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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these days, and 15 subsequently proved fatal. The following table shows the day of the puerperium on which (a) a rise of temperature was noted, (b) medical help was obtained, (c) the case was notified as puerperal fever, and (d) the death took place in fatal cases
| Day of Confinement. | 2nd day. | 3rd day. | 4th day. | 5th day. | 6th day. | 7th day. | 8th day. | 9th day. | 10th day. | After 10th day. | Total. | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| (a) Rise of temperature | ||||||||||||
| Recovery cases | 1 | 1 | 9 | 12 | 4 | 6 | 1 | 1 | 1 | — | 36 | |
| Fatal cases | 2 | 2 | 9 | 6 | 1 | 3 | 2 | — | 2 | 1 | — | 28 |
| Recovery cases | 1 | 1 | 6 | 10 | 7 | 5 | 1 | 3 | 2 | — | 8 | 44 |
| Fatal cases | 4 | 2 | 6 | 6 | 2 | 4 | 3 | — | 3 | 2 | 7 | 39 |
| (c) Notified as puerperal fever— | ||||||||||||
| Recovery cases | — | — | 1 | 3 | 6 | 5 | 4 | 6 | 2 | 2 | 15 | 44 |
| Fatal cases | — | 1 | 1 | 2 | — | 3 | 1 | 4 | 4 | — | 17 | 33f |
| 1 | 4 | 4 | 3 | 4 | 23 | 39 |
Of the 23 deaths occurring after the tenth day, 14 patients died within 20 days, 6 died within a
month, 2 died two months, and 1 six months after confinement. In 3 cases in the above table
medical assistance was advised by the midwife on account of abdominal pain, and in one case on
account of post partum haemorrhage. All these four cases had no high temperature during the midwife's
attendance. In 15 other cases medical assistance was called in by the patient's friends after the
tenth day, and the date of rise of temperature, if such rise occurred, has not been learnt. These 15
cases are said to have first shown symptoms which led to the calling of a medical practitioner on the
following days:—11 th day, 1 recovery; 12th day, 4 recovery, 2 fatal; 13th day, 1 recovery, 2 fatal;
16th day, 1 fatal; 17th day, 2 fatal; 19th day, 1 recovery; 32nd day, 1 fatal.
The parity of women suffering from puerperal fever was ascertained from the midwives to be as follows:—
| Total. | Primi-para. | 2 para. | 3 para. | 4 para. | 5 para. | 6 para. | 7 para. | 8 para. | 9 • para. | 10 para. | Over 10. | Multipara, no definite statement. | No statement. | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Recovery | 44 | 9 | 5 | 5 | 5 | 2 | 2 | 3 | 3 | 0 | 0 | 2 | 5 | 3 |
| Fatal ,. | 39 | 12 | 5 | 3 | 5 | 2 | 0 | 2 | 0 | 1 | 1 | 4 | 3 | 1 |
The following conditions were noted among the cases of puerperal fever attended by midwives:—
Laceration of the perineum in 7 cases.
Adherent placenta in 5 cases.
Retained placenta in 3 cases.
Ante partum haemorrhage in 1 case.
Post partum haemorrhage in 3 cases.
Uterine inertia and delay in birth in 3 cases.
Decomposed faetus in 1 case.
In 9 cases the birth took place before the midwife arrived and consequently she could not
adopt proper measures to cleanse her patient before labour.
One midwife had 5 cases of puerperal fever in her practice during the year. This midwife
had a large practice. Her first case of puerperal fever occurred on August 1st. She ceased
attending patients and was disinfected. She subsequently resumed her practice, and attended
consecutively 65 patients, who did well. A second case of puerperal fever then occurred in her
practice. This patient was confined on the 29th October, two months after the occurrence of the
first case, and her illness was notified on the 3rd November. The midwife again ceased practice
and was disinfected. Later she resumed her practice, and delivered some 18 women, all doing well,
until November 20th, when one of those who had been confined on the 15th November had a rise of
temperature on the 20th November, and on the 27th November was recognised to be suffering from
septic pneumonia. On the occurrence of this symptom in this patient on the 20th November, the
midwife, as a precautionary measure, again ceased practice and was disinfected, but subsequently
resumed her practice, using entirely different appliances and attending numerous patients, two of whom,
confined on the 27th and 28th November, apparently before the nature of the case notified on the 27th
November was known to her, later developed puerperal fever.
† Six cases were not notified.
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