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26 SEPTIC DISEASES.
Having regard to the relatively larger proportion of female servants employed in parts
of Paddington, Kensington and Hampstead, it is natural that the rates per 1,000 females of
marriageable ages should he low. A similarlv low rate might have been expected in Marylebone,
where there are a considerable number of servants, and it is difficult to explain the
comparatively high rate recorded (0*15). The rate per 1,000 births was highest in
Marylebone (1'78 gross, 2*48 corrected) being, however, very cioselv followed bv that of
Willesden (2*40).
The fatality last year (4 deaths to 3 cases) works out at 133.3 per cent., but two deaths
scheduled under "puerperal fever" were not notified as such. Allowing for them the fatality
is 66.6 per cent., compared with 35.71 percent, in 1002, the corresponding figures for the
Metropolis being 72.29 and 04*32 per cent, respectively. The fatality rates for the adjacent
districts are not known. The four (4) deaths were equal to a rate of 0.2 per 1,000 persons
of all ages, as compared with mean rates of 0*03 for the decennium and two quinquennia.
There was no death from this cause in St. John's Sub-District, the four deaths comprising
3 from St. Mary's Sub-District (rate 0.03, mean-rates (all) 0004) and 1 from that of NorthWest
Paddington (rate 0.05, mean rates, decennium 0*04, first quinquennium 0.05, second
quinquennium 0.03).
To fully measure the fatality of childbearing, deaths from "accidents and diseases of
parturition" should be added to those from "puerperal fever." The deaths from these
latter causes numbered 9 last vear—7 of the deceased residing in St. Mary's Sub-District,
and 1 each in the other two. Appended are the figures for the Metropolis, the Borough,
and the three Sub-Districts arranged in same way as in Table 20.

* If the births in outlying institutions be added, the rate becomes 3'75.
The rates per 1,000 births in the Borough and its Sub-Districts were higher than that
for the Metropolis, except in the case of the Sub-District St. John. The low rate (per 1,000
females of childbearing ages) is undoubtedly due, in part, to the large number of female
domestic servants residing there. The corresponding rates for the adjacent districts are not
available.
The following are the more important facts relating to the three notified cases—
I. A. L., aet 33„ married; confined loth Dec. 1002; fever commenced 24th Dec.; to Infirmary 7th Jan.,
* 1903 ; died 18th Jan.
Third child ; instruments used ; nurse untrained.
II. M. P., .net. 25, married; confined 20th Aug.; fever commenced 30th Aug.; to hospital 27th Sept.
First child; instruments used.
III. E. B., at. 25; unmarried; confined 22nd Sept.; fever commenced 20th Sept.; to Infirmary 30th Sept.,
. died same day.
Second child ; attended in labour by midwife, who, it is alleged, used a borrowed enema syringe
without any preliminary cleansing ; four previous confinements and two subsequent attended by
same midwife recovered without fever. Midwife unqualified. A woman living in the house
who had been recently confined was reported to have abcesses in both breasts at the date of
E. B's confinement.
The two fatal cases which were not notified were recorded as—
f. 39, died St. Mary's Hospital, on May 22 ; cause of death "incomplete abortion; septicaemia following
miscarriage."
f. 28, died at home on 10th March; cause of death "septic meningitis, 10 days; confinement, 9 weeks."