Construction, however, in a lying-in institution, holds only the second
place to good management in determining whether the lying-in patients
shall live or die. And without such management, no construction, however
perfect, will avail.
And the first elementary principle of good management is to have always
one pavilion of four or eight beds, according as it is of one floor or
of two, standing empty in rotation for purposes of thorough cleansing.
_A fortiori_—one delivery pavilion on each floor is always to be vacant
alternately.
The pavilion to be in rotation unoccupied for the purposes of cleansing
must necessarily be the _whole_ pavilion, with all its sculleries and
ward offices, since the process of cleansing is—turning out all the
little furniture a lying-in ward ought ever to possess, bringing in
lime-washers, possibly scrapers and painters, leaving doors and windows
open all day, and even all night.
Every reason for having each ordinary pavilion ward completely separate,
and individually _pavilionised_, applies with tenfold force to the
delivery ward. Each must be complete in itself, with all its
appurtenances and bye-ward for extreme cases, as a little pavilion.
There is no possibility for properly cleansing and lime-washing the
delivery ward _not_ in use, unless this be the case.
_One_ delivery ward, however spacious and well arranged _constantly_
used, would be a centre of deplorable mischief for the whole
institution. This makes _two_ delivery wards for each floor of the
institution indispensable, to be used alternately for the whole floor at
given periods.
_N.B._ Liverpool Workhouse with 25 lying-in beds, exclusive of delivery
beds, has had an average of 500 deliveries _a year_ for eleven years. A
civil lying-in hospital in or near a large town is generally _just as
full as it is permitted_ to be. Five or six hundred deliveries or more
_a year_ might be reckoned upon; occasionally three or four deliveries a
night. Sculleries will be _always_ in use, _day and night_. All this
renders it imperative that an inexorable rule should be made and kept
to, viz. that every lying-in pavilion should be vacant in rotation, each
delivery pavilion alternately, for thorough cleansing.
2. The second elementary principle of good management is to remove every
case of _illness_ arising in the institution, and every such case
admitted into the institution, at once to an isolated sick ward or
infirmary ward.
This is _must_, not may.
Though we should have no puerperal fever or peritonitis in a building of
this _make_, yet unfortunately other institutions will send in (say)
erysipelas or small-pox patients seized with labour.
Sad experience tells that this unprincipled practice has often proved
fatal to many other inmates of the lying-in institution, turning an
institution into a hospital.
Every sick case should therefore be completely isolated, in a separate
sick ward, from the lying-in women. And if admitted before delivery, her
delivery should take place in this separate ward.
_N.B._ The nurse’s dinner and meals may be prepared in the general
kitchen and sent to her. The patient’s arrowroot, gruel, &c., must be
made, and her beef-tea warmed, in the ‘sick or segregation’ building,
and all linen must be sent to the ward well aired.
Is it desirable to connect the ‘segregation’ ward by any covered passage
with the rest of the lying-in institution?
There is much to be said for and against.
The ward, it is to be hoped, will not often have to be used at all.
But small-pox has appeared after labour.
There might be danger in taking a patient from the institution to this
ward through the open air, in all weathers, unprotected by any covered
passage.
On the other hand, when once the patient is in the ward, complete
isolation is by far the best, for the sake of all the others.
And there is by no means the same necessity for a passage as in the
other parts of the institution where any night there may be three or
four ordinary delivery cases to be conveyed through the passages.
A covered ambulance for sick cases is not, however, a nice thing, though
often suggested.[22]
3. The first two may be called universal and essential principles of
good management in every lying-in institution, large or small, however
perfectly constructed.
Here is a third, hardly less essential, wherever there is more than one
bed to a ward, viz. to remove a lying-in woman three times during her
stay in the institution.