London's Pulse: Medical Officer of Health reports 1848-1972
View report page
Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
London County Council 1911
[Report of the Medical Officer of Health for London County Council]
This page requires JavaScript
Report of the Medical Officer of Health.
79
The rule which requires that medical help shall be advised when the patient's temperature rises
to 100.4 deg. and remains above that figure for 24 hours has proved useful in affording information
concerning cases in which there is danger of the development of puerperal fever ; 225 notices were
received stating that medical assistance had been advised for this reason. The inspector learnt from the
midwife whether the high temperature was persistent and in 181 cases it was found that the temperature
had fallen, or that no further symptoms of puerperal fever occurred. In some cases where the temperature
remained high, although the case had not then been notified, the midwife was directed to undergo the
usual disinfection before going to another case. In 44 instances the rise of temperature proved to be
the first indication of septic trouble and the inspector was thus able in some cases, before the notification
as puerperal fever was known to her, to prevent the midwife from attending other patients until disinfection
had been thoroughly carried out. In cases of puerperal fever the services of the nurses of the
Queen Victoria Jubilee Institute, the Ranyard and the Holloway Institutes are usually available so
that when the midwife ceases to visit, the patient is left in the hands of a skilled nurse to carry out the
directions of the medical practitioner called in. In cases where a midwife has pupils or assistants one
of them is sometimes set apart to nurse the septic case, attending no other patients meanwhile. A
midwife is thus usually able to carry out disinfection and resume her work with as little delay as is
necessary to ensure that she is no longer likely to be a source of infection to other patients.
The following table shows the day or the puerperium on which (a) the rise or temperature (if noted) occurred,
| Day of confine- ment. | 2nd day. | 3rd day. | 4th day. | 5 th day. | 6th day. | 7 th day. | 8th day. | 9 th day. | 10th day. | After 10th day. | Total. | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Recovery cases | 1 | 1 | 10 | 9 | 6 | 6 | 1 | 5 | 1 | 6 | 46 | |
| Fatal cases | -— | 6 | 3 | 2 | 1 | 1 | 2 | 15 | ||||
| Recovery cases | 3 | 1 | 6 | 13 | 5 | 4 | 2 | 3 | 5 | 52 | ||
| Fatal cases | 2 | 6 | 1 | 2 | - | 2 | 3 | |||||
| Recovery cases | -— | 2 | 6 | 4 | 3 | 3 | 3 | 5 | 7 | 19 | 52 | |
| Fatal cases | -— | 2 | 2 | 3 | 2 | 2 | - | - | 2 | 13* | ||
| -— | -— | 1 | 2 | - | 1 | 2 | 2 |
Of the 8 deaths occurring after the 10th day of lying in, five occurred before the 20th day, another
before the 30th day, and two after the 30th day. In 7 cases (1 of them fatal) no rise of temperature
above 100.4 deg. was noted by the midwife during her attendance, and medical help was either called
by her for some other reason or else it was called by the patient's friends after the midwife had ceased
to attend.
The parity of women who contracted puerperal fever was ascertained from the midwife to be:-
| Total. | Primipara. | 2 para. | 3 para. | 4 para. | 5 para. | 6 para. | 7 para. | 8 para. | 9 para. | 10 para. | Over 10 para. | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Recovery | 52 | 13 | I 9 | 8 | 3 | 6 | 4 | 1 | 3 | 2 | 1 | |
| Fatal | 16 | 5 | 1 | 4 | 1 | - | 2 | 3 | - | - | - | - |
The following conditions were noted among the cases of puerperal fever attended by midwives :—
Recovery. Fatal.
Laceration of perineum 2
Retained or adherent placenta 4 3
Ante partum hæmorrhage 1 —
Post partum hæmorrhage 5 1
Ragged placenta (thought complete by midwife) 3 —
Prolonged labour 1 —
Syphilis or gonorrhœa 1 1
Pneumonia 1
Macerated infant 1 —
Domestic trouble after confinement 2 1
In six cases of puerperal fever, birth took place before the arrival of the midwife.
Nine midwives each had two cases during the year, in three instances the interval between the
cases was three months or more and there was no reason to connect the cases with one another.
* 3 fatal cases attended by midwives were not notified.