Part 4

And in 27 London workhouse infirmaries (Table VI.), amongst which deaths took place, having 9,411 deliveries in five years, there were 93 deaths from all causes. The death-rate was 9·8 per 1,000.

TABLE VI.—Mortality after Childbirth in Five Years, up to the end of 1865, in Forty London Workhouse Infirmaries in which Deliveries took place. (Abstracted from Report on Metropolitan Workhouses.) ┌────────────────────┬─────────┬──────────┬─────────┬───────────┬──────┬──────┐ │ Deliveries │ Deaths│ Deaths │ Deaths │Deaths from│Deaths│Total │ │ │ from│ from │ from │Consumption│ from │Deaths│ │ │Puerperal│Accidents │Miasmatic│ and Chest │ all │ │ │ │ Diseases│ in │Diseases │ Diseases │Other │ │ │ │ │Childbirth│ │ │Causes│ │ ├────────────────────┼─────────┼──────────┼─────────┼───────────┼──────┼──────┤ │27 workhouses: 9,411│ 39│ 20│ 0│ 15│ 19│ 93│ │13 „ 2,459│ 0│ 0│ 0│ 0│ 0│ 0│ └────────────────────┴─────────┴──────────┴─────────┴───────────┴──────┴──────┘

The City of London Lying-in Institution, during ten years, 1859–1868, had 4,966 deliveries, and 54 deaths—a rate of 10·9 per 1,000.

The British Lying-in Institution had 1,741 deliveries, and 25 deaths, in 11 years, 1858–1868, giving a death-rate of 14·3 per 1,000 (Table VIII.).

The mortality in Queen Charlotte’s Lying-in Hospital: 9,626 deliveries, and 244 deaths, from 1828 to 1868 (Table VII.), was 25·3 per 1,000.

TABLE VII.—Mortality in Queen Charlotte’s Lying-in Hospital, 1828 to 1868. ┌──────────┬─────────┬──────────┬─────────┬───────────┬───────┬───────┐ │Deliveries│ Deaths │ Deaths │ Deaths │Deaths from│Deaths │ Total │ │ │ from │ from │ from │Consumption│ from │Deaths │ │ │Puerperal│Accidents │Miasmatic│ and Chest │ all │ │ │ │Diseases │ in │Diseases │ Diseases │ Other │ │ │ │ │Childbirth│ │ │Causes │ │ ├──────────┼─────────┼──────────┼─────────┼───────────┼───────┼───────┤ │ 9,626│ 138│ 51│ 8│ 32│ 15│ 244│ └──────────┴─────────┴──────────┴─────────┴───────────┴───────┴───────┘

The Rotunda Hospital, Dublin, with 6,521 deliveries in the years 1857–1861, yielded 169 deaths—a death-rate of 26 per 1,000. But, if we take the years 1828–1861, with 63,621 deliveries, we find that the deaths were 924, and the death-rate only 14·5 per 1,000—the average annual number of deliveries being almost as many thousands as in Queen Charlotte’s Hospital were hundreds.

TABLE VIII.—Mortality per Thousand from all Causes after Delivery. (Abstracted from Official Reports and Returns.) ┌───────────────────────────────────┬───────────┬─────────┬───────────┐ │ Places │ │ │ Deaths per│ │ │ │ │ Thousand│ │ │Deliveries │ Deaths │ Deliveries│ ├───────────────────────────────────┼───────────┼─────────┼───────────┤ │12 Parisian hospitals {1861 │ 7,309│ │ 95·1│ │ „ {1862 │ 7,027│ │ 69·7│ │ „ {1863 │ 7,289│ │ 70·3│ │King’s College Hospital, 1862–7 │ 780│ 26│ 33·3│ │Rotunda Hospital, Dublin, 1857–61 │ 6,521│ 169│ 26·0│ │Queen Charlotte’s Lying-in │ │ │ │ │ Hospital, 1828–68 │ 9,626│ 244│ 25·3│ │British Lying-in Institution, 11 │ │ │ │ │ years, 1858–68 │ 1,741│ 25│ 14·3│ │City of London Lying-in Hospital, │ │ │ │ │ 1859–68 │ 4,966│ 54│ 10·9│ │8 military lying-in hospitals, 2 to│ │ │ │ │ 12 years │ 5,575│ 50│ 8·8│ │Liverpool Workhouse Lying-in Wards,│ │ │ │ │ 13 years, 1858–70 │ 6,396│ 58│ 9·06│ │40 London workhouse infirmaries, 5 │ │ │ │ │ years │ 11,870│ 93│ 7·8│ │1 military lying-in hospital (a │ │ │ │ │ wooden hut) 1865–70 │ 252│ 0│ 0│ │All England, 1867 │ 768,349│ 3,933│ 5·1│ └───────────────────────────────────┴───────────┴─────────┴───────────┘

