London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1912

[Report of the Medical Officer of Health for London County Council]

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Annual Report of the London County Council, 1912.
The number of fatal cases of puerperal fever which followed abortion or miscarriage was 31.
The classification of these cases is shown by the figures in brackets in the last column of the above

The age incidence of the 415 cases was as follows:—

Total.15-2020-2525-3535-45Over 45
Recovery cases256969115621
Fatal cases15942784431

In case where a midwife was concerned the Council's inspector visited her, learnt particulars
of the case, made enquiries as to any other patients recently attended, and took steps to
ensure that the rules as to disinfection were fully carried out before the midwife resumed her work.
The rule which requires that medical help shall be advised when the patient's temperature rises
to 100.4 deg. and remains above that figure for 24 hours has proved useful in affording information
concerning cases in which there is danger of the development of puerperal fever; 272 notices were
received stating that medical assistance had been advised for this reason. The inspector learnt from the
midwife whether the high temperature was persistent and in 166 cases it was found that the temperature
had fallen, or that no further symptoms of puerperal fever occurred. In cases of puerperal fever the
services of the nurses of the Queen Victoria Jubilee Institute, the Ranyard and the Holloway
Institutes are usually available so that when the midwife ceases to visit, the patient is left in the
hands of a skilled nurse to carry out the directions of the medical practitioner called in. In cases
where a midwife has pupils or assistants one of them is sometimes set apart to nurse the septic
case, attending no other patients meanwhile. A midwife is thus usually able to carry out disinfection
and resume her work with as little delay as is necessary to ensure that she is no longer likely
to be a source of infection to other patients.

The following table' shows the day of the puerperium on which (a) the rise of temperature (if noted) occurred,(b) medical aid was obtained, and (c) the death took place if the case were fatal.

Day of confinement.2nd day.3rd day.4th day.5th day.6th day.7th day.8th day.9th day.10th day.After 10th day.Total.
1 Rise of temperature—
Recovery cases44131410831251175
Fatal cases576711229
. Medical aid obtained—
Recovery cases741415811351077
Fatal cases155931429
Bay of death in fatal cases11122311829

The parity of women who contracted puerperal fever was ascertained from the midwife to be:—

TotalPrimipara.2 para.3 para.4 para.5 para.6 para.7 para.8 para.9 para.10 para.Over 10 para.

The following conditions were noted among the cases of puerperal fever attended by midwives:—

Laceration of perineum54
Retained or adherent placenta41
Ante partum haemorrhage1
Post partum hæmorrhage31
Prolonged labour1
Macerated infant1
Domestic trouble after confinement2