(_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.
Table XIV. shows that the total mortality in this hospital has been 10·1
per 1,000. Of the total deaths 27 are attributed to diseases and
accidents of childbirth, affording a mortality of 8·8 per 1,000, or
double that of the healthy districts of England.
If we exclude Aldershot as being unfit for childbirth cases, we find
that in the other seven hospitals the total mortality, as shown in Table
XIV., has been 7·4 per 1,000. The mortality from puerperal diseases in
these hospitals has been 2·7 per 1,000, and from diseases and accidents
of childbirth 5·4 per 1,000.
Table XIV.
┌────────────┬────────────────────────────────────────────────────────┐
│ │ All Women’s Hospitals (Military) │
├────────────┼──────────┬──────────┬────────────┬──────────┬──────────┤
│ │ Puerperal│ Accidents│Diseases and│ Others│ Total│
│ │ Diseases│ of│Accidents of│ │ Mortality│
│ │ │Childbirth│ Childbirth│ │ │
├────────────┼──────────┼──────────┼────────────┼──────────┼──────────┤
│Deaths per │ 3·9│ 3·4│ 7·3│ 1·5│ 8·8│
│ 1,000 │ │ │ │ │ │
│ deliveries│ │ │ │ │ │
├────────────┴──────────┴──────────┴────────────┴──────────┴──────────┤
│ │
├────────────┬────────────────────────────────────────────────────────┤
│ │ Aldershot Women’s Hospital │
├────────────┼──────────┬──────────┬────────────┬──────────┬──────────┤
│ │ Puerperal│ Accidents│Diseases and│ Others│ Total│
│ │ Diseases│ of│Accidents of│ │ Mortality│
│ │ │Childbirth│ Childbirth│ │ │
├────────────┼──────────┼──────────┼────────────┼──────────┼──────────┤
│Deaths per │ 4·9│ 3·9│ 8·8│ 1·3│ 10·1│
│ 1,000 │ │ │ │ │ │
│ deliveries│ │ │ │ │ │
├────────────┴──────────┴──────────┴────────────┴──────────┴──────────┤
│ │
├────────────┬────────────────────────────────────────────────────────┤
│ │ Other Women’s Hospitals, excluding Aldershot │
├────────────┼──────────┬──────────┬────────────┬──────────┬──────────┤
│ │ Puerperal│ Accidents│Diseases and│ Others│ Total│
│ │ Diseases│ of│Accidents of│ │ Mortality│
│ │ │Childbirth│ Childbirth│ │ │
├────────────┼──────────┼──────────┼────────────┼──────────┼──────────┤
│Deaths per │ 2·7│ 2·7│ 5·4│ 2·0│ 7·4│
│ 1,000 │ │ │ │ │ │
│ deliveries│ │ │ │ │ │
└────────────┴──────────┴──────────┴────────────┴──────────┴──────────┘
There are two camp hospitals for lying-in cases, consisting only of
wooden huts, appropriated for the purpose, which have yielded very
important experience. One of these is at Colchester, the other at
Shorncliffe.
The Shorncliffe Hospital is an old wooden hut of the simplest
construction, with thorough ventilation. It is situated on a rising
ground close to the sea, and facing it, so that the sea breeze sweeps
right through it. It is scarcely more than a makeshift. And here are the
results.
Table IV. shows that up to December 1869, there had been 702 deliveries
in the hut, among which there was one death from scarlet fever, and one
from hæmorrhage, besides two deaths following on craniotomy. There was
not a single death from any puerperal disease.
Colchester Lying-in Hospital, of which a plan and section are given on
Plate II., is nothing more than an ordinary officer’s wooden hut,
divided by partitions into four compartments, with a transverse passage
cutting them off from each other. This hut has been in use for a
considerable number of years as a place of lying-in for soldiers’ wives
living in the camp, and there have been altogether between 500 and 600
deliveries in it. The matron states that during the whole time the hut
has been in use for its present purpose, no death has taken place in it.
But as statistics have only been kept since 1865, we shall limit our
attention to them. They show that, up to the end of October 1870, there
had been 252 registered deliveries, and no deaths.
[Illustration: