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42
SEPTIC DISEASES.

Among the 8 cases reported there was 1 in which the septic intoxication followed an
illegal operation, and the woman (a married multipara) died, her death forming the subject of
an inquest. Of the remaining 7 patients 4 were primiparce and 3 multipara. Only 1 patient
was unmarried, and all were delivered of living children. Four of the confinements were
attended by medical practitioners, 3 being assisted by trained nurses and 1 by an untrained
woman; 2 were attended by midwives, assisted, in one instance, by an untrained woman; and
1 by an untrained woman alone. Dirty attendants and surroundings were reported in 2
instances, and in 2 others the labour was not of the normal type, placenta przevia occurring in
1 case and contracted pelvis (requiring the use of instruments) and adherent placenta being
recorded in the other. Four cases of puerperal fever were known to have occurred during the
year in the practice of a local midwife, 2 of the patients being residents of Paddington, 1 of
St. Marylebone, and 1 of Willesden. The cases occurred in April, May, June, and July. At
three of the confinements (those in May, June, and July) one particular nurse or pupil was present,
at the first two another. The facts were reported to and investigated by the County Council,
the supervising authority of midwives, but the conclusion arrived at was " that the cases ....
appear to have no connection with each other."
Two of the 7 patients died as well as the victim of the illegal operation. The fatality from
natural, as distinct from accidental, puerperal fever was 28.5 per cent. One death was reported
from a lunatic asylum from this cause, but as the case was not "notified" it should not be included
for local purposes in calculations of fatality; such discrimination is, however, not
possible when comparing the rates observed in different localities as in Table 31. In that
table the various rates are based on the numbers recorded without any adjustments. It will
be noted that, owing to the inclusion of the death in the lunatic asylum and of the notification
of the disease in the case of criminal abortion, the fatality in the Borough during the past year
is given as 27.5 per cent., instead of the more correct figure 28.5. The local fatality is lower
than that recorded in any other district, except Willesden, where a rate of 1818 was recorded.
The rate of 200 per cent., recorded in Hampstead, can only be taken to mean that certain cases
were not notified. The only district besides Hampstead with a fatality in excess of the average
(1908-12) was St. Marylebone.
Mortality in Childbed.—Besides the three deaths from puerperal fever there were seven
others from " accidents and diseases of the puerperium," a somewhat vague group of
causes of death which are not notified during life. The mortality from such causes was
at the rate of 2.47 per 1,000 births last year, as compared with one of 2.16 in 1912,
and an average (1908-12) of 247. Higher rates of mortality were observed in St. Marylebone
(4.50) and Westminster (3.01). In those districts and in the County as a whole last
year's mortality was in excess of the average. The total mortality in childbed in the
Borough (Table 31) was 3.52 per 1,000 births registered, as compared with 3.70 in 1912, and
an average of 3.57. The maximum rate recorded last year (5.40) was that of St. Marylebone
and the minimum (2.25) that of Willesden. The mortality rates recorded in the Wards of
the Borough are given below. It should be remarked that in the three southern Wards, viz,
the two Lancaster Gates and Hyde Park, puerperal fever has an almost insignificant effect on
the mortality in childbed.