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46
her who had an attack of what was pronounced by the
relatives to have been chicken-pox, no doctor being called
in. The child returned to his home in Fulham, the Medical
Officer of which district saw him at my request, but was
unable, owing to the long interval, to say what the disease
had really been.
Cholera. —The only case notified as cholera, proved to
be one of severe diarrhoea, due to an excessive consumption
of vegetables and fruit.
Relapsing Fever.—The patient in this case was a
publican's manager, whose circumstances in life were
altogether the reverse of those with which this disease is
usually associated.
Puerperal Fever.—There were 8 cases of this disease
notified during the year, 6 of which terminated fatally.
The inquiries made showed that each case was independent
of the others, and that there was no community of medical
attendants or midwives.
There was in addition one case of this disease which was
not notified, the death being registered on the Coroner's
certificate, after inquest and post-mortem examination.
In two other cases the certificates of notification were
not received until after the deaths had been registered,
when the attention of the medical attendants was called to
the omission to notify.
The mortality among the notified cases last year was very
excessive, 75 per cent., but there is good reason to think
that all cases of this disease were not notified. It is by no
means easy to say what is puerperal fever. It is almost
certain that there should be no fever in the puerperium,
and that any fever so occurring means septic infection,
unless there be an intercurrent disease, such as scarlet
fever. Assuming that all febrile symptoms during this stage
to be due to sepsis, there remains the difficulty of deciding
what is "puerperal fever" in the strict sense of the
word, as the septic infection may take a very mild form,