The following table gives the actual fates and dates:—

Midwifery Statistics, King’s College Hospital.
Year Total Deliveries Fatal Cases Deaths to Labours
Date of Birth Nature of Labour Cause of Death Date of Death
1862 97 Nov. 6 Natural Puerperal peritonitis Nov. 25 1 in 32·3
„ 30 Twins Phthisis and puerperal fever Dec. 27
Dec. 10 Natural Puerperal peritonitis Dec. 20
1863 105 Jan. 10 Natural. Child still-born Puerperal fever Jan. 16 1 in 52·5
April 29 Natural Puerperal fever May 20
1864 141 Feb. 16 Natural Puerperal fever Feb. 25 1 in 47
April 14 Induced Pyæmia April 29
Dec. 1 Born in cab Hæmorrhage Dec. 7
1865 163 Jan. 30 Natural Embolism Feb. 12 1 in 32·6
Feb. 8 Natural Puerperal fever Feb. 18
June 24 Forceps Puerperal metritis and pelvis cellulitis July 30
Oct. 20 Forceps Laceration of perinæum, puerperal fever Nov. 3
Oct. 29 Natural Puerperal fever Nov. 9
1866 150 Jan. 10 Natural Gastro-enteritis Jan. 20 1 in 30
Mar. 24 Natural Retained placenta, puerperal fever April 10
Oct. 8 Placenta prævia. Turning Emphysema and bronchitis Oct. 10
Nov. 10 Forceps Peritonitis Nov. 15
Dec. 4 Natural Puerperal fever Dec. 31
1867 125 Jan. 10 (Had erysipelas when admitted[[2]]) Puerperal fever Jan. 30 1 in 13·8
Feb. 7 Natural Considerable hæmorrhage, puerperal fever Feb. 22
„ 8 Natural Puerperal fever Feb. 22
April 12 Turning Puerperal fever April 22
May 18 Natural Pyæmia May 27
June 4 Natural Puerperal fever June 19
July 26 Natural Puerperal fever Aug. 11
Nov. 5 Twins: 1st dead, 2nd by turning Puerperal fever Nov. 10
„ 8 Forceps Laceration of vagina, puerperal fever Nov. 14
Total 781 deaths: 27 1 in 28·9

Under these deplorable circumstances the closing of the wards was a matter of course; and since that event we have been anxiously enquiring whether it would be justifiable to re-open our Midwifery Nursing School under other conditions.

This question is discussed in the following pages, from a basis of statistical facts supplied by the best authorities; and a few proposals have been added, with the view of turning to the best account our past experience, by extracting from it any leading principles which may present themselves for practical application in the future construction and management of Lying-in Institutions, and more especially in connection with means of training Midwifery nurses.

These Introductory Notes, collected and put together under circumstances of all but overwhelming business and illness, are now thrown out merely as a nucleus, in the hope that others will be kind enough to supplement, to add, and to alter; in fact, only as a hook with a modest little fish on it—a bait to catch other and finer fish.

The facts themselves, the nucleus, have been made as correct as it was possible, and as would have been done for a finished work. But the facts themselves are only put forth as feelers—feelers to feel my own way.

I need scarcely say either that these ‘Notes’ are not at all meant to discuss every point which presents itself in Midwifery statistics. On the contrary, they are, for the moment, purposely limited to the consideration of facts immediately relating to the present object.

Let me thank once more with true gratitude all those who have so kindly supplied me with help and information, some of whose names will appear in the following pages.

CONTENTS.