The lying-in wards of King’s College Hospital, years 1862–1867 (Table IX.), gave 27 deaths—a death-rate of 33·3 per 1,000 on 780 deliveries.

TABLE IX.—Mortality after Childbirth in Lying-in Ward, King’s College Hospital, 1862 to 1867. ┌──────────┬─────────┬──────────┬─────────┬───────────┬───────┬───────┐ │Deliveries│ Deaths │ Deaths │ Deaths │Deaths from│Deaths │ Total │ │ │ from │ from │ from │Consumption│ from │Deaths │ │ │Puerperal│Accidents │Miasmatic│ and Chest │ all │ │ │ │Diseases │ in │Diseases │ Diseases │ Other │ │ │ │ │Childbirth│ │ │Causes │ │ ├──────────┼─────────┼──────────┼─────────┼───────────┼───────┼───────┤ │ 781│ 23│ 1│ 0│ 1│ 2│ 27│ └──────────┴─────────┴──────────┴─────────┴───────────┴───────┴───────┘

Lamentable as are these death-rates in many British institutions, they are small in comparison with those which have ruled in many foreign hospitals.

Table X. contains an abstract from Dr. Le Fort’s work of the statistics of 58 lying-in institutions in nearly every country of Europe, and extending in many cases over a considerable number of years. There is only one hospital (at Bourg) in which there was no death in 4 years, out of 461 deliveries.

There is one hospital (at Troyes), with a death-rate of 4 per 1,000 on 460 deliveries in 4 years.

There are two instances of death-rates of 7 per 1,000. There is one of 9, and there are two of 10 per 1,000.

In every other case the death-rates have exceeded these amounts, rising higher and higher in different institutions, until they culminate in a death-rate of no less than 140 per 1,000, at Strasburg, on a four years’ average among 556 deliveries. Le Fort’s data show a striking variation in the death-rates of the same hospitals in different years, as will presently be seen to be the case in hospitals in this country. There are instances in these foreign hospitals of the death-rates varying from 4 to 7–fold in different groups of years in the same hospital.

Le Fort’s data show that in lying-in hospitals in various countries and climates, scattered over nearly the whole of Europe, out of 888,312 deliveries there were no fewer than 30,394 deaths, giving an average death-rate of 34 per 1,000, a rate exceeding the high mortality which led to the discontinuance of our school for training midwifery nurses in King’s College Hospital.

