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Of the 33 cases, 15 occurred in hospital practice, 15 in the practice of private practitioners,
and 3 in the practice of midwives. 11 cases were removed to the M.A.B. hospitals and 4 to
the hospitals of the St. Pancras Guardians. There had been instrumental delivery in 6 cases.
In estimating the significance of the incidence and death rates for puerperal fever, due
allowance should be made for the fact that the termination of pregnancy before the 7th month,
though it is not recorded as a birth, is attended by the same, if not a greater risk, of puerperal
fever. Of the 33 cases of puerperal fever recorded during 1928, only 22, and of the 5 deaths,
only 2 followed the birth of a viable child. The remaining 11 cases and 3 deaths followed the
occurrence of miscarriages, the total number of which is an unknown quantity. Although
puerperal sepsis following miscarriage forms such a large proportion of the total notifications
and deaths due to puerperal fever, yet puerperal fever is commonly spoken of as though it were
principally a risk of childbirth and might be altogether prevented be proper ante-natal care
and improved technique at confinements. Such measures may, no doubt, prevent those cases
of difficult labour and excessive manipulation of which puerperahisepsis is often the sequel, but
puerperal sepsis following miscarriage is scarcely affected. In some of these cases there is
definite evidence that illegal interference caused the miscarriage, and subsequent sepsis and
such cases are excluded from the puerperal mortality figures by the Registrar-General. But in
many other cases, it is probable that interference occurs, though definite evidence of this is
lacking. Owing to the statistical methods adopted, such cases swell the annual list of
obstetrical fatalities, though it is difficult to see by what obstetrical measures they could be
prevented.
PUERPERAL PYREXIA.
Forty cases were notified, and one case notified as Puerperal Fever was afterwards
found to be Puerperal Pyrexia. The actual number of cases was therefore 41. One death
occurred. On investigation the causes of this condition were ascertained to be as follows:—
1. Infection of Genital passages (12).
Puerperal Fever 2 cases Sapræmia 6 cases*
Pelvic peritonitis 3 „ Uterine sepsis 1 case
* 1 case died.
2. Conditions associated with Childbirth (15).
Perineal laceration 1 case Retained Membranes 1 case
Cracked Nipples 1 „ Mastitis 7 cases
Breast Abscess 1 ,, Pyelitis 3 ,,
Superficial Sepsis of Caesarean incision 1 case
3. Intercurrent disease (14).
Bronchitis 3 cases Cystitis 1 case
Influenza 1 case Abscess of leg 2 cases
Constipation 1 „ Empyema 1 case
Scarlet Fever 1 „ Coryza 1 „
Serum reaction 1 „ No cause discovered 2 cases
Twenty-four of these cases were notified by Medical Officers of Institutions, the
remainder by private practitioners.
ERYSIPELAS.
Ninety-seven cases were notified and 2 deaths occurred, as compared with 98 cases
and 6 deaths during the previous year.