PAGE
Preface [vii]–x
Table of Midwifery Statistics, King’s College Hospital [ix]
What is the real normal Death-rate of Lying-in Women? [1]
Midwifery Statistics [2]
Normal Death-Rate of Lying-in Women in England [4]
Table I.—Mortality after Childbirth in England, 1867 [4]
Table II.—Mortality per 1,000 after Delivery from Puerperal Diseases and Accidents of Childbirth [6]
Normal Mortality of Lying-in Women in different Countries [7]
Table III.—Death-rate from all Causes amongst Women delivered in their own Homes [8]
Objections to the Data [9]
Estimated Approximate Home Death-rate [11]
Death-rates in Lying-in Institutions [11]
Table IV.—Admissions and Deaths in Childbirth in eight Women’s Hospitals (Military) [12]
Table V.—Statistics of Midwifery Wards in Liverpool Workhouse [13]
Table VI.—Mortality after Childbirth in forty London Workhouses [13]
Table VII.—Mortality in Queen Charlotte’s Hospital [14]
Table VIII.—Mortality per 1,000 from all Causes after Delivery [15]
Table IX.—Mortality in Lying-in Ward, King’s College Hospital [15]
Table X.—Death-rate from all causes in Lying-in Hospitals [17]
Table XI.—Mortality per 1,000 among Lying-in Women at Paris Hospitals, 1861 [20]
Table XII.—Mortality per 1,000 among Lying-in Women at Paris Hospitals, 1862 [20]
Table XIII.—Mortality per 1,000 among Lying-in Women at Paris Hospitals, 1863 [21]
Classification of Causes of Mortality in Lying-in Institutions [21]
Causes of high Death-rates in Lying-in Institutions [23]
Puerperal Fever [24]
Admission of Students [25]
Effect of Numbers [26]
Danger of Puerperal Epidemics [31]
Fatality of Lying-in Wards in General Hospitals [32]
Influence of Construction and Management of Lying-in Wards on the Death-rate [33]
Maternité, Paris [34]
Hôpital de la Clinique, Paris [36]
Queen Charlotte’s Lying-in Hospital, London [38]
Midwifery Wards, King’s College Hospital, London [40]
Improved Lying-in Ward Construction [41]
Military Female Hospitals [41]
Table XIV.—Classification of Causes of Death in Childbirth in Eight Women’s Hospitals (Military) [43]
Proposed new Female Hospital at Portsmouth [45]
Should Medical Students be admitted to Lying-in Hospital Practice? [48]
Influence of Time spent in a Lying-in Ward on the Death-rate [50]
Effect of Good Management on the Success of Lying-in Establishments [52]
Liverpool Workhouse [53]
Summary of Cases Delivered in the Lying-in Wards of Liverpool Workhouse, 1868–1870 [53]
Summary of Deaths and Causes of Death in the same, 1858–1870 [54]
London Workhouses [58]
Management of Military Lying-in Wards [62]
Note on altogether disconnecting Lying-in Institutions even with the very name of Hospital [64]
Recapitulation [65]
Table XV.—Comparative Mortality among Lying-in Women in Hospitals and at Home [68]
Can the Arrangement and Management of Lying-in Institutions be Improved? [68]
CHAPTER II.
Construction and Management of a Lying-in Institution and Training School for Midwives and Midwifery Nurses [72]
I. Construction of a Lying-in Institution [74]
1. How many Beds to a Ward? [74]
Table XVI.—Proposed Registry of Midwifery Cases [75]
2. How many Wards to a Floor? [76]
3. How many Floors to a Pavilion (Hut or Cottage)? [76]
How many Beds to a Pavilion or Hut? [76]
How many Pavilions or Huts to a Lying-in Institution? [76]
4. How much Space to the Bed? [77]
The Delivery Ward [77]
5. How many Windows to a Bed? [78]
6. What are Healthy Walls, and Ceilings, and Floors? [78]
7. What is a Healthy and Well-lighted Delivery Ward? [79]
8. Scullery, Lavatory, W.C. [81]
9. How to ventilate Lying-in Wards [83]
10. Furniture, Bedding, Linen [84]
11. Water supply, Drainage, Washing [85]
12. Medical Officer’s Room and Waiting-Room [85]
13. Segregation Ward [86]
14. Kitchen [86]
Site [86]
II. Management [90]
First Rule of Good Management [90]
Second Rule of Good Management [91]
Third Rule of Good Management [93]
III. Training School for Midwives [94]
Description of Sketch-plans of Proposed Institution [100]
A Lying-in Institution For 40 beds (32 to 36 occupied), with a training school for 30 pupil Midwives and Nurses [102]
Appendix: Midwifery as a Career for Educated Women [105]