Part 26

Footnote 13:

1 puerperal convulsions, 1 bowel disease.

Footnote 14:

1 after instrumental labour, 1 metritis.

Footnote 15:

1 heart disease, 1 dropsy.

Footnote 16:

The approximate number of deliveries, 6396, given elsewhere, is rather under the mark than over, as will be seen by this Table, and is taken in order to be on the safe side. For, up to the three last years, the numbers are rather estimated than reckoned from the records. The total annual average deliveries calculated from different monthly records, i. e. 10 years of months = 500 in round numbers—1858–1867.

The three years 1868–9–70, for which only there are accurate records, speak for themselves; and they show that the death-rate is marvellously low: not higher than in the healthy districts of England.

Footnote 17:

An attempt has been made in certain cases to account for the high death-rates of lying-in hospitals from the large proportion of unmarried women admitted. This opinion is directly contradicted by the experience of Liverpool workhouse, where out of 1,401 deliveries of women, 936 of whom, or two-thirds, were unmarried, there were only 6 deaths = 4·2 per 1,000 death-rate.

Footnote 18:

In Lambeth and St. Pancras the wards are generally full.

Footnote 19:

These arrangements are commonly the same in civil lying-in institutions.

Footnote 20:

I call a midwife a woman who has received such a training, scientific and practical, as that she can undertake all cases of parturition, normal and abnormal, subject only to consultations, like any other accoucheur. Such a training could not be given in less than two years.

I call a midwifery nurse a woman who has received such a training as will enable her to undertake all normal cases of parturition, and to know when the case is of that abnormal character that she must call in an accoucheur.

No training of six months could enable a woman to be more than a midwifery nurse.

Footnote 21:

In some London workhouses it is yet larger.

Footnote 22:

The only difficulty is as to protecting the patient (a lying-in woman) during the transit in cold or wet weather; but perhaps some cover might be contrived for the bed or litter on which she is carried, which would be light, easily removable, and which could be exposed to the free action of the open air when not in use.

Footnote 23:

For a great part of the foregoing details of management I am indebted to the valuable experience of her, who, as then Superior of the nursing at King’s College Hospital, conducted our Training School for Midwifery Nurses there, so kindly, so wisely, and so well, that its necessary breaking up was the more to be deplored by all.

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MEDICAL and SURGICAL WORKS.

NOTES on HOSPITALS. By FLORENCE NIGHTINGALE. Third Edition, enlarged, and for the most part re-written. Post 4to. with 13 Plans, 18s.