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24 SEPTIC DISEASES.
found to be a "carrier." She had had an attack of enteric fever some eighteen months
previously while in India. So far as the Department had information, the Widal reaction was
resorted to on four occasions only. In no house or family was a second case recorded during
the year.
Eight patients (533 per of the reported cases) were removed to institutions for treatment,
the proportions of removals to institutions showing decreases when compared both with
the preceding year and with the period 1907.11 (Table 16). The numbers of cases removed
from each Ward are given in Table 15. The total fatality of the disease (Table 16) was notably
less last year (6.6 per ) than in 1911 (18.5 per ) and than the average for the preceding
five years (14.6). The mortality (0 01 per 1,000 persons) was just one-third the rate recorded
in 1911 and the like proportion of the mean for 1907-11. In Hampstead only was so low a rate
as 0.01 recorded during the year (Table 13).
The excessive rainfall of the summer and early autumn roused some fears of an abnormal
prevalence of enteric fever during the late autumn, such fears being based on the theories of the
association of the disease with a high level of ground water and a flooded Thames. Happily
such fears proved groundless, the morbidity rate recorded in the whole County (Table 7) being
only 0.15 per 1,000, 0.09 less than the average for the preceding five years. In England and
Wales, outside London (Table 10), the morbidity rate was 0.24 last year, or 0.03 above that
for 1911.
SEPTIC DISEASES.
Puerperal Fever.—The number of reported cases of this disease increased from 7 in
1911 to 11 last year, the annual average for the five years 1907-11 being 5. Last year 3 eases
were reported in each of two Wards (Maida Vale and Westbourne), and 2 in each of two
(Queen.s Park and Harrow Road), the remaining case being reported from Lancaster Gate,
West, Ward, the first case to be reported from that Ward since 1901. For the first time
within that same period no case was reported during the year from Church Ward. No case has
been reported from Lancaster Gate, East, Ward since 1902.
Of the 11 cases reported last year 5 were in the persons of primiparae, 2 following miscarriages,
and the remaining 6 (or rather 5, since 1 case was not confirmed at the Infirmary,
whither the patient was removed for treatment) of multipara;. There was only one case reported
in an unmarried woman. In 5 instances the confinements were attended by medical men,
in 2 by students, and 3 by midwives, one patient being unattended (a miscarriage). In 6 instances
unqualified persons were reported as assisting at the confinements and subsequently.
At 4 of the confinements no instruments were used; at 3 it was known that they were used;
while at the remaining 4 (including the 2 miscarriages) there was no record. One woman,
suffering from a "sloughing umbilicus," apparently infected herself.
In previous reports various data have been used for calculating morbidity and other rates
due to this disease, but, after considerable search for data which would be both reliable and
always available, it has been decided to use on this (and future) occasions the numbers of births
recorded in the Borough for the purpose. The estimated numbers of women aged 15-45
years (married and/or unmarried) are most commonly taken as the basis for these calculations,
but a considerable proportion of such women are not " at risk " in any year, as they
are neither pregnant nor giving birth to children. The number of births expresses accomplished
facts, and although an element of error is introduced by the occurrence of puerperal fever after
miscarriages and abortions (which are not counted among the births), and by the number of
multiple births (twins, &c.), it is thought that that figure affords a better test of the frequency
of the disease, especially as the ratio of confinements to women living is decreasing, as evidenced
by the decreasing birth.rate. Last year the notified cases (11) were equivalent to a morbidity
rate of 3.96 per 1,000 births registered in the Borough (see Table 6), as compared with one of