TABLE X.—Table Showing the Death-rate from all Causes amongst Women Delivered in Lying-in Hospitals. (Abstracted from Dr. Le Fort’s ‘Des Maternités.’) ┌────────────────────────────┬───────────┬──────────┬────────┬────────┐ │ Maternity Hospitals │ No. of │ │ │ Deaths │ │ │ Years of │ │ │ per │ │ │Observation│Deliveries│ Deaths │Thousand│ ├────────────────────────────┼───────────┼──────────┼────────┼────────┤ │Vienna │ │ │ │ │ │ Maternité │ 50│ 103,731│ 2,811│ 25│ │ „ Students’ │ │ │ │ │ │ Clinique │ 30│ 104,492│ 5,560│ 53│ │ „ Midwives „ │ 30│ 88,083│ 3,064│ 34│ │ „ Académie │ │ │ │ │ │ Joséphine │ 1│ 277│ 24│ 86│ │Prague Maternité │ 15│ 41,477│ 1,383│ 33│ │Munich „ │ 4│ 4,064│ 86│ 21│ │Göttingen „ │ 8│ 1,029│ 32│ 32│ │Gratz „ │ 3│ 3,089│ 97│ 31│ │Greifswald Clinique │ 4│ 316│ 18│ 56│ │Bremen Hospital │ 6│ 139│ 10│ 71│ │Halle Clinique │ 1│ 102│ 3│ 29│ │Berlin Clinique de │ │ │ │ │ │ l’Université │ 1│ 401│ 11│ 27│ │Frankfort-on-Main Maternité │ 7│ 1,213│ 13│ 10│ │Leipzig Ancienne „│ 46│ 5,137│ 89│ 17│ │ „ Nouvelle „│ 3│ 594│ 20│ 33│ │Pesth Clinique │ 5│ 2,571│ 86│ 33│ │Moscow Maternité de la │ │ │ │ │ │ Maison des Enfans Trouvés │ 11│ 11,556│ 230│ 19│ │Ditto │ 10│ 16,721│ 436│ 26│ │Ditto │ 10│ 27,759│ 776│ 28│ │St. Clinique de la │ │ │ │ │ │ Petersburg Faculté │ 6│ 376│ 34│ 90│ │ „ Hospital │ │ │ │ │ │ Kalinkin │ 15│ 1,288│ 20│ 15│ │ „ Institut des │ │ │ │ │ │ Sages │ │ │ │ │ │ „ Femmes │ 15│ 8,036│ 238│ 29│ │ „ Maternité des │ │ │ │ │ │ Enfans │ │ │ │ │ │ „ Trouvés │ 15│ 16,011│ 825│ 51│ │Dublin Maternité │ 58│ 84,390│ 875│ 10│ │Ditto │ 7│ 21,867│ 309│ 14│ │Ditto │ 5│ 12,885│ 198│ 15│ │Ditto │ 7│ 16,391│ 158│ 9│ │Ditto │ 7│ 13,167│ 224│ 17│ │Ditto │ 7│ 13,699│ 179│ 13│ │Ditto │ 7│ 13,748│ 163│ 11│ │London Lying-in Hospital │ 28│ 5,883│ 172│ 29│ │Edinburgh Hospital │ 1│ 277│ 3│ 10│ │Stuttgart „ │ 1│ 424│ 3│ 7│ │Zurich Maternité │ 1│ 200│ 20│ 100│ │Stockholm „ │ 1│ 650│ 37│ 56│ │Göttenburg „ │ 1│ 223│ 18│ 80│ │Lund „ │ 1│ 33│ 2│ 60│ │Freiburg en Breisgau │ 3│ 281│ 10│ 35│ │Jéna Clinique │ 4│ 308│ 21│ 67│ │Dresden Maternité │ 51│ 15,356│ 373│ 27│ │Paris Maternité │ 8│ 15,307│ 610│ 39│ │Ditto │ 10│ 23,484│ 1,114│ 47│ │Ditto │ 10│ 25,895│ 1,293│ 49│ │Ditto │ 10│ 26,538│ 1,125│ 42│ │Ditto │ 10│ 34,776│ 1,458│ 41│ │Ditto │ 10│ 25,094│ 1,298│ 51│ │Ditto │ 5│ 9,886│ 1,226│ 124│ │Total for ditto │ 63│ 160,704│ 8,124│ 56│ │Paris Clinique de la Faculté│ 5│ 1,654│ 117│ 70│ │Ditto │ 10│ 9,079│ 359│ 39│ │Ditto │ 10│ 9,462│ 379│ 40│ │Ditto │ 5│ 4,100│ 288│ 70│ │Total for ditto │ 30│ 24,295│ 1,143│ 47│ │Paris, St. Antoine │ 9│ 28│ 5│ 178│ │Ditto │ 10│ 32│ 15│ 468│ │Ditto │ 10│ 129│ 20│ 155│ │Ditto │ 10│ 788│ 65│ 82│ │Ditto │ 10│ 2,359│ 134│ 56│ │Ditto │ 5│ 1,868│ 110│ 58│ │Total for ditto │ 54│ 5,204│ 349│ 67│ │Paris, Hôtel Dieu │ 8│ 833│ 36│ 43│ │Ditto │ 10│ 658│ 34│ 51│ │Ditto │ 10│ 1,757│ 81│ 46│ │Ditto │ 10│ 2,338│ 17│ 7│ │Ditto │ 10│ 3,012│ 106│ 35│ │Ditto │ 10│ 11,744│ 325│ 27│ │Ditto │ 5│ 4,972│ 232│ 46│ │Total for ditto │ 63│ 25,314│ 831│ 32│ │Paris, St. Louis │ 3│ 4│ 0│ 0│ │Ditto │ 10│ 128│ 2│ 15│ │Ditto │ 10│ 1,282│ 51│ 39│ │Ditto │ 10│ 2,832│ 173│ 61│ │Ditto │ 10│ 2,736│ 102│ 37│ │Ditto │ 10│ 7,244│ 200│ 27│ │Ditto │ 5│ 3,812│ 252│ 66│ │Total for ditto │ 58│ 19,038│ 780│ 40│ │Paris, La Charité │ 3│ 648│ 84│ 126│ │Lyons „ │ 4│ 3,325│ 91│ 17│ │ Hôtel Dieu │ 4│ 2,016│ 33│ 16│ │Rouen Hôpital Général │ 4│ 1,275│ 9│ 7│ │Bordeaux Maternité │ 4│ 714│ 30│ 42│ │Lille │ 4│ 683│ 25│ 35│ │Rheims │ 4│ 646│ 15│ 23│ │Strasburg │ 4│ 556│ 78│ 140│ │Grenoble │ 4│ 554│ 20│ 36│ │Bordeaux, St. André │ 4│ 547│ 36│ 65│ │St. Etienne │ 4│ 515│ 8│ 15│ │Toulouse │ 4│ 493│ 9│ 18│ │Bourg │ 4│ 461│ 0│ 0│ │Troyes │ 4│ 460│ 2│ 4│ │Marseilles │ 4│ 444│ 16│ 36│ │Châteauroux │ 4│ 423│ 20│ 47│ │Amiens │ 4│ 396│ 5│ 12│ │Colmar │ 4│ 396│ 26│ 65│ │Nantes │ 4│ 340│ 17│ 50│ │Nancy │ 4│ 320│ 9│ 28│ │Orleans │ 4│ 301│ 3│ 9│ ├────────────────────────────┼───────────┼──────────┼────────┼────────┤ │ Total for all hospitals │ │ 888,312│ 30,394│ 34│ └────────────────────────────┴───────────┴──────────┴────────┴────────┘

