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It will thus be seen that whereas the deaths from puerperal fever in 1899 increased some
14 per cent. upon the deaths in 1898, the notified cases increased some 32 per cent. In 1898 the
London County Council had under consideration a letter from the Vestry of Bethnal-green, asking the
Council to add to the list of notifiable diseases named in section 55 of the Public Health (London) Act
the names of diseases included under the head of puerperal fever by the Registrar-General as follows—
" Both peritonitis and metritis when occurring in connection with parturition, as well aa puerperal
pyaemia, puerperal septicaemia, and puerperal sapraemia." The Council consulted Sir Samuel Wilks,
the President of the Royal College of Physicians, asking him whether in his opinion the various
diseases in question are included in the term " puerperal fever " and notifiable as such. Sir Samuel
Wilks laid the Council's letter before a committee of the Royal College, who adopted the following
resolution, which Sir Samuel Wilks stated he entirely approved—
" That this committee is of opinion that, with a view to the limitation of dangerous
infectious diseases, the London County Council would be acting rightly in adopting the view
that the expression 'puerperal fever,'as contained in section 55 of the Public Health (London)
Act, 1891, should be taken to include septicaemia, pyaemia, septic peritonitis, septic metritis
and other acute septic inflammations in the pelvis occurring as the direct result of childbirth."
Copies of this resolution have in some districts been communicated by medical officers of health
to medical practitioners in their districts, and this opinion has otherwise become known to medical men
in London, leading no doubt to increase in the number of cases of " puerperal fever " notified.
Inquiries by the medical officer of health of Paddington with respect to notified cases of " puerperal
fever," showed that "of four cases occurring in connection with the Queen Charlotte Maternity, two
were due to a septic case in Kensington not diagnosed at the date of the labours in this parish, and one
was a woman who had in bed with her at the time of her confinement, a child with a discharging sore (hip
disease;." In all of seven cases notified " there was evidence that drain emanations could and probably
did get access to the lying-in room." Inquiries by the medical officer of health of Kensington, who
warns nurses as to the precautions to be taken, showed that there was no extension of the disease from
one person to another. In Hampstead five cases were recorded, among which were two deaths. The
medical officer of health states that infection by the agency of the midwife was thought to be traced in
certain instances. The medical officer of health of Bethnal-green reports that a midwife practising in
the district had a number of cases. He directed her to cease attendances, to destroy all her infected
clothing, and to go into the country for a month. She had no fresh cases on her return. The medical
officer of health of St. Saviour, Southwark, states that after the occurrence of cases of puerperal fever
the bed and bedding were burnt and the rooms thoroughly disinfected, compensation being given
for the articles destroyed. In one of the cases the nurse in attendance was prevented from attending
any other lying-in patient for a period of two months, compensation being made to her. In Plumstead
of five cases of puerperal fever, which were recorded during the year, three were attended by
midwives.
Influenza, Bronchitis and Pneumonia.
The deaths attributed to influenza, which in 1898 numbered 1,283, rose to 1,817 in 1899,
the corrected annual average for the preceding ten years being 1,272. The deaths attributed to
bronchitis numbered 9,195, being 1,008 below the corrected annual average for the preceding ten
years; the deaths from pneumonia, however, were 597 in excess of this average, and numbered
0.666.

1 See footnote (2), page 3.