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76 Annual Report of the London County Council, 1914,

The number of fatal cases of puerperal fever which followed abortion or miscarriage was 27.
The classification of these cases is shown by the figures in brackets in the last column of the above
table.

In each case where a midwife was concerned the Council's inspector visited her, learnt particulars
of the case, made enquiries as to any other patients recently attended, and took steps to
ensure that the rules as to disinfection were fully carried out before the midwife resumed her work.
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; 271 notices were
received stating that medical assistance had been ad vised for this reason. The inspector learnt from the
midwife whether the high temperature was persistent, and in 160 cases it was found that the temperature
had fallen, or that no further symptoms of puerperal fever had occurred. In cases of puerperal fever
the services of the nurses of the Queen Victoria Jubilee Institute and the Holloway Institute are usually
available in the districts which they serve, 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.