Part 8

In this building we have three floors and a basement. A drain runs from back to front of the building, right across the basement—a most unsafe course for a drain in any inhabited building.

It will be seen that the rooms are placed on opposite sides of a main corridor running the lengthway of the building on each floor; that the corridors of the different floors communicate by the stairs; that the ventilation of each room communicates with the ventilation of every other room through the corridors; that none of the rooms have windows on opposite sides, and that there are water-closets having a ventilation common to that of the building. Now every one of these structural arrangements is objectionable, and would be considered so in any good hospital, and nobody now-a-days would venture to include all of them in a general hospital plan. They are hence à fortiori altogether inadmissible in a building for the reception of lying-in women.

We have thus, in Queen Charlotte’s Hospital, the following defects:—

1. Agglomeration of a number of cases under the same roof.

2. A form of construction unsuited for hospital purposes.

3. No means of removing outside the building febrile or other cases of puerperal diseases from the vicinity of patients recovering after delivery.

Since 1856, notwithstanding the great improvements, the death-rates per 1,000 have been 12·2, 8·8, 81·2, 70·3, 54·2, 39·2, 15·5, and so on: in several years very considerably larger than the mortality which led to the closing of the lying-in wards in King’s College Hospital. These varying deaths lead to the exercise of much caution in drawing conclusions as to their causes; but the main fact remains, namely, there are the death-rates, and they are many times greater than occur among London poor women delivered at home.

Midwifery Wards, King’s College Hospital.—The following plan shows the provision which existed for training midwifery nurses at King’s College Hospital.

MIDWIFERY WARDS, KING’S COLLEGE HOSPITAL.

(Plan of Third Floor.) ]

A, A. Accouchement Wards, used alternately.

B. Recovery Ward.

C. Contains Linen Presses, and Infants’ Baths, &c., for Ward use.

D. Superior’s Bed-room.

E. Midwife’s Room.

F. Post-mortem Theatre.

G, G. General and Provision Hoists.

K. This roof is not higher than the basement.

x. Ventilating openings on a level with upper part of opposite window.

a, a, a, a. Doors cutting off communication with either Accouchement Ward when necessary.

b. No. 4 Ward.

The plan shows the relation of the delivery wards to the recovery ward, and to the other parts of the hospital; to the lecture room, post mortem theatre, &c. The main defects in the construction are: the back to back wards; proximity of these wards to the general wards of the hospital; the large staircase, common to both sets of wards, although its size and openness, and the windows opposite each other and on each floor, ensured ventilation, and separated the respective blocks; the position of the post-mortem theatre, the smell from which, as stated on the best authority, could be distinctly detected in the wards. As already stated, students were admitted from other parts of the hospital to the midwifery wards.

RESULTS OF IMPROVED LYING-IN WARD CONSTRUCTION.

A few instances of improved lying-in ward construction, together with the death-rates in these establishments, will next be given.

Military Female Hospitals.—These buildings vary in constructive arrangements. Some are much better than others, and during recent years lying-in wards of improved construction have been provided in connection with several newly erected military female hospitals. The earlier plans of the new female hospitals consist of a block formed of two pavilions joined end to end, with a passage across the block to separate the pavilions from each other. Each pavilion contains a single ward, with its own separate offices and nurses’ rooms. It has windows on opposite sides, with one large end window, and abundant means of warming and ventilation. One pavilion is devoted to general cases, the other to lying-in cases.

The midwifery ward has space for twelve beds. Each bed has a superficial area of ninety square feet, and a cubic space of 1,350 feet. The wards are fifteen feet high.

Two hospitals on this plan have been in use at Woolwich and Chatham for upwards of six years. During this period there have been at the two 1,093 deliveries, and 11 deaths. At Chatham there was one accidental death from removal of the patient to hospital, and out of 342 deliveries there have been no deaths from puerperal diseases. There were, however, two deaths from scarlet fever, occurring while this disease was prevalent in soldiers’ families in the garrison. At Woolwich, among 751 deliveries, there have been 8 deaths, of which five were from puerperal diseases, but of these five deaths one took place in a woman who had gastric fever at the time of admission, and in other two women puerperal peritonitis came on after instrumental delivery. There was one death from embolism, one from exhaustion, and one from dropsy. The total death-rate in these two hospitals has been under 10 per 1,000. The deaths due to diseases and accidents of childbirth have been 6, or at the rate of 5½ per 1,000.

Of the other military hospitals, the statistics of which are given in Table IV., Devonport and Portsmouth are unsuitable adapted buildings. Aldershot Hospital consists of a number of huts joined together as a general female hospital, with accommodation for all kinds of cases, including lying-in cases. This arrangement is a very undesirable one, and the results have been unsatisfactory.