5. Passing women who have been delivered as speedily as possible out of
the division altogether, either into the house or outside.
6. The deliveries being conducted by a woman specially attached to the
delivery ward, and no part of whose duty it is to attend sick.
7. The immediate isolation or removal of all cases exhibiting feverish
symptoms and their treatment out of the division.
8. The reduction of intercommunication between the lying-in and hospital
divisions to the smallest possible degree on the part of medical
officers and nurses.
The practical result of this system of management has been, as we have
seen, that the lying-in division of this workhouse, although working
under many singular disadvantages, has escaped the usual fatality of
special lying-in hospitals.
During the thirteen years included in the tables there has been no
epidemic, and the deaths have almost always been single and
disconnected.
The experience of lying-in wards in London workhouses somewhat resembles
the experience of Liverpool workhouse.
In the report of the committee appointed to consider the cubic space of
metropolitan workhouses, 1867, is given a table, No. 11, shewing the
number of deliveries and deaths after delivery during five years in
forty metropolitan workhouses.
The leading facts are abstracted in Table VI. Workhouses in which deaths
after delivery took place, during the five years, are separated in the
abstract from workhouses in which no deaths took place.
There were during these five years in all the workhouses 11,870
deliveries and 93 deaths, giving a death-rate of 7·8 per 1,000. The
deaths from puerperal diseases amounted to 39, giving a death-rate of
3·3 per 1,000. There were 20 deaths from accidents of childbirth; being
a death-rate of 1·7 per 1,000. The total death-rate due to both classes
was 5 per 1,000.
The largest number of deliveries took place in Marylebone and in St.
Pancras. In the former, on an average of 243 deliveries per annum, the
death-rate was 8·2 per 1,000. One half of this, however, was due to
consumption. Of the remaining deaths 3 were due to puerperal diseases
(2·4 per 1,000) and 2 to accidents. The death-rate due to puerperal
diseases and accidents of childbirth was thus 4·1 per 1,000.
In St. Pancras workhouse, on an average of 200 deliveries per annum, the
death-rate was 11 per 1,000, of which 9 per 1,000 were due to puerperal
diseases. Recent disclosures with regard to St. Pancras workhouse may to
some extent account for this high death-rate. The number of deliveries
in these two workhouses bring them almost within the category of
lying-in hospitals.
There are four other workhouses in which the annual deliveries are
respectively 171, 120, and two of them 111, while in all the others the
numbers fall much below 100.
In one such instance (Holborn), where the deliveries have averaged fifty
a year, the death-rate was exceptionally high, 24 per 1,000, one half of
which was due to puerperal disease. In another instance, St. Mary’s,
Islington, with seventy-five deliveries per annum, the death-rate
averaged 29 per 1,000. But the causes are not stated, and cannot now be
ascertained. In Whitechapel, where there were 111 deliveries per annum,
the death-rate was 10·8 per 1,000, one half being due to puerperal
diseases.
It is possible that local enquiry might elucidate the causes of this
mortality. The cases are, however, exceptional to the experience of
London workhouses, viz. that the death-rates from puerperal diseases and
accidents of childbirth are scarcely higher than they are in all
England, town and country. Let us try to ascertain how far the
management adopted may have led to these comparatively favourable
results.
The conditions for recovery in a great majority of the London workhouse
lying-in wards are at least as favourable as they are in the Liverpool
workhouse; in most cases undoubtedly more so, as will immediately be
seen when we consider that the average annual number of deliveries in
Liverpool workhouse is more than twice that of the two largest London
workhouses, and from five to ten times most of the others; that in the
London workhouses the rule is to have many unoccupied beds, while this
is the exception in the Liverpool workhouse.
The cardinal principle in the management of these London workhouse
lying-in wards appears to be this: their occupants are a fluctuating
number; often the wards have but one woman at a time, and the cubic
space for each of these women is ‘in fact the cubic space of the whole
ward.’[18] Sometimes, but only for brief periods, all the lying-in beds
may be occupied. For much longer intervals the occupants are very few in
number, so that each has a large proportion of cubic space, and
sometimes the wards in some of the workhouses are empty. There are no
medical schools attached to the institutions, and no medical students
who may have passed from a case of erysipelas or from the post-mortem
theatre to the lying-in bedside; there is the possibility of removing
immediately any case of febrile or other disease which may occur in the
lying-in ward into the general sick wards of the workhouse; there is
discharge of convalescent cases at the earliest possible period, either
to their own homes or to other parts of the establishment; these
conditions, together with the paucity of numbers and the occasional
vacating and rest of the wards, appear to constitute the main difference
between a workhouse lying-in ward and a lying-in hospital.
In both classes of establishments the same attention is doubtless
bestowed on ventilation, cleanliness, and frequent change of bedding.
_MANAGEMENT OF MILITARY LYING-IN WARDS._