London's Pulse: Medical Officer of Health reports 1848-1972
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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
London County Council 1909
[Report of the Medical Officer of Health for London County Council]
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101
In the foregoing table, where the conduct of the case by the midwife was criticised by the jury,
the reason for the censure was as follows:—
Not advising medical assistance early enough 6
Want of cleanliness and antiseptic precautions 4
Lack of ordinary skill (uncertified women) 4
Leaving a patient in a dangerous condition while going to obtain medical help 1
Not taking a patient's temperature 1
Making a declaration that a child suffocated in bed was still-born uncertined
woman) 1
17
In every case where a midwife did not comply with the rules of the Central Midwives Board
a letter of caution was addressed to her.
The medical evidence given at the inquests was that death was due to the following causes .—
| Mothers. | Infants. | ||
|---|---|---|---|
| Septicaemia | 11 | Weakness from prematurity | 15 |
| Peritonitis | 2 | Atelectasis | 22 |
| Perimetritis | 1 | Congenital heart disease or malformation | 10 |
| Exhaustion from ante partum hæmorrhage | 3 | Suffocation in bed | 11 |
| Post partum haemorrhage | 6 | Suffocation during act of birth | 7 |
| Pneumonia and pleurisy | 1 | Convulsions | 5 |
| Fatty degeneration of heart | 1 | Cerebral haemorrhage | 3 |
| Suicide | 1 | Haemorrhage from cord | 3 |
| 26 | Malnutrition | 2 | |
| Rupture of bowel | 1 | ||
| Acute inflammation of lungs | 1 | ||
| Bronchitis and broncho pneumonia | 9 | ||
| Jaundice | 1 | ||
| Syphilis | 1 | ||
| Suffocation from vomiting | 1 | ||
| Tubercle in mesenteric glands | 1 | ||
| Still-born | 3 | ||
| 101 | |||
Puerperal Fever.—During the year 1909, 287 cases of puerperal fever were notified within the
county, and the Registrar-General records 180 deaths from "puerperal septic diseases" during the
year. In addition to these, 2 deaths occurred in 1910 of cases notified in 1909. The term puerperal
septic disease used by the Registrar-General includes puerperal septicaemia, sapræmia and pyæmia,
as well as peritonitis and metritis occurring in connection with parturition. A list of these deaths
is obtained weekly from the General Register Office, and so it is possible to ascertain whether the
notified cases terminate fatally. Women confined outside the county who die in institutions in
London are included in the London deaths. Of the 287 notified cases, 132 proved fatal, a case
mortality of 46 per cent. Of the 50 remaining deaths recorded by the Registrar-General, 10 were
deaths in London institutions of women confined elsewhere, and probably notified as puerperal fever
in the district where the confinement took place. The other 40 cases were either cases in which
no diagnosis was made till after death or cases which for some other reason were not notified.
All cases of puerperal fever occurring in the practice of midwives were investigated by
the Council's inspectors, and full details of the illness obtained. Early information of notification of
this disease is received from the Metropolitan Asylums Board and the Medical Officers of Health,
and I am indebted to the latter for information as to by whom delivery was conducted. It has thusbeen
possible to learn whether a medical practitioner was in charge of the case or whether the delivery took
place in a hospital or poor law infirmarv or whether it was conducted bv a midwife or uncertified woman.
Adding the 50 deaths of cases not notified in London as puerperal fever to the 287 notified cases, we have 337 cases as to which enquiries were made, and the result of the enquiries was as follows:—
| Delivery conducted by | Cases. | Deaths. |
|---|---|---|
| (a) Medical practitioners (including cases attended by medical students and also cases in which, though a medical practitioner was in charge of the case, the birth took place before his arrival) | 182 | 90 |
| 83 | 39 | |
| (c) Medical practitioner and midwife (i.e., cases in which a midwife was unable to deliver and called in a medical practitioner) | 6 | 5 |
| 20 | 11 | |
| (e) Uncertified women acting as midwives | 10 | 6 |
| (f) Miscarriages and abortions where no attendant was engaged | 26 | 21 |
| (g) Cases where the patient died in London though confined elsewhere | 10 | 10 |
| Total | 337 | 182 |
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