The absolute loss of life in Parisian lying-in wards has been greater than in those of any other capital city.

This is clearly shown in the ‘Statistique médicale des Hôpitaux de Paris,’ kindly supplied to me by M. Husson, the Director of the General Administration of ‘Public Assistance’ at Paris, of whose many proofs of ability, activity, and benevolence, it is not here the place to speak. From this the following facts are abstracted. The death-rates are therein given for 12 hospitals receiving lying-in cases, only one of which, however, is a lying-in hospital (the ‘Maison d’accouchement’), and will be found in Tables XI., XII., XIII.

In 1861 the average death-rate in these establishments was no less than 95·1 per 1,000.

In 1862 it was 69·7 per 1,000.

In 1863 it was 70·3 per 1,000.

TABLE XI.—Mortality per Thousand among Lying-in Women at the undermentioned Parisian Hospitals during the Year 1861. (Abstracted from ‘Statistique Médicale des Hôpitaux,’ 1861.) ┌──────────────────────┬──────────┬───────────────────────────────────┐ │ Hospital │ Total │ Mortality per Thousand │ │ │Deliveries│ │ ├──────────────────────┼──────────┼──────────┬─────────────┬──────────┤ │ „ │ „ │Puerperal │Non-Puerperal│ Total │ │ │ │ │ │ Deaths │ ├──────────────────────┼──────────┼──────────┼─────────────┼──────────┤ │Hôtel Dieu │ 1,057│ 43·5│ 16·1│ 59·6│ │Pitié │ 468│ 72·6│ 34·2│ 106·8│ │Charité │ 253│ 154·2│ 39·7│ 193·7│ │St. Antoine │ 350│ 71·4│ 34·3│ 105·7│ │Necker │ 234│ 29·9│ 29·9│ 59·8│ │Cochin │ 56│ 142·9│ 35·7│ 178·6│ │Beaujon │ 276│ 43·5│ 3·6│ 47·1│ │Lariboisière │ 782│ 69·1│ 15·3│ 84·4│ │St. Louis │ 802│ 58·6│ 13·7│ 72·3│ │Lourcine │ 41│ 24·4│ │ 24·4│ │Cliniques │ 875│ 75·4│ 34·3│ 109·7│ │Maison d’Accouchements│ 2,115│ 99·8│ 12·8│ 112·5│ ├──────────────────────┼──────────┼──────────┼─────────────┼──────────┤ │ Total │ 7,309│ 75·2│ 19·8│ 95·1│ └──────────────────────┴──────────┴──────────┴─────────────┴──────────┘

