Part 3

┌───────────┬──────────────────────────────────────────────────────┐ │ Station │ │ │ │ Causes of Death │ ├───────────┼─────────┬────────┬────────┬──────────┬────────┬──────┤ │ „ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ Pneumonia│ │ │ │ │Inversion│ │ │ and│ │ │ │ │of Uterus│Embolism│Metritis│Bronchitis│Phthisis│Dropsy│ ├───────────┼─────────┼────────┼────────┼──────────┼────────┼──────┤ │Devonport │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │Colchester │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │Portsmouth │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │Aldershot │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ 1[3]│ 2│ 1│ │ │Shorncliffe│ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │Chatham │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ 1[4]│ │ │ │ │ │ │Woolwich │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ 1│ │ │ │ 1│ │Curragh │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ ├───────────┼─────────┼────────┼────────┼──────────┼────────┼──────┤ │ Total │ 1│ 1│ 1│ 2│ 1│ 1│ └───────────┴─────────┴────────┴────────┴──────────┴────────┴──────┘

┌───────────┬────────┬──────┐ │ Station │Causes │Total │ │ │of Death│Deaths│ ├───────────┼────────┼──────┤ │ „ │ │ │ │ │ │ │ │ │ │ │ │ │ Cause│ │ │ │ not│ │ │ │recorded│ „ │ ├───────────┼────────┼──────┤ │Devonport │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ 1│ │Colchester │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │Portsmouth │ │ │ │ │ │ │ │ │ │ │ │ │ │ 4│ │Aldershot │ │ │ │ │ │ │ │ │ │ │ │ │ 1│ 31│ │Shorncliffe│ │ │ │ │ │ │ │ │ │ 4│ │Chatham │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ 3│ │Woolwich │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ 8│ │Curragh │ │ │ │ │ │ │ │ │ │ │ ├───────────┼────────┼──────┤ │ Total │ 1│ 51│ └───────────┴────────┴──────┘

In Liverpool workhouse lying-in wards (Table V.), with an approximate number of 6,396 deliveries in 13 years, there were 58 deaths from all causes—a mortality of 9·06 per 1,000.

TABLE V.—_Statistics of Midwifery Wards in Liverpool Workhouse for Thirteen Years, 1858–70 inclusive._ (_Abstracted from data supplied by Dr. Barnes, Liverpool._)

┌───────────┬─────────────────────────────────────────────────────┐ │Approximate│ Causes of Death │ │ Total │ │ │Deliveries │ │ ├───────────┼───────────┬─────────┬────────┬──────────┬───────────┤ │ „ │ Puerperal │Puerperal│Metritis│Phlegmasia│Convulsions│ │ │Peritonitis│ Fever │ │ Dolens │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ ├───────────┼───────────┬─────────┬────────┬──────────┬───────────┤ │ 6396│ 16│ 4│ 1│ 1│ 5│ └───────────┴───────────┴─────────┴────────┴──────────┴───────────┘

┌───────────┬──────────────────────────────────────────────────┐ │Approximate│ Causes of Death │ │ Total │ │ │Deliveries │ │ ├───────────┼──────────┬──────────┬──────────┬───────┬─────────┤ │ „ │ Debility │Obstructed│Hæmorrhage│Rupture│ Typhus │ │ │ and │ Labour │ │ of │ and │ │ │Exhaustion│ │ │Uterus │Relapsing│ │ │ │ │ │ │ Fever │ ├───────────┼──────────┬──────────┬──────────┬───────┬─────────┤ │ 6396│ 5│ 1│ 2│ 1│ 2│ └───────────┴──────────┴──────────┴──────────┴───────┴─────────┘

┌───────────┬───────────────────────────────────────────────────────┐ │Approximate│ Causes of Death │ │ Total │ │ │Deliveries │ │ ├───────────┼───────┬─────────┬──────────┬────────┬───────┬─────────┤ │ „ │Measles│Pneumonia│Laryngitis│Phthisis│ Heart │Nephritic│ │ │ │ │ │ │Disease│ Disease │ │ │ │ │ │ │ │ and │ │ │ │ │ │ │ │ Dropsy │ ├───────────┼───────┬─────────┬──────────┬────────┬───────┬─────────┤ │ 6396│ 1│ 3│ 1│ 4│ 5│ 3│ └───────────┴───────┴─────────┴──────────┴────────┴───────┴─────────┘

