The great mortality in lying-in hospitals everywhere is no doubt a strong argument against such a result being attainable; so much so that, in the absence of this security, the evidence in the preceding pages appears sufficient to warrant the question being raised, whether lying-in hospitals, arranged and managed as they are at present, should not be forthwith closed? Can any supposed advantages to individual cases of destitution counterbalance the enormous destruction of human life shown by the statistics? Without vouching for the entire accuracy of Le Fort’s data, they may still be taken generally as showing approximately the penalty which is being paid for the supposed advantages of these institutions. It is this: (see Table XV.) for every two women who would die if delivered at home, fifteen must die if delivered in lying-in hospitals. Any reasonable deduction from this death-rate for supposed inaccuracy will not materially influence the result. TABLE XV., _abstracted from_ TABLES III. _and_ X., _showing Comparative Mortality among Lying-in Women in Hospitals and at Home_. ┌──────────────────────────────────────────┬──────────┬──────┬────────┐ │ │ │ │ │ │ │ │ │ Deaths │ │ │ │ │ per │ │ │Deliveries│Deaths│Thousand│ ├──────────────────────────────────────────┼──────────┼──────┼────────┤ │Total for all hospitals │ 888,312│30,394│ 34│ │Total delivered at home │ 934,781│ 4,405│ 4·7│ ├──────────────────────────────────────────┼──────────┼──────┼────────┤ │Excess of deaths per thousand delivered in│ │ │ │ │ hospitals │ │ │ 29·3│ └──────────────────────────────────────────┴──────────┴──────┴────────┘ The evidence is entirely in favour of home delivery, and of making better provision in future for this arrangement among the destitute poor. _CAN THE ARRANGEMENT AND MANAGEMENT OF LYING-IN INSTITUTIONS BE IMPROVED?_ Must we, then, surrender the principle of lying-in institutions altogether, and limit the teaching of midwifery nurses solely to bedside cases at home, notwithstanding the well-known difficulties of teaching pupils at the beginning of their course elsewhere than in an institution? We will try to reply to this question; and, in doing so, perhaps some light may be thrown on another question, viz.: how to improve existing lying-in establishments so as to reduce the mortality in them. Evidence sufficient has been collected to show that no one panacea will enable us either to possess a perfectly healthy building, or to improve existing hospitals.