Part 16

One at least to each bed. Two beds and two windows on each side of the four-bed ward.

In a single-bed ward the bed should not be placed directly between window and door. And it must never be in an angle. There must be room for attendants on both sides the bed.

This is still more essential in a delivery ward. Each bed should be lighted on both sides by windows, and should have at least five feet of passage room on either side.

6. What are healthy Walls and Ceilings and Floors?

Oak floors, polished; furniture also; impervious glazed walls and ceilings, or frequent lime-washing.

All that has been so justly said as to the necessity of impervious polished floors and walls for hospitals applies tenfold to lying-in institutions, where the decomposition of dead organic matter, and the re-composition of new organic matter, must be constantly going on.

It is this, in fact, which makes lying-in institutions so dangerous to the inmates.

And it may literally be said that the danger increases as the square of the number of in cases.

Lying-in ‘infection’ is a very good illustration of what ‘infection’ really means, since parturition is not infectious or ‘contagious.’

The excessive susceptibility of lying-in women to poisonous emanations, the excessively poisonous emanations from lying-in women—these constitute a hospital influence on lying-in cases brought together in institutions, second to no influence we know of exercised by the most ‘infectious’ or ‘contagious’ disease.

The death-rate is not much higher among women lying-in at home in large towns than in healthy districts. Therefore the agglomeration of cases together and want of management required to meet it must bear the blame.

As to floors, the well-laid polished floor is a sine quâ non in a lying-in institution, where, with every care, slops, blood, and the like, must frequently be spilt on the floor.

7. What is a healthy and well-lighted Delivery Ward?

There must be two separate delivery wards for each floor of the whole lying-in institution, so arranged and connected under cover that the lying-in women may be removed after delivery to their own ward. And for this purpose the corridors must admit of being warmed during winter, especially at night, so as to be of a tolerably equable temperature.

Unlimited hot and cold water laid on, day and night, W.C. sink, bath-sink, clean linen, must be close at hand.

In a pavilion hospital one single-bed ward should be attached to each delivery ward, for an exhausted case after delivery, till she is able to be moved to her own ward.

The delivery ward should be so lighted and arranged that it can be divided, by curtains only, into three if not four compartments.

No woman being delivered should see another delivery going on at the same time.

The delivery bedsteads stand in their compartments.

Each delivery bed should have window light on either side, and also ample passage room all round and on both sides the bed.

Care should be taken that no bed should stand exactly between door and window, on account of draughts.

The curtains, of washing material, are only just high enough to exclude sight, not high enough to exclude light or air, and are made so as to pull entirely back when not wanted. Each area enclosed by the curtains should of course be sufficiently ample for pupils, attendants, and patient; also for a low truck on broad wheels covered with india-rubber, to be brought in, on which the bedstead with the clean warm bedclothes is placed, and the newly-delivered woman conveyed to her own ward.

The reason why there must be two delivery wards for each floor of a lying-in institution, to be used alternately, one ‘off,’ one ‘on,’ is that one delivery ward on each floor must be always vacant for thorough cleansing, lime-washing and rest for a given period, say month and month about.

It is understood that newly-delivered women cannot be removed from one floor to another. And it is quite necessary to have the means of keeping a corridor, along which a newly-delivered woman is to be moved, at a proper temperature.

The position of the delivery wards should be as nearly as possible equidistant from the lying-in wards, and should be such that the women in labour, on their way to the delivery ward, need not to pass the doors of other wards.

A separate scullery to each delivery ward is indispensable; such scullery to be on at least an equal scale to that of ward sculleries. Hot and cold water to be constantly at hand, night and day. A sink-bath is desirable for immediately putting in water soiled linen from the beds and the like.

The scullery should contain a linen-press, small range with oven, hot closet at side of the fire-place, sink with hot and cold water, &c. A small compartment should contain a slop-sink for emptying and cleansing bed-pans, and a sink about six inches deep and sunk below the floor, which is intended for filling and emptying a portable bath, and which when not required for this might be used for soaking linen, &c.

Beyond the scullery, so as to be as far removed as may be from the traffic of the main corridor and the noises of the delivery ward, should be the bye-ward, with not less than 2,100 cubic feet of contents.