┌───────────┬──────────────────┬──────┐ │Approximate│ Causes of Death │Total │ │ Total │ │Deaths│ │Deliveries │ │ │ ├───────────┼────────┬─────────┼──────┤ │ „ │Jaundice│ Not │ „ │ │ │ and │ Stated │ │ │ │ Bowel │(Inquest)│ │ │ │Disease │ │ │ ├───────────┼────────┬─────────┼──────┤ │ 6396│ 2│ 1│ 58│ └───────────┴────────┴─────────┴──────┘

And in 27 London workhouse infirmaries (Table VI.), amongst which deaths took place, having 9,411 deliveries in five years, there were 93 deaths from all causes. The death-rate was 9·8 per 1,000.[6]

TABLE VI.—_Mortality after Childbirth in Five Years, up to the end of 1865, in Forty London Workhouse Infirmaries in which Deliveries took place._ (_Abstracted from Report on Metropolitan Workhouses._) ┌────────────────────┬─────────┬──────────┬─────────┬───────────┬──────┬──────┐ │ Deliveries │ Deaths│ Deaths │ Deaths │Deaths from│Deaths│Total │ │ │ from│ from │ from │Consumption│ from │Deaths│ │ │Puerperal│Accidents │Miasmatic│ and Chest │ all │ │ │ │ Diseases│ in │Diseases │ Diseases │Other │ │ │ │ │Childbirth│ │ │Causes│ │ ├────────────────────┼─────────┼──────────┼─────────┼───────────┼──────┼──────┤ │27 workhouses: 9,411│ 39│ 20│ 0│ 15│ 19│ 93│ │13 „ 2,459│ 0│ 0│ 0│ 0│ 0│ 0│ └────────────────────┴─────────┴──────────┴─────────┴───────────┴──────┴──────┘

The City of London Lying-in Institution, during ten years, 1859–1868, had 4,966 deliveries, and 54 deaths—a rate of 10·9 per 1,000.

The British Lying-in Institution had 1,741 deliveries, and 25 deaths, in 11 years, 1858–1868, giving a death-rate of 14·3 per 1,000 (Table VIII.).

The mortality in Queen Charlotte’s Lying-in Hospital: 9,626 deliveries, and 244 deaths, from 1828 to 1868 (Table VII.), was 25·3 per 1,000.

TABLE VII.—_Mortality in Queen Charlotte’s Lying-in Hospital, 1828 to 1868._ ┌──────────┬─────────┬──────────┬─────────┬───────────┬───────┬───────┐ │Deliveries│ Deaths │ Deaths │ Deaths │Deaths from│Deaths │ Total │ │ │ from │ from │ from │Consumption│ from │Deaths │ │ │Puerperal│Accidents │Miasmatic│ and Chest │ all │ │ │ │Diseases │ in │Diseases │ Diseases │ Other │ │ │ │ │Childbirth│ │ │Causes │ │ ├──────────┼─────────┼──────────┼─────────┼───────────┼───────┼───────┤ │ 9,626│ 138│ 51│ 8│ 32│ 15│ 244│ └──────────┴─────────┴──────────┴─────────┴───────────┴───────┴───────┘

The Rotunda Hospital, Dublin, with 6,521 deliveries in the years 1857–1861, yielded 169 deaths—a death-rate of 26 per 1,000. But, if we take the years 1828–1861, with 63,621 deliveries, we find that the deaths were 924, and the death-rate only 14·5 per 1,000—the average annual number of deliveries being almost as many thousands as in Queen Charlotte’s Hospital were hundreds.