TABLE XII.—Mortality per Thousand among Lying-in Women at the undermentioned Parisian Hospitals during the Year 1862. (Abstracted from ‘Statistique Médicale des Hôpitaux de Paris,’ 1861, 2, 3.) ┌──────────────────────┬──────────┬───────────────────────────────────┐ │ Hospital │ Total │ Mortality per Thousand │ │ │Deliveries│ │ ├──────────────────────┼──────────┼──────────┬─────────────┬──────────┤ │ „ │ „ │Puerperal │Non-Puerperal│ Total │ │ │ │ │ │ Deaths │ ├──────────────────────┼──────────┼──────────┼─────────────┼──────────┤ │Hôtel Dieu │ 975│ 35·8│ 9·2│ 45·1│ │Pitié │ 462│ 45·4│ 10·8│ 56·2│ │Charité │ 270│ 62·9│ 25·9│ 88·8│ │St. Antoine │ 311│ 61·0│ 19·2│ 80·3│ │Necker │ 190│ 52·6│ 21·0│ 73·6│ │Cochin │ 24│ 41·6│ 83·3│ 124·9│ │Beaujon │ 257│ 38·9│ 19·9│ 58·8│ │Lariboisière │ 816│ 34·3│ 13·5│ 47·8│ │St. Louis │ 704│ 79·5│ 8·5│ 88·0│ │Lourcine │ 45│ 22·2│ —│ 22·2│ │Cliniques │ 769│ 79·3│ 14·3│ 93·6│ │Maison d’Accouchements│ 2,204│ 63·5│ 11·3│ 74·9│ ├──────────────────────┼──────────┼──────────┼─────────────┼──────────┤ │ Total │ 7,027│ 56·7│ 12·9│ 69·7│ └──────────────────────┴──────────┴──────────┴─────────────┴──────────┘

TABLE XIII.—Mortality per Thousand among Lying-in Women at the undermentioned Parisian Hospitals during the Year 1863. (Abstracted from ‘Statistique Médicale des Hôpitaux’, 1863.) ┌──────────────────────┬──────────┬───────────────────────────────────┐ │ Hospital │ Total │ Mortality per Thousand │ │ │Deliveries│ │ ├──────────────────────┼──────────┼──────────┬─────────────┬──────────┤ │ „ │ „ │Puerperal │Non-Puerperal│ Total │ │ │ │ │ │ Deaths │ ├──────────────────────┼──────────┼──────────┼─────────────┼──────────┤ │Hôtel Dieu │ 925│ 26·7│ 4·1│ 30·8│ │La Pitié │ 544│ 44·1│ 1·8│ 46·0│ │Charité │ 256│ 66·4│ 19·5│ 85·9│ │St. Antoine │ 410│ 63·4│ 11·6│ 78·0│ │Necker │ 232│ 38·8│ 21·6│ 60·3│ │Cochin │ 68│ 73·5│ 14·7│ 88·2│ │Beaujon │ 313│ 19·2│ 12·8│ 31·9│ │Lariboisière │ 870│ 31·0│ 9·2│ 40·2│ │St. Louis │ 871│ 23·0│ 9·2│ 32·1│ │Lourcine │ 43│ 27·9│ │ 27·9│ │Clinique │ 751│ 30·6│ 18·6│ 49·3│ │Maison d’Accouchements│ 2,006│ 130·1│ 7·4│ 137·6│ ├──────────────────────┼──────────┼──────────┼─────────────┼──────────┤ │ Total │ 7,289│ 60·6│ 9·7│ 70·3│ └──────────────────────┴──────────┴──────────┴─────────────┴──────────┘

CLASSIFICATION OF CAUSES OF MORTALITY IN LYING-IN INSTITUTIONS.

The next thing is to endeavour to show to what causes these death-rates are to be attributed. Unfortunately Dr. Le Fort’s tables do not enable us to distinguish the causes of death. But the data supplied by British and Parisian hospitals allow the causes to be classified to a certain extent under the heads adopted by the Registrar-General in his Reports.

A classified arrangement of this kind is given in Table II., and may be resumed, with the view of showing the enormous differences in death-rates among puerperal women under different conditions, as follows:—