The role of the Doran Building in puerperal fever in Canada

The Doran Building at the Kingston General Hospital, opened in 1894, represents an early Canadian initiative to apply the principles of sanitation, antisepsis, and asepsis to prevent puerperal fever ina freestanding lying-in hospital. This initiative was a response to maternal mortality during the 17th and 18th centuries, when approximately half of maternal deaths were due to puerperal fever. During the 250 years leading up to 1890, an understanding of the clinical nature of puerperal fever, its cause, mode of spread, and means of prevention had gradually developed. Despite this progress, puerperal fever remained a major cause of maternal mortality in the latter part of the 19th century. The Doran Building is a compact example of a pavilion hospital,built as a freestanding facility for women and children, with its own staff. Kenneth Fenwick, who was Professor of Obstetrics and Gynaecology at Queen's University and a vigorous advocate of sanitation, antisepsis, and asepsis, established the principles of patient care in the Doran Building during the period 1894 to 1928.His goal was the prevention of maternal mortality due to puerperal fever. During this period, there was a modest increase in the number of deliveries each year to a total of 3111 by 1928. There were 26 direct and indirect maternal deaths, representing a maternal mortality rate of 8.25 per 1000 live births. Puerperal fever accounted for the deaths of three women: one who had delivered in hospital and two who had delivered in the community and had been admitted following delivery. The application of the principles of isolation, sanitation, antisepsis, and asepsis limited the mortality in hospital due to puerperal fever in a manner consistent with the best hospitals elsewhere at that time.