Part 7

The delivery ward is well-lighted on two sides, and communicates with an operation theatre, where lectures are also given.

The woman, if progressing favourably after delivery, was removed to one of the cells in what may be called the recovery ward. The construction of these cells was as follows:—a long corridor, with windows on opposite sides, was divided into separate cells, each cell having its own window, by partitions stretching one third across the corridor, but not cut off on the end towards the middle of the corridor. Each cell was provided with a bed and a cradle, so that in walking up the centre of the corridor the divisions, or rather the cells, opened right and left from the passage, like the stalls of a stable. This construction rendered it almost impossible to open the windows. The infirmary consisted of small wards of three or four beds each, into which were moved indiscriminately patients suffering with all classes of disease. And it appears, from Dr. Le Fort’s account, that pupil midwives had at the same time patients in the infirmary, and healthy women, both delivered and not delivered, under their care. Pregnant women are often admitted weeks, and even months before delivery, at the Maternité. [So also at the Midwives’ Clinique at Vienna.]

Recently the cells have been removed from the corridor, and glass partitions have been thrown across from back to front, each division containing six beds, but communicating with the adjoining divisions by means of doors intended to be used only when the service requires it.

The infirmary has been completely separated from this portion of the establishment, but all classes of cases are still transferred into the infirmary as before.

As consequences of these arrangements, we have in the Maternité the following conditions:—

1. The agglomeration of a number of lying-in women under the same roof.

2. An internal construction of the building not suited to give fresh air, to say the least of it.

3. The infirmary until recently connected with the other portions of the building, and even now receiving all classes of cases among lying-in women, whether febrile or not, for treatment.

4. One class of attendants devoted indiscriminately to all classes of inmates.

5. As already mentioned, women admitted and retained within the walls of the establishment before and after the time simply required for delivery and convalescence.

Lastly, an enormous death-rate mainly from puerperal diseases.

Hôpital de la Clinique, Paris.—This establishment is part of the hospital for clinical instruction, close to the buildings of the École de Médecine. The hospital consists of a parallelogram with a central court, containing not only the clinical surgery wards, but also an amphitheatre devoted to anatomical studies, with a mean number of fifty corpses in the course of dissection.

There are six wards devoted to the midwifery department, arranged in a complicated manner, partly across the corridor, and partly on each side of the corridor, all of them entered from a central passage lighted by the open doors of the wards along the sides. They contained 54 lying-in beds. From 800 to 900 deliveries took place here annually. 18 to 20 days appear to be the average stay. The beds must, therefore, have been pretty constantly full.

The wards devoted to women who have been delivered communicate freely with one another by open doors. The beds are curtained, and the curtains are washed only once in six months, even though the occupants of the bed may have died of puerperal fever. The beds are of iron, and are provided with a spring mattress, over which is a wool mattress. The latter is removed after each delivery, cleansed, and renewed. There is no infirmary for diseases; whether cases of puerperal fever or others, all are treated in the beds in which they are placed after delivery.

The female staff performs its duty to all classes of cases.

Students entered upon the roll for midwifery practice are called into the wards from other parts of the establishment by signals placed in a window.

It is quite unnecessary to search for any more recondite causes of the past excessive mortality of this establishment than these simple facts.

HÔPITAL DE LA CLINIQUE, PARIS.

(Former arrangement of Lying-in Wards.) ]

The above plan, taken from M. Husson’s ‘Étude sur les Hôpitaux,’ will show the arrangement of wards and beds in this place. [Dr. Le Fort says that the number of beds in each ward has since been reduced by a third.]

Queen Charlotte’s Lying-in Hospital, London.—Plate I. shows a plan and section of Queen Charlotte’s Hospital, as rebuilt in 1856.

On each floor are 6 wards, containing 3 beds each, in which the patients are delivered, with an average of 1,000 cubic feet to each patient. On each floor, also, is one convalescent ward, containing 6 beds. Two floors are devoted to patients: one for married, and one for single women. As soon as 3 patients have been delivered in a ward, it remains vacant for 8 or 10 days, and is cleansed. Patients are removed as soon as possible to the convalescent ward. When a case of fever occurs, the ward is freshly whitewashed, and not occupied again for at least a month.

PLAN I

SECTION.

Queen Charlotte’s Lying-in Hospital.

FIRST FLOOR PLAN.

Scale

M & N HANHART, LITH. ]