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.
[Illustration: