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prepared and observe these precautions, and that nurses, midwives and doctors
should also supervise and exercise these precautions. An important bearing
upon this is the fact that since the passing of the Midwives Act, 1902, there
has been a remarkable permanent fall in the mortality from puerperal septic
diseases, as shown in the Annual Reports of the Registrar-General.
I have come to the conclusion that the question of the desirability of, or
necessity for, providing hospital accommodation for puerperal septic diseases
is one that can only be satisfactorily thrashed out in an inquiry by the
Metropolitan Asylums Board, where the evidence of medical experts, midwives
and nurses of all shades of opinion would be heard.
Your Borough Council resolved, on the 15th December, 1909, that the
Metropolitan Asylums Board be asked to make an inquiry into the desirability
of, and the necessity for, providing hospital accommodation for puerperal
septie diseases upon the evidence of medical experts, midwives, and nurses,
and to publish a report upon the subject for the guidance of the public, the
profession, and the Metropolitan Borough Councils.
In January, 1910, the Guardians of St. Pancras concurred with the proposals
of the Borough Council and took similar action.
A reply was received from the Metropolitan Asylums Board stating that
whilst the Managers are in sympathy with the Council they are of opinion
that such an inquiry could best be made by the Local Government Board,
inasmuch as the Managers have no machinery for instituting or conducting
such an inquiry, nor have they the power to incur expenditure for the creation
of the necessary machinery. They state, however, that in the event of the
Local Government Board deciding to add puerperal fever to the list of
infectious diseases for which the Asylums Board are required to provide accommodation,
they would be prepared to make arrangements for the reception
of certified cases of this disease into the hospitals under their control.
The Medical Officer of Health drew further attention to the fact that in
London, in 1908, as the number of deaths from puerperal fever was 137 and
the number of cases was 228, the case mortality was 60 per cent.—a very high
proportion. It is possible that prompt expert treatment in hospital would
reduce both the case mortality and the prevalence of the disease, and the
amount of hospital accommodation required to effect this would be small.
Assuming that of the 228 cases as large a proportion as one-half required to
be promptly removed to the hospital, then 114 cases would have to be provided
for during the year. This represents 2.2 cases per week—say 3—and if they
remain in the hospital an average of three weeks, there would be nine cases in
hospital at the same time, so that by the provision of about a dozen beds with
the necessary staff and appliances the requirements would be satisfied.
Your Borough Council resolved, on 23rd February, 1910, that the Local
Government Board be asked to make an inquiry into the desirability of, and
and the necessity for, providing hospital accommodation for puerperal septic
diseases, and to publish a report upon the subject for the guidance of the
public, the profession, the Metropolitan Asylums Board, and the Metropolitan
Borough Councils.