View report page

Report of Medical Officer of Health.] 25
"I hope that you are right in thinking that the Authority has accomplished something
with regard to puerperal fever; but, to my mind, the medical practitioner is probably
responsible in the vast majority of cases; and where such a feeling exists, it must be a little
hard to obtain notification, as no man likes giving himself away. However, it may be
useful to call his attention to notification of the disease."
It cannot be denied that not only is it difficult to decide what cases may be septic, and therefore
to be notified, but also that an often unmerited opprobrium rests on the practitioner in charge of
such a case.
The actual routine followed with respect to such cases may be usefully recorded in connection
with this correspondence.
As soon as a case of puerperal fever has been reported, steps are taken to obtain information as
to previous cases attended by the practitioner, midwife, and nurse, and the following letter is sent
to the nurse or midwife:—
Madam,—I am informed that you attended of
during her recent confinement. The said has been certified to me to
be ill with puerperal fever, and I have therefore to warn you not to attend any other confinement
until all necessary disinfection and cleansing of yourself, your clothes, instruments,
&c., shall have been done, and certificate as to the sufficiency of such disinfection obtained
from me or some other Medical Officer of Health. Should you neglect to observe this caution,
you will render yourself liable to prosecution under the 68th section of the Public Health
(London) Act, 1891.
I shall be pleased to advise and assist you in this matter, on which you can see me if
you will call here on between the hours of
I am, Madam,
Your obedient servant,
Medical Officer of Health.
The nurse's clothing, instruments, &c., are disinfected by the Department, and she is advised to
take a complete bath, not forgetting to wash her head. No case has been brought to the knowledge
of the Department attributable to infection conveyed by any nurse or midwife who has followed the
instructions given to her. At the termination of the case, the patient's room, bedding, &c., are
disinfected, and any defects in the sanitary arrangements are remedied.

The 2 cases of this disease reported during the year were both erroneously diagnosed.
Although cases have from time to time been reported in the past year, none have been found to be
typhus fever when closely investigated. The disease does, however, continue to occur at rare
intervals in other parts of the Metropolis.
The particulars of the 2 cases reported were as follow:—
The first case was that of a man, aged 55, reported on January 23rd. He resided in Portnall
Road. He was visited by the Medical Officer of Health, after conference with the certifying
practitioner, on the day the notification was received. The symptoms and rash were not those of
typhus fever, but more like those of acute rheumatism. As the patient was not housed suitably to
allow of his case being watched, he was sent to one of the Asylums Board's Hospitals as a
"possible" ease of typhus fever. The ultimate diagnosis was one of rheumatic fever with sudamina.