View report page

27
Re-port of the County Medical Officer—General.
The high mortality rate of age-group 15-20 is due to the smallness of the figures upon which it
is calculated ; apart from this age-period it will be noticed that the mortality increases with advancing
age.
The Council as Local Supervising Authority receives information of cases of puerperal fever
occurring in the practice of midwives. During the year 1914 one midwife had four cases of puerperal
fever, seven had three, and fourteen had two each.
Midwife having four cases during the year:—
The first case was confined on 7th March, but was not notified as puerperal fever until the 17th
day, two days after being sent into the infirmary. On the 13th day of the puerperium there was a
rise of temperature and when the midwife heard of this she disinfected. The second case occurred on
28th March (third day of the puerperium), and was immediately removed to infirmary. There was an
interval of 16 days between midwife's last visit to former patient and this delivery, during which she
attended 24 women, all of whom did well. The midwife was disinfected and was allowed to resume
work four days later. The next case occurred on 29th May, and the fourth at the end of September.
None of the patients died.
Midwives having three cases each during the year :—
A attended a case early in January and was disinfected; the patient died. The second case
occurred early in April, after which the midwife was again disinfected. The third case occurred six
weeks later.
B attended a case on 5th February. The midwife ceased attendance on the twelfth day and
went away for a few days' holiday. No special disinfection was done as the case was not notified as
puerperal fever until some time after the midwife had left. In the second case the birth occurred on
20th February, but the case was not notified as puerperal fever till seven days after the midwife had
ceased attending. The midwife did not disinfect but refrained from practising for two weeks. The
third case occurred in October, and all three patients recovered.
C attended a case on 12th April, which, however, was not notified as puerperal fever till two
days after the midwife ceased attending. The temperature having temporarily risen during the
puerperium the midwife, on leaving, disinfected as in cases of puerperal fever except as regards her
bonnet and cloak which were only exposed to the air. On 22nd April the midwife delivered the
second woman, whose temperature became raised on 28th April. In the interval between these two
births the midwife had delivered sixteen other cases in none of which was there a rise of temperature.
The third case occurred in July. All three patients recovered.
D was engaged, as nurse, for a confinement in April and the doctor, under whose directions she
was to act, arrived after the birth. This case terminated fatally. In the second instance, the confinement
took place on 22nd October, and the case was notified as puerperal fever on 30th October,
after which the midwife ceased attending all her other patients and disinfected on 2nd November when
she was allowed to resume work. Prior to the notification of this patient the midwife had been nursing
a third patient who was, however, not notified as suffering from puerperal fever until 9th November.
Neither of these cases proved fatal, and the midwife did not resume work for some weeks.
E had a case in June, after which she was disinfected and resumed work. Two other cases
occurred in October, there being a rise of temperature in each instance on the same day. All three
patients recovered.
F had a case in June, and after disinfection resumed work. The second case was notified as
puerperal fever on 21st September. After disinfection, work was resumed. The third confinement
took place on 14th October, and in this instance the patient was very excited owing to the absence of
her husband on war service. All three patients recovered.
G had a case in March, after which she was disinfected and resumed work. The second confinement
took place on 31st October. As soon as the patient was known to be suffering from puerperal
fever (4th November), the midwife notified the Council and, as she had taken all necessary precautions
against infection, she was allowed to resume work on the evening of 5th November. In the third
case the patient was confined on 6th November. On the third day a doctor was called in, and
on the fifth day the patient was notified to be suffering from puerperal fever. Extra precautions against
infection were again taken and the midwife attended no cases for six days. No blame was attributable
to the midwife, whose cases have since done well.
Phthisis.
The London deaths from phthisis, including acute miliary tuberculosis, during 1914 (52 weeks)
numbered 6,281, as compared with 5,981 in 1913 (53 weeks). The death-rates from this disease in
1914 and preceding periods are given in table I., page 40.
Since the year 1910 the deaths from phthisis belonging to the London population have been
more completely ascertained than in previous years; and further the deaths from phthisis
include deaths from miliary tuberculosis, which previously had been included under general
tuberculosis. These two circumstances in conjunction disturb the continuity of the phthisis deathrates
shown on page 40, but it is unfortunately not possible to determine with any certainty from
the published figures of the Registrar-General whether, or to what extent, the increase in the deathrate
in 1911 denotes an actual increase in the mortality in that year over 1910. The more accurate
local distribution of deaths would not, however, affect the rate for England and Wales as a whole ;
and from the fact that the increase shown in this rate (exclusive of miliary tuberculosis), in 1911 over
1910, in the Annual Report of the Registrar-General for 1911 (see p. 35) amounted to 4'6 per cent., it
27715
E 2