Introductory notes on lying-in institutions : $b Together with a proposal for organising an institution for training midwives and midwifery nursesNightingale, Florence
Science
Introductory notes on lying-in institutions : $b Together with a proposal for organising an institution for training midwives and midwifery nurses
Nightingale, Florence
Women's hospitals
We must also protest against massing hospitals, alike only in one
circumstance, together for the sake of taking their statistics _in bulk_
in this way, except for the most general purposes—which is indeed all
Dr. Le Fort has in view here—especially as our own lying-in institutions
of these islands, which come out best individually, appear here
confounded amongst the greatest sinners. But Dr. Le Fort’s general
conclusion, against the influence of size _per se_, is no doubt correct.
As a general rule, statistics appear to show that the great mortality of
lying-in hospitals is of periodical occurrence.
Puerperal women, as everyone knows, are the most susceptible of all
subjects to ‘blood-poisoning.’ The smallest transference of putrescing
miasm from a locality where such miasm exists to the bedside of a
lying-in patient is most dangerous. Puerperal women are, moreover,
exposed to the risks of ‘blood-poisoning’ by the simple fact of being
brought together in lying-in wards, and especially by being retained a
longer time than is absolutely necessary in lying-in wards after being
delivered, while to a great extent they escape this entire class of
risks by being attended at home.
There are no doubt difficulties in assigning the exact effect of every
condition to which a lying-in woman may be exposed in contributing to
these death-rates, but there are, nevertheless, a few great fundamental
facts which arrest attention in such an enquiry.
It is a fact, for instance, that however grand, or however humble, a
home may be in which the birth of a child takes place, there is only one
delivery in the home at one time. Another fact is, that a second
delivery will certainly not take place in the same room, inhabited by
the same couple, for 10 months at least, and may not take place in the
same room for years. The Registrar-General has shown us that under these
conditions the death-rate among lying-in women all over England, and
from all registered causes, is about 5·1 per 1,000.
In many London workhouses the number of deliveries yearly is so small
that, so far as concerns annual deliveries, they approach more closely
to dwelling-houses divided among a number of families than they do to
lying-in hospitals properly so called.
Let us now see what relation there is between the annual deliveries and
the death-rates in these workhouse wards.
Assuming that the London workhouse lying-in wards have certain
conditions in common, we find that twenty-seven infirmaries suffered
from lying-in deaths in five years, and that in thirteen there were no
deaths in the same years. Now, in each of these twenty-seven hospitals
yielding deaths, the deliveries averaged 29 per annum, while in the
thirteen infirmaries without deaths the deliveries averaged under 16 per
annum.
Public-domain text, read in full here on John Shaqi.
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