Part 18

Unlimited hot and cold water supply, day and night, should be laid on all over the buildings.

All drains and sewers must be kept outside the walls of the buildings, and great care should be bestowed on trapping and ventilating them, to prevent foul air passing into the institution.

The washing in a lying-in institution is, it need not be said, very large, and should be conducted quite at a distance. Sink-baths, for immediately putting in water soiled linen, are necessary.

12. Medical Officer’s Room and Waiting-room.

No dispensary, especially no dispenser, is needed in a lying-in institution.

A medical officer’s room is necessary. The medical officer is not resident. He makes his morning and evening visit, and is called in by the head midwife for any difficult case. He gives instruction, scientific and practical, to the pupil midwives. [These lectures are given in the pupil midwives’ mess-room.]

In the medical officer’s room should be kept the instruments, to which a fully qualified head midwife also has a key. The medical officer keeps the notes of cases, &c., and of instruction to the pupil midwives in this room.

The few, very few, drugs needed in a good lying-in institution are kept here, or in the head midwife’s sitting-room.

A waiting-room is necessary.

There must be a room where the head midwife can examine a woman, to know if labour is imminent.

This might be done in the medical officer’s room or the waiting-room.

13. Segregation Ward.

A ward is unfortunately necessary, completely isolated, where a sick case, brought in with small-pox or erysipelas or the like, could be delivered and entirely separated from the others, or where a case of puerperal fever or peritonitis (though such ought never to arise after delivery in a properly constructed and managed institution) could be transferred. But if, unfortunately, puerperal fever should appear in the hospital, no new admissions should be allowed until the buildings have been thoroughly cleansed, lime-washed, and aired.

The segregation ward must have a nurse’s room, and a provision of sink, slop-sink, &c.

14. Kitchen.

The kitchen should be well placed, conveniently near, yet sufficiently cut off from the main corridor by a neck of passage and intermediate offices.

SITE.

The site of a lying-in institution must be open, airy, surrounded with its own grounds, not adjoining or near to any other building, still less to any hospital or any nuisance or source of miasm. But it must be in the immediate vicinity of any large centre of population from which the lying-in women come.

And this involves the question of receiving-rooms.

Should there be a receiving-room, as well as a waiting-room?

The lying-in woman’s name is put down for admission some time beforehand.

Lying-in hospitals differ as to their rules whether or no to admit women any time before labour is imminent. If they are not so admitted, they often have to be sent back again home.

It is now believed to be the soundest principle that the fewer days a lying-in woman spends in a lying-in institution, beyond the time she is actually under treatment, the better; and this involves that she should not be admitted till labour is imminent—even at the risk of the infant being born in cab or lift (which has happened).

Lying-in institutions must (unfortunately) be, therefore, in the immediate neighbourhood of great towns or centres of population.

The difference, however, as has been shown by our statistics, is not so great between the mortality of women lying-in at home in the country and in the town as should make us pronounce against lying-in institutions in great centres of population—provided they have a large and entirely isolated area completely to themselves, perhaps a proportion of two acres to fifty beds.

But this involves another question.

A large proportion, alas! of workhouse lying-in women (we have seen two-thirds at Liverpool) are unmarried. Of these many have no home.

It is difficult to send these women back again, even if labour is not actually imminent. And it is impossible to send them out after delivery, till recovery is fairly confirmed.