TABLE VIII.—_Mortality per Thousand from all Causes after Delivery._ (_Abstracted from Official Reports and Returns._) ┌───────────────────────────────────┬───────────┬─────────┬───────────┐ │ Places │ │ │ Deaths per│ │ │ │ │ Thousand│ │ │Deliveries │ Deaths │ Deliveries│ ├───────────────────────────────────┼───────────┼─────────┼───────────┤ │12 Parisian hospitals {1861 │ 7,309│ │ 95·1│ │ „ {1862 │ 7,027│ │ 69·7│ │ „ {1863 │ 7,289│ │ 70·3│ │King’s College Hospital, 1862–7 │ 780[7]│ 26│ 33·3│ │Rotunda Hospital, Dublin, 1857–61 │ 6,521│ 169│ 26·0│ │Queen Charlotte’s Lying-in │ │ │ │ │ Hospital, 1828–68 │ 9,626│ 244│ 25·3│ │British Lying-in Institution, 11 │ │ │ │ │ years, 1858–68 │ 1,741│ 25│ 14·3│ │City of London Lying-in Hospital, │ │ │ │ │ 1859–68 │ 4,966│ 54│ 10·9│ │8 military lying-in hospitals, 2 to│ │ │ │ │ 12 years │ 5,575│ 50│ 8·8│ │Liverpool Workhouse Lying-in Wards,│ │ │ │ │ 13 years, 1858–70 │ 6,396│ 58│ 9·06│ │40 London workhouse infirmaries, 5 │ │ │ │ │ years │ 11,870│ 93│ 7·8│ │1 military lying-in hospital (a │ │ │ │ │ wooden hut) 1865–70 │ 252│ 0│ 0│ │All England, 1867 │ 768,349│ 3,933│ 5·1│ └───────────────────────────────────┴───────────┴─────────┴───────────┘

The lying-in wards of King’s College Hospital, years 1862–1867 (Table IX.), gave 27 deaths—a death-rate of 33·3 per 1,000 on 780 deliveries.

TABLE IX.—_Mortality after Childbirth in Lying-in Ward, King’s College Hospital, 1862 to 1867._ ┌──────────┬─────────┬──────────┬─────────┬───────────┬───────┬───────┐ │Deliveries│ Deaths │ Deaths │ Deaths │Deaths from│Deaths │ Total │ │ │ from │ from │ from │Consumption│ from │Deaths │ │ │Puerperal│Accidents │Miasmatic│ and Chest │ all │ │ │ │Diseases │ in │Diseases │ Diseases │ Other │ │ │ │ │Childbirth│ │ │Causes │ │ ├──────────┼─────────┼──────────┼─────────┼───────────┼───────┼───────┤ │ 781[8]│ 23│ 1[8]│ 0│ 1│ 2│ 27│ └──────────┴─────────┴──────────┴─────────┴───────────┴───────┴───────┘

Lamentable as are these death-rates in many British institutions, they are small in comparison with those which have ruled in many foreign hospitals.

Table X. contains an abstract from Dr. Le Fort’s work of the statistics of 58 lying-in institutions in nearly every country of Europe, and extending in many cases over a considerable number of years. There is only one hospital (at Bourg) in which there was no death in 4 years, out of 461 deliveries.

There is one hospital (at Troyes), with a death-rate of 4 per 1,000 on 460 deliveries in 4 years.

There are two instances of death-rates of 7 per 1,000. There is one of 9, and there are two of 10 per 1,000.

In every other case the death-rates have exceeded these amounts, rising higher and higher in different institutions, until they culminate in a death-rate of no less than 140 per 1,000, at Strasburg, on a four years’ average among 556 deliveries. Le Fort’s data show a striking variation in the death-rates of the same hospitals in different years, as will presently be seen to be the case in hospitals in this country. There are instances in these foreign hospitals of the death-rates varying from 4 to 7–fold in different groups of years in the same hospital.

Le Fort’s data show that in lying-in hospitals in various countries and climates, scattered over nearly the whole of Europe, out of 888,312 deliveries there were no fewer than 30,394 deaths, giving an average death-rate of 34 per 1,000, a rate exceeding the high mortality which led to the discontinuance of our school for training midwifery nurses in King’s College Hospital.