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fatality in childbed.
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Errors of Diagnosis.—The signs and symptoms of a case—even one which is not of
great severity—are fairly characteristic It is, however, somewhat remarkable that errors are
comparatively rare in the notification certificates, a fact which raises a suspicion that
notification is not as complete as could be desired. Last year a review of diagnosis followed
after one certificate, but in two or three instances puerperal patients admitted to the Infirmary,
after labour, (apparently for illnesses other than puerperal fever) were diagnosed after admission
to have that disease The single error recorded last year was equal to 16.2 per cent. of the
notifications as compared with averages of 8 8 and 10 per cent. for the periods 1914-18 and
1919-20.
Institutional Treatment.—All the 16 cases reported last year received institutional treatment,
12 (including the error) in the Infirmary and 4 in the Hospitals of the Metropolitan Asylums
Board. The proportion receiving this class of treatment (100 per cent.) was a good deal above
the proportions recorded during 1914-18 (80.6) and 1919-20 (83.3).
Fatality, Mortality.—Of the 16 women, 5 died, but in 2 instances the deaths were due to
other diseases (influenza and pulmonary tuberculosis, one each), and not to puerperal fever. The
corrected fatality rate was 20 per cent. last year as compared with rates of 33.3 and 55 per cent.
during 1919-20 and 1914-18 respectively.
The total number of deaths from puerperal fever recorded last year was 4, one fatal case
being un-notified. In that case death followed a surgical operation to remove a partially
macerated foetus. During the quinquennia 1909-13 and 1914-18, the deaths from this cause
averaged 3 and 5 respectively, which latter number was recorded in each of the years
1919 and 1920.
Accidents and Diseases of Pregnancy and Parturition.—The deaths from these causes
averaged 8 a year during 1909-13 and 4 during 1914-18. In 1919 there were 4 deaths and in
1920, 11, while the total for last year was 9. The Index Numbers, based on the average for
1909-13 (= 100) are—1914-18, 50,1919, 50,1920,137, and 1921,112. (See Tables IX. and IXa.)
Fatality in Childbed.—The total number of deaths in connection with childbearing
was 13 last year, as compared with 16 in 1920 and 9 in 1919. The deaths from these causes
averaged 11 each year during 1909-13 and 9 during 1914-18. The fatality rates per 1,000
births (corrected) for the quinquennia 1909-13 and 1914-18 were 3.65 and 3.61, those for the
last three years being—1919, 3 88; 1920, 4.68; and 1921, 4.54. The average for the two years
1919-20 was 4.32. There is little or no evidence of any decline in the risks attaching to
child-bearing since the war. Confirmation of that conclusion is afforded by the fatality rates
recorded in the Wards of the Borough. (See below.)

Ophthalmia Neonatorum.
General Prevalence.—Last year 34 (males, 12; females 22) cases were reported, the highest
number for any year since 1915, when 51 cases were reported. The figures given in Table V.
do not suggest any indication of a diminution in the prevalence of this disease. This question
was dealt with rather fully in the Report for 1919-20 (see p. 15). In addition to the 34 cases
which were formally notified, 6 other cases of "stickiness of the eyelids," not severe enough
to constitute ophthalmia, were brought to the notice of the Department by the Officers of
the County Council. The numbers ot cases notified from the different wards and the
morbidity rates are set out below.