Part 19

In workhouses the question is solved by women being admitted into the body of the house during pregnancy, and discharged into the body of the house, if not to their own homes, when quite convalescent.

In Liverpool Workhouse fourteen days after labour the lying-in women are thus discharged. Fourteen, eighteen, twenty-one days, are the average of a woman’s stay in the lying-in division in London workhouses.

A soldiers’ wives’ hospital takes in no unmarried women to lie-in.

Civil lying-in institutions almost invariably have to make exceptions and take in unmarried women.

In workhouses they are not the exception, they are the rule. Married women are the exception.

It is to be observed that married women will rarely come in an hour before, or stay an hour after it is necessary, in any lying-in institution.

Ten to twelve days is ‘the average period of hospital treatment’ in Colchester, Woolwich, and other soldiers’ wives’ lying-in hospitals. ‘Women of this station of life cannot, as a rule, be prevailed upon to submit to longer detention,’ it is added.

The average number of days in King’s College Hospital lying-in ward was sixteen. None were permitted to leave under fourteen days. Twenty-one days were allowed, in ordinary cases. It is feared this might be too long; but so very many weakly, half-starved women sought admission, that to send some away sooner was ‘to ensure a breakdown,’ it is stated.

In a civil lying-in institution it would not be by any means desirable absolutely to exclude single young women primiparæ; it would be grievous to some of these poor things to be sent among the (often hardened) wretched women of the workhouse. The whole question of these poor young women—unmarried mothers of a first child—is full of difficulty. It would never do, morally, to make special provision for them. And for this very reason we seem bound to receive such, conditionally, into well regulated lying-in institutions, and afford some kindly care to prevent, at the very least, their sinking lower. But it would not be right to leave any admissions for single women in the hands of any young assistant, or morally inexperienced person.

The principle appears to be that, if pregnant women are to be received some time before and kept some time after delivery, the excess of time should not be passed in the lying-in wards, but in separate accommodation.

II. MANAGEMENT.

Construction, however, in a lying-in institution, holds only the second place to good management in determining whether the lying-in patients shall live or die. And without such management, no construction, however perfect, will avail.

And the first elementary principle of good management is to have always one pavilion of four or eight beds, according as it is of one floor or of two, standing empty in rotation for purposes of thorough cleansing. A fortiori—one delivery pavilion on each floor is always to be vacant alternately.

The pavilion to be in rotation unoccupied for the purposes of cleansing must necessarily be the whole pavilion, with all its sculleries and ward offices, since the process of cleansing is—turning out all the little furniture a lying-in ward ought ever to possess, bringing in lime-washers, possibly scrapers and painters, leaving doors and windows open all day, and even all night.

Every reason for having each ordinary pavilion ward completely separate, and individually pavilionised, applies with tenfold force to the delivery ward. Each must be complete in itself, with all its appurtenances and bye-ward for extreme cases, as a little pavilion. There is no possibility for properly cleansing and lime-washing the delivery ward not in use, unless this be the case.

One delivery ward, however spacious and well arranged constantly used, would be a centre of deplorable mischief for the whole institution. This makes two delivery wards for each floor of the institution indispensable, to be used alternately for the whole floor at given periods.

N.B. Liverpool Workhouse with 25 lying-in beds, exclusive of delivery beds, has had an average of 500 deliveries a year for eleven years. A civil lying-in hospital in or near a large town is generally just as full as it is permitted to be. Five or six hundred deliveries or more a year might be reckoned upon; occasionally three or four deliveries a night. Sculleries will be always in use, day and night. All this renders it imperative that an inexorable rule should be made and kept to, viz. that every lying-in pavilion should be vacant in rotation, each delivery pavilion alternately, for thorough cleansing.

2. The second elementary principle of good management is to remove every case of illness arising in the institution, and every such case admitted into the institution, at once to an isolated sick ward or infirmary ward.

This is must, not may.

Though we should have no puerperal fever or peritonitis in a building of this make, yet unfortunately other institutions will send in (say) erysipelas or small-pox patients seized with labour.

Sad experience tells that this unprincipled practice has often proved fatal to many other inmates of the lying-in institution, turning an institution into a hospital.

Every sick case should therefore be completely isolated, in a separate sick ward, from the lying-in women. And if admitted before delivery, her delivery should take place in this separate ward.

N.B. The nurse’s dinner and meals may be prepared in the general kitchen and sent to her. The patient’s arrowroot, gruel, &c., must be made, and her beef-tea warmed, in the ‘sick or segregation’ building, and all linen must be sent to the ward well aired.

Is it desirable to connect the ‘segregation’ ward by any covered passage with the rest of the lying-in institution?

There is much to be said for and against.

The ward, it is to be hoped, will not often have to be used at all.

But small-pox has appeared after labour.

There might be danger in taking a patient from the institution to this ward through the open air, in all weathers, unprotected by any covered passage.