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21 are totally unfit for work of any kind, and 3
cannot be traced.
In addition to the high mortality and the diminution
in working and earning capacity resulting from this
condition, marked mental and physical changes occur
which profoundly alter the patient's character and
intellect and lead to paralysis and insanity. The
disease causes congestion, infiltration and ultimately
degeneration of the central nervous system.
Cases are admitted to the Fulham Hospital in all
stages of the disease, and those in the early stage are
admitted to the infectious diseases hospitals of the
Metropolitan Asylums Board. The London County
Council make special provision for the institutional
treatment of children under 15 suffering from the later
manifestations and after effects of the disease, and
provision will doubtless be available for adults as soon
as this can be arranged. Institutional treatment is
much needed for patients who are non-certifiable as
insane, as home supervision and treatment are quite
inadequate.
Puerperal Fever and Puerperal Pyrexia.—There has
been a steady decline in the incidence and mortality
from puerperal fever during recent years, and in 1926
both the number of cases and the death-rate were the
lowest on record for the Borough.
During the four years from 1923 to 1926 the number
of cases notified was 32, 26, 21 and 15. The incidence
in 1926 was equivalent to 5.6 per thousand registered
births. The number of deaths from 1923 to 1926
was nine, four, four and three respectively.
The treatment of puerperal fever is best carried
out in institutions, and in 1922, according to Dr.
Hewat's suggestion the Council made arrangements
with the Guardian" whereby suspicious cases could
be admitted to the Fulham Hospital. The object
of this arrangement, which was a forerunner of the