Cleanliness in Maternities 
JOSEPH PRICE, M. D., 
PHYSICIAN TO THE PRESTON RETREAT, PHILADELPHIA. 
FROM THE 
Medical and Surgical Reporter, 
July 26, 1890. [From the Medical and Surgical Reporter, 
July 26, 1890.] 
CLEANLINESS IN MATERNITIES.1 
PHYSICIAN TO THE PRESTON RETREAT, PHILADELPHIA. 
JOSEPH PRICE, M. D., 
There was a time when the abolishment 
of maternities was seriously considered, ow- 
ing to the ghastly death-rate, and the reason 
of the general mortality was not appreciated. 
Now we are come upon an era of cleanli- 
ness, and the recoveries from child-bed are 
about taken for granted, barring complica- 
tions entirely apart from a sanitary consid- 
eration. Not a great while ago there was 
an epidemic of typhoid fever in one of our 
great Eastern colleges. The students were 
prostrated in such numbers that the institu- 
tion was closed. Those who were not sick 
or dead went home, while those who were 
brave enough to stay were daily treated to 
addresses, and listened to prayers upon the 
inscrutable providence of God. But after 
a while a sanitary investigation was made and 
a reeking sewer-pipe, emptying its filth and 
poisoning all within its reach, was found and 
repaired, the premises were disinfected and 
the visitation of Providence ceased. This 
is about the light in which puerperal fever 
was not long ago considered. We now 
1 Read before the Section on Medicine, American 
Medical Association, May, 1890. 4 
know that in a majority of cases, especially 
in maternities, and illy drained and plumbed 
houses, it is due either to dirt or a poisonous 
miasm, deadly in the extreme or so attenu- 
ated as to produce annoying if not danger- 
ous symptoms. 
It is not my intention, in this paper, to 
discuss the etiology or the treatment of pu- 
erperal fever, but rather to give, from my 
own observation and practice, what I con- 
sider essential to the avoidance of child-bed 
mortality and complications. First of all, 
the water-closets and bath-rooms should be 
entirely outside of the maternity proper. 
In even the most poorly ventilated houses, 
I have noticed an absence of all puerperal 
complications when there was no closet in 
the house, even where the other sanitary ar- 
rangements were most ordinary. I thus con- 
cluded that the water-closet or imperfect 
plumbing was responsible for a great deal of 
the annoying and dangerous complications 
noticed in the maternity of which I have 
charge. The directors of the Retreat accord- 
ingly had the closets and bath-rooms put 
outside the lying-in wards and separated from 
them by wide halls, through which a current 
of fresh air is constantly passing. The pipes 
in the closets are all set out from the walls 
eight inches, the bath tubs likewise ; and all 
that is in any way likely to hold or retain 
dirt is rigidly excluded, even from these. 
The result was that the temperature charts 
of all the patients showed a lowering of 
their record, and a fever which was put 
down as due to the coming of the milk was 
shown to be avoidable by this improvement 
in the sanitary surroundings. 5 
Of course all this must be prefaced by 
scrupulous cleanliness within the wards. In 
the first place, no bed or mattress is used a 
second time without refilling. Each ward, 
after it has been occupied about two weeks, is 
emptied and scrubbed twice, and allowed to 
air for two or more weeks., after which time 
it again comes into use. The wards are all 
treated thus in order. The patients on being 
introduced into the house are all given a 
thorough bath, their clothes are changed and 
they are not allowed to wear anything from 
the outside or to keep it within the mater- 
nity proper. On being brought into the 
delivery room, after having been again 
bathed, they are given a vaginal douche of 
bichloride, and are delivered antiseptically 
at every stage. Nothing ever comes into 
the delivery room that does not belong 
there; neither is anything allowed to be 
taken therefrom. After delivery the woman 
is removed to the ward. For napkins I use 
corrosive jute covered with corrosive cheese 
cloth. They are made for the Retreat in 
quantity, and are a great convenience, in- 
suring entire cleanliness, and obviating the 
necessity of washing linen or cotton nap- 
kins, These are used the first three days 
and are frequently renewed, especially im- 
mediately after delivery. The greatest at- 
tention is given to the linen of the patients 
and of their beds. No spot or stain is 
allowed, and when a garment is spotted or 
stained in the least it is removed. Cloth- 
ing so removed is collected outside the 
ward in one of the free passages, where air 
is circulating constantly, and the basket for 
this purpose is emptied regularly every two 6 
hours by a laundry attache whose business 
it is to look after this part of the work. 
I shall make a still farther improvement 
in this respect as soon as the arrangements 
can be perfected, so that the collection of 
soiled linen shall be entirely without the 
building. 
So far as the wards are concerned, they 
are ventilated by central passages at right 
angles having free communication with the 
outside air. In addition to this, each ward 
on one side has direct communication with 
one of the outside porches, enclosed simply 
by window walls for the admission of light 
and air. The laundry and all its appurte- 
nances are outside of the maternity. The 
only defective regulation is that of the culi- 
nary department. This unfortunately is 
within the building. It should be either on 
the top floor or entirely outside, which is 
far preferable. These are the main points 
which I feel justified in referring to as con- 
nected with the results in the maternity 
within the last three years. There have 
been about 500 deliveries with no deaths of 
the mother and with a mortality of none in 
infants. 
In private obstetrical practice, where a 
mixed population is absent, some of the de- 
tails of the extreme measures for protection 
from dirt are, of course, not needed. Never- 
theless, the general practitioner, if he would 
have a clear record and a clear conscience, 
must adopt a system of general cleanliness, 
which he must practice in a routine fashion, 
in order to avoid sooner or later a fatality 
where he will least expect it. He must see 7 
that the arrangement of the lying-in bed is 
not completed with dirty sheets, which soiling 
is supposed not to hurt, that no old carpets or 
table oil-cloths are used to protect the bed 
and that the patient has had no preceding vag- 
inal irritative discharge ; or if she has had, 
he should take measures to render it harm- 
less, both for the mother’s sake and for that 
of the infant. In these days any physician 
who allows a child to be born with a puru- 
lent ophthalmitis is directly responsible for 
it, simply because with the proper precau- 
tions this can be avoided. A scrupulous 
observance of cleanliness in his own person, 
a change of garments and a bath after the 
handling of doubtful cases or of dangerous 
cases of fever or of sepsis before entering 
the lying-in room, will take away the chance 
of poisoning the lying-in woman and ren- 
der ridiculous the custom still in vogue, 
by which a physician, when he has poisoned 
a series of women, seeks to escape the dan- 
ger of further malfeasance by taking a va- 
cation, instead of going to a Turkish bath 
and leaving his filth behind him and com- 
ing out a clean man. 
The obstetrician who goes to an obstetric 
case without clean hands, clean finger-nails, 
clean linen and clean clothes runs just as 
much risk as the physician who recklessly 
prescribes a dangerous medicine and allows 
his patient to take it ad libitum. 
The whole obstetric procedure has, for its 
first element of success, cleanliness; for its 
second element, cleanliness, and cleanliness 
for its every element—cleanliness of the pa- 
tient, cleanliness of the physician, cleanli- 8 
ness of the nurse, cleanliness of the instru- 
ments when they are used and cleanliness 
in the after attention. 
A final word in reference to the changing 
of napkins. These, during the first three 
days after delivery, should be changed every 
hour and burned. Soft, clean old linen 
should be employed, and due attention 
should be given to protect, by napkin or 
pad, the bed clothing which, of course, is 
usually not so abundant in the ordinary pri- 
vate house as in the specially equipped 
hospital.