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.