N. Coals.
_Proposed new Female Hospital at Portsmouth._—When military female
hospitals were first designed, it was intended that they should receive
only lying-in and general cases from married soldiers’ families in
separate pavilions. But at a subsequent date zymotic cases were admitted
into the same pavilion with general cases. Very decided objections were,
however, urged against this step by medical officers, and the next
hospital planned was divided into three distinct pavilions. It was
intended for Portsmouth garrison, and is shown in the annexed figure.
A female hospital on this plan has been erected at Dublin, with the two
end wards built in the line of the corridor beyond the ends of it, in
place of at right angles to the corridor, as shown in the proposed
Portsmouth plan. By this form of construction the cases received from
soldiers’ families can be divided into three classes: general,
infectious, and midwifery—each class in its own separate building. Such,
however, has been the feeling of medical officers as to the
undesirableness of trusting even to this amount of separation, that at
Dublin the ‘infectious’ cases have been removed to another locality
altogether. The same separation had been already effected at Chatham and
Woolwich.
Close observation of lying-in cases has led to further change in the
construction, and it is now proposed to adopt for lying-in wards in
female hospitals a different form of arrangement altogether: namely, to
divide the lying-in pavilion into separate one-bed rooms, as shown on
Plan IV.
The experience of these small military female lying-in hospitals has
shown the favourable effect of simplicity of construction, plenty of
space, light, and fresh air, perfect cleanliness, a small number of
lying-in beds, not by any means constantly occupied, administration
separate from that of general hospitals, and allowing the lying-in women
to return to quarters in as few days after delivery as their recovery
admits.
But there is one remarkable instance in which a plan of construction, on
the principle of the earlier British military female hospitals described
above, has been adopted without having led to equally satisfactory
results.
The new ‘Maternité’ belonging to the Hôpital Cochin at Paris has been
constructed on a ground-plan similar to that at Woolwich, viz., with two
pavilions projecting in line from a centre, and containing two ten-bed
wards. It is in two floors, with small wards on the upper floor. Part of
its sanitary arrangements are certainly not what we should adopt in this
country, but there are many hospitals in which there are worse defects.
Puerperal fever appeared in this hospital within a month of its being
opened.
Where so much attention had been paid to construction, the causes of the
fever must be looked for somewhere else than in the ward plan.
Dr. Le Fort has stated that puerperal fever cases had been retained
temporarily in the wards after the development of the disease; that the
same nurses took charge, not only of cases of disease in the isolated
wards, but also of women making healthy recoveries; and that there is
nothing to prevent the medical attendant passing almost directly from
the autopsy of a puerperal fever case to render assistance to a healthy
woman.
This experience is very important. It shows how much the safety of
lying-in hospitals depends on common-sense management, and that it would
be disastrous to trust to improved construction alone, while everything
else is left to take its own course.