | 1 Day |
| 20 | 20 Days | 42 | 2 Days |
| 21 | 17 Days | 43 | 14 Days |
| 22 | 5 Weeks | | |
NUMBER of Cubic Feet allowed to each Inmate in the Sick and Healthy Wards. The following Statement, of course, has reference to the condition of the Wards, as regards the Number of Occupants in each of them, at the time of my visit :-
The Fever Hospital contains four wards and 56 beds.
No. 1 contains 14 beds, in which there were 16 people, 331 cubic feet to each.
No. 2 contains 13 beds, in which there were 21 people, eight adults and 13 children, 252 cubic feet to each.
No. 3 contains 15 beds, in which there were 16 people, 306 cubic feet to each.
No. 4 contains 14 beds, in which there were 14 people, 250 cubic feet to each.
Infirmary
What was once the Idiot department is now filled with patients suffering under fever and dysentery; the former occupants, who do not, as I was informed, amount to a dozen, being placed in other parts of the institution. Ground-floor, female side of idiot department, No. 1, consists of three cells, opening into a front room; each cell contained three children in measles, 234 cubic feet to each. The front room contained four adults, 500 cubic feet to each.
No. 2, an inspector's room, a small dark apartment, now used as a day-room for convalescents patients.
No. 3 contained seven beds and 14 fever patients, nine adults and five children, 315 cubic feet to each.
First-floor - Two wards, one containing nine patients, 157 cubic feet to each; the other, used as a convalescent fever ward, has 15 beds, but only six patients, 560 cubic feet to each bed.
Male Side. - No. 1, 12 beds; 26 patients in dysentery, principally children, 178½ cubic feet to each; seven of the beds contain three patients each.
Nos. 2 & 4, Day Rooms. - No. 3, 12 beds, 28 patients, dysentery, 160 cubic feet to each.
The Convalescent Ward upon this side contained only three patients.
Of two wards upstairs, one was occupied by a wardmaster; the other contained 11 beds and 19 patients, 235 cubic feet to each.
Female Side of Infirmary
No. 1, 13 patients, 156 cubic feet to each.
No. 2, 11 beds and 28 patients, 80 cubic feet to each. One bed has four patients in it.
No. 3, 14 beds, 27 patients, 76 cubic feet to each; six adults and 21 children.
Aged Female Ward - No. 1, 13 patients, 193 cubic feet to each; dysentery.
Aged Female Ward - No. 2, 28 patients, 180 cubic feet to each, dysentery.
Aged Male Ward - No. 1, used as a day-room.
Aged Male Ward - No. 2, 28 patients, 180 cubic feet to each; dysentery.
Aged Male Ward - No. 3, 9 patients, 516 cubic feet to each; dysentery.
Aged Male Dormitory - No. 1, 23 people, 301 cubic feet to each.
Aged Male Dormitory - No. 2, now used as a store room for beds.
Boys Dormitory - Thirteen inmates, 441 cubic feet to each.
School Boys Dormitory - No. 1, 16 beds, 32 inmates, 207 cubic feet to each.
School Boys Dormitory - No. 2, 11 beds, 22 inmates, 301 cubic feet to each.
2 dormitories for female children, containing 17 beds, and 34 inmates; 195 cubic feet to each.
A Female Sleeping Ward, 12 beds, 24 inmates, 193 cubic feet to each.
A Female Sleeping Ward, 19 inmates, 140 cubic feet to each.
A Fever Shed for Females, 17 patients, 354 cubic feet to each.
A Fever Shed for Males, 14 beds, 31 patients, 22 children and nine adults, 190 cubic feet.
With respect to the sick wards, as regards their ventilation and cleanliness, and the comfort of the patients, I regret to be obliged to report unfavourably. There are four wards in the Idiot department that are without any flooring but the earth, and in two of them there are no bed steads, so the beds lie upon the damp ground. One of them (in which at the time of my visit two wretched creatures were dying) was in an exceedingly foul condition; in one corner a pile of old filthy clothes, shoes, &c.; in another a large heap of straw; in another place a quantity of coals scattered about; the ventilation very imperfect. It presented altogether a picture of neglect and discomfort, such as I have never seen in any other charitable institution. Generally speaking, the floors and walls of the ward in the infirmary were in a discreditable condition; the windows were almost universally closed, the atmosphere close and foul, and the smell upon entering the rooms most offensive.
A long period has elapsed since some of the wards were whitewashed; I was told that it could not be done while there were patients in them, also that no person could be got to do it, from fear of infection. The inmates of one of the wards, the walls of which were particularly dirty, applied to me to have the whitewashers sent in.
In some of the dysenteric wards, I observed that the chamber utensils, when used, were not at once taken away and emptied. In one ward especially, a large uncovered bucket, nearly half filled with aloine discharges, was allowed to remain for hours; and I found that this was the case upon each day that I visited the ward. When I spoke of it, I was told that there had been no wardmaster for several days. One of the patients, who was able to be up, but was lame, complained that he was obliged to stay in bed day after day, because there was no person to bring him crutches. I observed in other wards also a want of attendants to look after the comfort of the patients, and the cleanliness and ventilation of the wards.
In another part of the infirmary I found, lying upon the lobby into which several wards opened, the bodies of two females, who had been eight hours dead.
There was a great want of night-chairs in most of the sick wards, and I do not recollect seeing in any of them a table or anything upon which to place the medicines or drink for the patients; in many of them the floor served the purpose, and in such especially the boards were in a filthy state. I was told there were no presses in which to keep the clothes of the patients.
The physician informed me that the sick had frequently to lie upon damp beds and damp straw, there being no drying-room. While I was there, a large quantity of fresh straw was brought into one of the yards, and left upon the wet ground, although close beside there was a shed under which it might have been placed. In this yard I also found a number of beds upon the ground, saturated with wet.
The fever sheds, which contained 48 patients in 31 beds, are without floor; the ground was very damp; there is but little ventilation in them; in one, many of the windows open into another ward, itself badly ventilated. They were both very dirty, and most uncomfortable in appearance.
A reference to the statement, with regard to the number of cubic feet allowed for each person, will show the greatly over-crowded state of the establishment.
With respect to diet and drink, the dysenteric patients for a long time used stirabout, but this has now been given up, and tea diet given to the adults, and milk to the children; but milk in any form does not appear to agree. For drink they are allowed toast-water and rice-water, with sugar and lemon peel; the fever patients also use lemonade. Buttermilk is given to the healthy inmates.
As regards the medical treatment of the patients, there is, as far as I am capable of judging, nothing to be desired.
It has been the custom, until very lately, to bury the dead in the immediate proximity of the Fever Hospital; many of the recent graves are scarcely four yards from the building. In the centre of this burial ground is the well from which the hospital is supplied with water; the graves were dug so close to it, that the water became muddy and unfit for use. This being represented by the physician to the Board of Guardians, at last led to the discontinuance of the practice, to which I now only allude in order to prevent its being resumed.
The physician informed me that in consequence of the crowding of the house, the supply of clothes was quite inadequate, and that it had hence become necessary to use the linen of some of those who had died of fever and dysentery, without time having been afforded to have it washed and dried; and that from the same cause, damp beds had in many instances been made use of.
From the foregoing statement, which I have endeavoured to make as accurate as possible, it is not difficult to deduce the causes of the mortality which has lately devastated the Lurgan Workhouse, and which still continues.
I am willing to admit the influence of external causes, but these at present operate more or less throughout the whole country, and I am not aware that the Lurgan district is more distressed than many others in which the mortality is nearly so great. I am of opinion that the chief causes of the evil in question are internal, and the result of defective management of the institution.
The misfortune seems to date from the death of the late master, who appears to have been a most efficient officer. Four or five weeks were suffered to elapse before his successor was appointed, and during this period the house became greatly overcrowded., about 200 having been admitted more than it was capable of safely accommodating; disease then broke out in an epidemic form, but the admissions continued to take place up to the end of January, so that there was very inadequate accommodation either for the healthy or for the sick.
