Seven or eight hours in the delivery ward.
Five or six days in the lying-in ward.
Nine or ten days in the convalescent ward.
The nearer wards to the delivery ward in use should always be made the
wards for women immediately after delivery; the farther wards for the
same women when removed for their convalescent stage.
In a single-bed ward the woman may remain in her own ward from after her
delivery till her discharge; that is, no further removal after her
delivery is necessary.
4. Cases of extreme exhaustion after delivery, which are better out of
the delivery ward yet cannot be moved many yards, should be carried _in
their beds_ to the bye-ward adjoining the delivery ward, till they are
somewhat recovered.
These must have a constant watcher by them.
5. In a lying-in institution about three times the quantity of linen and
bedding for each patient is necessary of what is used at a general
hospital.
The day’s and night’s provision of linen is kept in each ward scullery,
and in the scullery of each delivery ward in use.
The linen-store in the store-room, and the bedding-store, need to be
very complete and ample.
The bedding, that is, the mattress and blankets, of any one bed in the
delivery ward should not be used for more than three or four delivery
cases in succession without undergoing some process of purification—and
this quite independent of any accident, the mattress of course being
protected by Macintosh sheeting.
_III. TRAINING SCHOOL FOR MIDWIVES._
The few words which will here be added on the management of a midwifery
training school are not at all to be understood as a manual for
practical instruction, which it is quite impossible to introduce here,
but as simply treating of the management, in so far as this determines
some constructive arrangements as imperative, and others as to be
avoided.
No charity or institution, I believe, could possibly bear the expense of
a single-bed ward, or even of a four-bed ward lying-in establishment,
for a pretty constant succession of thirty-two patients, unless there
were a training school.
[Thirty-two single-bed wards, an administrator would say, would require
sixteen nurses, independently of midwives!!]
Even with a training school, the first year would be one of great
difficulty, since all well managed training schools ‘take in’ pupils as
much as possible at only two periods of the year, so as never to have
the whole of the pupils fresh hands at once. But the _first_ batch must
necessarily be all fresh hands. A raw girl cannot be turned in to sit up
with a newly-delivered woman and new-born infant. And a midwife cannot
be spared to each girl all to herself, to teach her how to handle an
infant. [That is, in each single-bed ward.]
The whole nursing service of a large four-bed or one-bed ward lying-in
institution is so complicated, so different from that of a general
hospital with its 20 or 32–bed wards, that it is difficult to provide
for.
In even guessing at what the nursing accommodation should be for so
completely new an experiment as a lying-in institution of 40 beds in
single-bed or four-bed pavilions, we must begin by stating the probable
requirements, the whole being tentative.