Part 22

The whole of the pupil midwives’ quarters should have direct and ready means of communication with the hospital proper. Each relief should be independent of the other two, and under the immediate supervision of the official woman, whose quarters are attached to its own.

It need scarcely be stated that an essential part of a Pupil Midwife’s training is to attend lying-in women at their own homes, with the conveniences or rather the inconveniences of those homes. Otherwise the Pupil will be the less fit for her after-work. The last two months of every six might well be given to this. But, as above said, these ‘Notes’ about management, for they are nothing more, simply treat of it as regards construction, and do not refer to the necessary training, either in-door or outdoor, at all.

DESCRIPTION OF SKETCH-PLANS OF PROPOSED INSTITUTION.

I know of no single building which requires more ingenuity to plan, and has hitherto received less, than a lying-in institution, especially with a training school for midwives attached.

Lieut. Ommanney, R.E., has been kind enough to give his time and mind to the subject—having previously had considerable experience at the War Office in planning female hospitals—and to embody the whole of the working accommodation required for both lying-in institution and school in the thoughtfully arranged sketch-plans, Nos. III., IV., and V.

The estimated cost of these plans is large; but if we must have lying-in institutions at all, it is only ‘penny wise and pound foolish’ to cripple either space or necessary appliances, or the means of regularly and periodically vacating every ward and every ward-office destined for the use of lying-in women.

PLAN III

SCALE ¹⁄₁₂₀

M & N HANHART, LITH.

W. F. OMMANNEY, L^T. R. E. ]

PLAN IV

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M & N HANHART, LITH.

W. F. OMMANNEY L^T. R. E. ]

PLAN III.

This plan shows a lying-in ward unit for the institution, together with its scullery and separate offices, and the relation which these bear to the corridor of communication joining all parts of the hospital on each floor together.

The measurements and other details shown on this plan are the result of repeated and careful consideration of the requirements already described; and it is believed that in practice they would be found sufficient for every purpose.

The four beds shown on it are not the minimum, but the maximum number which, judging from all past experience, could be safely placed together.

PLAN IV.

Shows a floor of one of the lying-in ward pavilions, divided into four separate one-bed rooms. This plan also represents a unit, but of another construction. The great advantage of the arrangement is complete separation of cases from each other, so that each room is as far as possible assimilated to a room in a private dwelling-house. To obtain this advantage the rooms are arranged in pairs on each side of a nine-feet passage, having a window at one end and a corridor-window opposite the other end.

Two of the rooms open from the corridor, and two rooms from the passage, but the doors are not opposite each other. In this, as in the four-bed ward plan, the scullery and offices are completely isolated from the rooms by a nine-feet corridor. In this case, also, the measurements and other details have been arrived at after full consideration. This plan would be somewhat more costly than the previous one (Plan III.). The justification of it is found in the fact that it reproduces, in a permanent form, the conditions in Colchester Lying-in Hut, already described. And in this hut there has, as yet, been no death after delivery.

PLAN V.

A lying-in institution for forty beds (thirty-two to thirty-six occupied), with a training school for thirty pupil midwives and midwifery nurses.

This plan gives a sketch of an arrangement of pavilions, offices, quarters, &c., forming a complete lying-in institution and training school. As already stated, such an institution must, from its very objects, be situated in a town where land is scarce and valuable, and this is a chief difficulty in erecting it. Hence it has been necessary to keep the different parts as close together as possible, and yet not to crowd them so as to interfere injuriously with the external ventilation. The mere architecture, as will be seen, has been subordinated to this necessity, but it must be borne in mind that utility, and not architectural effect, is to be sought for.

In the centre of the plan project the quarters for pupils, on three floors, ten quarters on each floor. They are arranged in this way to enable the reliefs to be taken from one floor at a time. Behind these, in the same block, are quarters for matron and midwives, waiting-room, surgery, stores, kitchen, and pupils’ dining-room. The general entrance is in one side of the centre block. The two front pavilions, on either side the centre, contain the delivery wards, two on each floor. Each delivery pavilion contains a ward for three beds on each floor, with its bye-ward and offices. Only one delivery pavilion will be in use at one time. While one pavilion is in use, the other will be vacant, and undergoing ventilation and cleansing. These delivery wards are connected with the centre, and with all the pavilions on each floor by a nine-feet corridor, with crosslight and ventilation. Fire-places are shown for warming in winter. On the ground floor are three four-bed wards, with offices, on each side, on the construction shown on Plan III. There will thus be twenty-four lying-in beds, and six delivery beds (but three delivery beds and 20 lying-in beds only in use at the same time) on the ground floor. The second pavilion from the front, on each side, is only one storey in height, so as to afford a freer circulation of air among the pavilions in the space within which it might be necessary to place them.

As a consequence of this arrangement there would be only four lying-in wards, of four beds each, on the upper floor, together with a delivery ward at each side (one delivery ward to be used at a time).

A special detached ward for febrile cases is shown behind the building.

The total accommodation in an establishment of this size would be sufficient for 6 simultaneous deliveries and 32 to 36 lying-in women. There would be 6 delivery beds always resting, and 4 or 8 lying-in beds always unoccupied. There would be training accommodation and facilities for 30 pupils.