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70
HOSPITAL PROVISION FOR PUERPERAL FEVER.
In December, 1909, I reported specially upon this subject.
During 1908, in London, according to the Registrar-General's returns, there
were 228 cases of puerperal fever notified and 137 deaths, which included
puerperal septicaemia, pyaemia, sapraemia, and fever, that is to say, the puerperal
septic diseases.
During 1908, in St. Pancras, eight cases of puerperal fever were notified,
four cases were removed to hospital, and two deaths occurred of this class of
disease.
Of the four cases removed to hospital, two were removed to the North
Infirmary of St. Pancras, one to the University College Hospital, and one to
the British Lying-in Hospital. The case removed to the University College
Hospital appears to have been one attended through the extern maternity
department of the hospital, and was therefore a hospital case from the
beginning. The case admitted into the British Lying-in Hospital entered
that Hospital to be confined, and possibly was a case of auto infection after a
difficult confinement, at any rate a hospital case from the first.
I have caused inquiry to be made of the General Hospitals in St. Pancras—
University College Hospital, Royal Free Hospital, New Hospital for Women,
Temperance Hospital—and I am informed that they do not admit lying-in
women suffering from puerperal septic diseases. Doubtless one of the reasons
for this is the danger of the disease being so easily carried from one patient
to another in a maternity ward. The cases usually admitted to maternity
wards of hospitals are those of diseases, injuries, or malformations of women
about to be confined, and who require special attention, and possibly some form
of manipulation or operation. The Poor Law Hospitals, that is the North
and South Infirmaries in St. Pancras, are compelled to admit destitute persons
suffering from disease, and cannot refuse to admit cases of such an urgent
nature as puerperal sepsis suddenly brought to the door of the Infirmary and
thrown upon the care of the Guardians.
The Metropolitan Asylums Board do not admit cases of puerperal fever to
their hospitals. The infections of scarlet fever, diphtheria, &c., have always
been legarded as particularly dangerous to women lying-in, and it has been
considered inadvisable to admit lying-in women to fever hospitals.
From the point of view of the spread of infection, it is open to question
whether it is the more desirable to remove a puerperal fever patient from her
isolation at home into the ward of a hospital. This may free the home,
medical practitioner, midwife, and nurse from the chance of conveying infection,
but will transfer the chance to the hospital practitioner, midwife, and
nurse. The latter will have more appliances and facilities at hand to minimise
infection, but will also be subject to greater facilities for conveying infection.
From the point of view of the treatment of the patient, in the homes of the
poorer classes it cannot be expected that the same facilities, appliances, and
attendance can be provided as are to be found in the ward of a hospital. But
it can be expected that extreme cleanliness and the utmost precautions should
be observed in the house, that pregnant women should be instructed to be well