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infection become manifest, in order that adequate nursing and treatment can be ensured and the
spread of infection to others prevented.
Whilst prescribing new forms for the notification of cases of puerperal fever, the Regulations
also require the notification of cases of puerperal pyrexia in addition to the present notification of
puerperal fever. Thus there is an obligation upon medical practitioners to notify all cases of
pyrexia arising during the puerperal period irrespective of the cause to which the fever may be
attributed.
These requirements will lead to an increase in the number of notifications and many cases so
reported will be relatively trivial in degree, but the great importance of securing adequate treatment
in the early stages of puerperal infection outweighs any objection to the notification of a certain
amount of minor illness.
If the more complete notification is to have practical value, it should be supplemented by the
provision, when necessary, of facilities for assistance in diagnosis and for the treatment of patients
who are not able to secure adequate treatment for themselves. In Circular No. 722, dated August
9th, 1926, the Minister of Health points out that Maternity and Child Welfare Authorities are
empowered, with his sanction, to make provision for (a) institutional treatment, (b) special treatment
of women suffering from puerperal pyrexia, (c) skilled nursing, and (d) consultation with an
obstetric specialist. The Minister points out that these Authorities and their Medical Officers of
Health should do all that is possible to meet the requests of medical practitioners for special
assistance for women suffering from puerperal pyrexia which is, or is likely to be, serious in
character, in order that maternal mortality and morbidity from this cause may be so far as possible
prevented.
(a) Institutional Treatment.—As pointed out in the Ministry of Health Circular No. 622, dated
September 14th, 1925, arrangements have been made by the Metropolitan Asylums Board whereby
cases of puerperal fever are received at three of their hospitals, namely, the Eastern Hospital, the
North-Western Hospital, and the South-Western Hospital. Special wards are set aside for these
cases and special medical and nursing staffs are provided. The Board have also, with the approval
of the Minister of Health, appointed an obstetric consultant at these three institutions.
(b) Special Treatment of Women Suffering from Puerperal Pyrexia.—The Kensington Board of
Guardians have arranged for puerperal pyrexia cases to be admitted to the St. Mary Abbot's
Hospital on the order of Dr. Hobbs, the Medical Superintendent, and thus the delay and inconvenience
of making an application to the Relieving Officer is saved. Dr. Hobbs has devoted
considerable attention to the treatment of this disease and, judging from papers he has published,
he has adopted a method of treatment which is remarkably successful.
From October 1st, 1926, onwards, the Metropolitan Asylums Board admit to their hospitals
cases of puerperal pyrexia in the same manner as they admit cases of puerperal fever, and therefore,
the arrangements made by the Metropolitan Asylums Board and the Guardians provide all that is
necessary in Kensington in the way of special treatment.
(c) Skilled Nursing.—By an agreement between the Council and the Kensington District
Nursing Association, the nurses of the latter body undertake, when requested by the Medical
Officer of Health, the nursing of any disease for which skilled nursing is necessary, and their services
can be and have been requisitioned for cases of puerperal fever and puerperal pyrexia. The nurses
are skilled and doctors appreciate very much the splendid assistance they can obtain from these
trained women. Indeed, it would be impossible at the present time to improve upon the arrangements
for nursing in the homes of the poor which now exist in the Borough.
(d) Consultation with an Obstetric Specialist.—Since 1922, Dr. Hobbs has acquired a high
reputation in connection with the treatment of puerperal pyrexia which extends beyond the
boundaries of this country. The practitioners in Kensington generally have been very much
interested in his work, and have welcomed very heartily the opportunity of being able to consult
him in any difficult case.
Dr. Hobbs is a whole-time officer of the Kensington Guardians and the Board have allowed
him to act as a consultant to medical practitioners in Kensington when assistance is required in
difficult cases of puerperal pyrexia. A remuneration of £50 per annum is paid for the services of Dr.
Hobbs in this respect.
The appointment of Dr. Hobbs as obstetric consultant, together with the other facilities
already available, has provided the doctors of Kensington with every reasonable measure for
securing the effective treatment of puerperal fever and puerperal pyrexia.
Puerperal Pyrexia.—Eleven cases of puerperal pyrexia were notified, nine of which were
removed to hospital. One case only developed into puerperal fever; this patient received prompt
surgical treatment in St. Mary Abbot's Hospital and made a good recovery.