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PREFACE vii–x
_Table of Midwifery Statistics, King’s College Hospital_ ix
_What is the real normal Death-rate of Lying-in Women?_ 1
MIDWIFERY STATISTICS 2
NORMAL DEATH-RATE OF LYING-IN WOMEN IN ENGLAND 4
TABLE I.—_Mortality after Childbirth in England, 1867_ 4
TABLE II.—_Mortality per 1,000 after Delivery from Puerperal
Diseases and Accidents of Childbirth_ 6
NORMAL MORTALITY OF LYING-IN WOMEN IN DIFFERENT COUNTRIES 7
TABLE III.—_Death-rate from all Causes amongst Women delivered in
their own Homes_ 8
OBJECTIONS TO THE DATA 9
ESTIMATED APPROXIMATE HOME DEATH-RATE 11
DEATH-RATES IN LYING-IN INSTITUTIONS 11
TABLE IV.—_Admissions and Deaths in Childbirth in eight Women’s
Hospitals (Military)_ 12
TABLE V.—_Statistics of Midwifery Wards in Liverpool Workhouse_ 13
TABLE VI.—_Mortality after Childbirth in forty London Workhouses_ 13
TABLE VII.—_Mortality in Queen Charlotte’s Hospital_ 14
TABLE VIII.—_Mortality per 1,000 from all Causes after Delivery_ 15
TABLE IX.—_Mortality in Lying-in Ward, King’s College Hospital_ 15
TABLE X.—_Death-rate from all causes in Lying-in Hospitals_ 17
TABLE XI.—_Mortality per 1,000 among Lying-in Women at Paris
Hospitals, 1861_ 20
TABLE XII.—_Mortality per 1,000 among Lying-in Women at Paris
Hospitals, 1862_ 20
TABLE XIII.—_Mortality per 1,000 among Lying-in Women at Paris
Hospitals, 1863_ 21
CLASSIFICATION OF CAUSES OF MORTALITY IN LYING-IN INSTITUTIONS 21
CAUSES OF HIGH DEATH-RATES IN LYING-IN INSTITUTIONS 23
_Puerperal Fever_ 24
_Admission of Students_ 25
_Effect of Numbers_ 26
_Danger of Puerperal Epidemics_ 31
_Fatality of Lying-in Wards in General Hospitals_ 32
INFLUENCE OF CONSTRUCTION AND MANAGEMENT OF LYING-IN WARDS ON THE
DEATH-RATE 33
_Maternité, Paris_ 34
_Hôpital de la Clinique, Paris_ 36
_Queen Charlotte’s Lying-in Hospital, London_ 38
_Midwifery Wards, King’s College Hospital, London_ 40
IMPROVED LYING-IN WARD CONSTRUCTION 41
_Military Female Hospitals_ 41
TABLE XIV.—_Classification of Causes of Death in Childbirth in
Eight Women’s Hospitals (Military)_ 43
_Proposed new Female Hospital at Portsmouth_ 45
SHOULD MEDICAL STUDENTS BE ADMITTED TO LYING-IN HOSPITAL
PRACTICE? 48
INFLUENCE OF TIME SPENT IN A LYING-IN WARD ON THE DEATH-RATE 50
EFFECT OF GOOD MANAGEMENT ON THE SUCCESS OF LYING-IN
ESTABLISHMENTS 52
_Liverpool Workhouse_ 53
_Summary of Cases Delivered in the Lying-in Wards of
Liverpool Workhouse, 1868–1870_ 53
_Summary of Deaths and Causes of Death in the same,
1858–1870_ 54
_London Workhouses_ 58
MANAGEMENT OF MILITARY LYING-IN WARDS 62
NOTE _on altogether disconnecting Lying-in Institutions even with
the very name of Hospital_ 64
RECAPITULATION 65
TABLE XV.—_Comparative Mortality among Lying-in Women in
Hospitals and at Home_ 68
CAN THE ARRANGEMENT AND MANAGEMENT OF LYING-IN INSTITUTIONS BE
IMPROVED? 68
_CHAPTER II._
CONSTRUCTION AND MANAGEMENT OF A LYING-IN INSTITUTION AND
TRAINING SCHOOL FOR MIDWIVES AND MIDWIFERY NURSES 72
I. CONSTRUCTION OF A LYING-IN INSTITUTION 74
1. _How many Beds to a Ward?_ 74
TABLE XVI.—_Proposed Registry of Midwifery Cases_ 75
2. _How many Wards to a Floor?_ 76
3. _How many Floors to a Pavilion (Hut or Cottage)?_ 76
_How many Beds to a Pavilion or Hut?_ 76
_How many Pavilions or Huts to a Lying-in Institution?_ 76
4. _How much Space to the Bed?_ 77
_The Delivery Ward_ 77
5. _How many Windows to a Bed?_ 78
6. _What are Healthy Walls, and Ceilings, and Floors?_ 78
7. _What is a Healthy and Well-lighted Delivery Ward?_ 79
8. _Scullery, Lavatory, W.C._ 81
9. _How to ventilate Lying-in Wards_ 83
10. _Furniture, Bedding, Linen_ 84
11. _Water supply, Drainage, Washing_ 85
12. _Medical Officer’s Room and Waiting-Room_ 85
13. _Segregation Ward_ 86
14. _Kitchen_ 86
SITE 86
II. MANAGEMENT 90
_First Rule of Good Management_ 90
_Second Rule of Good Management_ 91
_Third Rule of Good Management_ 93
III. TRAINING SCHOOL FOR MIDWIVES 94
DESCRIPTION OF SKETCH-PLANS OF PROPOSED INSTITUTION 100
_A Lying-in Institution For 40 beds (32 to 36 occupied),
with a training school for 30 pupil Midwives and Nurses_ 102
APPENDIX: MIDWIFERY AS A CAREER FOR EDUCATED WOMEN 105