The infirmary having thus become crowded to such an extent as to render it necessary to put in many instances there, and in some cases four patients into one bed, appears to have fallen into confusion; and ventilation, whitewashing, and cleanliness to have been neglected, at the very time when the strictest attention to these important means of arresting the spreading of disease were most imperatively called for.
There serious omissions are to a certain extent, no doubt, attributable to the want of subordinate officers, the matron and some of the wardmasters and their assistants being ill; but although I am free to acknowledge that from this cause the physician had considerable difficulties to contend with, yet I cannot help thinking that a little more activity upon his part, and a stricter surveillance upon that of the guardians, would in some measure, at all events, have prevented the mortality which has occurred.
It appeared to me (but in this idea I may perhaps be mistaken) that the guardians had no knowledge of the state of the infirmary as regards cleanliness, ventilation, &c., either from personal observation or otherwise. The reports of the physicians informed them of its overcrowded state, and this was on the particular about it which they seem to be acquainted.
I have already mentioned numerous other circumstances which are calculated to produce disease, and which show that the infirmary is not looked after by its various superintendents with that degree of care which is absolutely necessary to maintain in a wholesome condition, and that the comforts of the patients might be increased without a corresponding segmentation of expense; I need not, therefore, again allude to them further than to observe, that although some of them may be considered trifling, it should be remembered that if minor matters be neglected in a hospital, the more important ones cannot be in a sound condition; the perfection of the institution as a whole must depend upon the perfection of its details.
Having now pointed out what I conceived to have been the chief causes of the origin and continuance of the mortality at present prevailing in the Lurgan workhouse, it only remains to allude to the means most likely to succeed in checking its further progress, and I am sure that these will at once suggest themselves to the members of the Board of Health.
No admissions into the workhouse should take place until the tendency to fever and dysentery ceases, and until the rooms which may have been occupied by the sick have been properly fumigated and whitewashed.
The crowded state of the infirmary should be relieved by removing some of the patients into the workhouse, in which there are, at all events, even three rooms available.
The wards of the infirmary should all be whitewashed immediately; the floors secured and kept perfectly clean; proper persons should be appointed to see that the wards are ventilated as well as possible; they should, for this purpose, visit the wards repeatedly during the day. The ventilation of the wards should not be left (as is too much the case at present) in the power of or optional with the patients, who will be sure to keep the windows shut, and the ventilators obstructed.
The medical attendant should daily inspect the condition of the wards, as regards ventilation and cleanliness, and at once report to the Board of Guardians any neglect that he may observe in these respects.
One of the largest wards should be emptied as fast as possible by removing the patients into the workhouse, as far as the latter will accommodate them, and the remainder into such of the other wards in the infirmary as are least crowded. This ward should then be carefully fumigated and whitewashed, and the woodwork either painted or well scoured. It should then be supplied with fresh and dry beds and bedding. The bedsteads also should be scoured. The patients of another ward can thus be removed into it, and the second ward, thus vacated, should undergo the same process. By carrying on this system, there will always be a fresh and pure ward available.
The ventilators of many of the wards require to be improved; I would recommend inserting into one or more of the windows of such wards, in place of one of the panes, a piece of window-blind wirework of the finest description.
I am not aware of anything else to which I have to call the attention of the Board of Health, which has not been already attended to in the body of the Report; but I cannot terminate without alluding to a custom which prevails. I believe, in all the workhouses in Ireland, and which I think highly objectionable; I mean the practice of employing the paupers as nurses. They are unfit for the efficient discharge of the important duties which devolve upon them; nor have they any motive for showing kindness or attention to the sick under their charge. Regularly educated nurses should be employed and paid for their services; the patients would be better attended, and the wards kept in a more wholesome condition. The only creditable portion of the sick department of the Lurgan workhouse is the fever hospital; the beds are comfortable, the walls are clean, the floors white the wards well ventilated, and the sick well attended; and why is this? because there is a respectable, kind, and intelligent nurse at the head of it.
Robert William Smith M.D.
17th February 1847.
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