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

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London County Council 1913

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

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82
Annual Report of the London County Council, 1913.
Puerperal
fever.
The medical evidence given at the inquests as to the cause of death was as follows:—
Mothers. Infants.
Exhaustion due to septicaemia Atelectasis 8
Suffocation at birth 4
Suffocation in bed 17
Prematurity and debility 14
Convulsions 8
Bronchitis and pneumonia 4
Want of skilled attention at birth 3
Cerebral haemorrhage 3
Syncope 7
Marasmus 6
Congenital heart disease or malformation 5
Stillbirth 4
1 83
During the year 1913, 349 cases of puerperal fever were notified in the County, and
the Registrar General records 139 deaths from puerperal septic disease during the year. Two
deaths recorded by the Registrar General refer to cases which were notified in 1912. The term
puerperal septic disease used by the Registrar General includes puerperal septicaemia, pyaemia
and sapræmia, as well as peritonitis and metritis occurring in connection with parturition.
A list of deaths is received weekly from the Registrar General and the deaths are compared
with the notified cases so that it is possible to ascertain whether the latter terminate fatally. Of the 349
notified cases, 95 proved fatal, a case mortality of 27.2 per cent. Of the remaining deaths recorded,
three occurred in London institutions, the patients having been confined outside London and probably
notified as puerperal fever in the districts where the confinements took place. The other deaths
related to cases which were not notified.
Early information of notified cases of puerperal fever is received from the Metropolitan
Asylums Board or from the borough medical officers, and information as to the person by whom the
patient was delivered has been supplied by the latter.

The following table gives the results of these inquiries which relate to the 349 notified cases and 44 deaths of cases not notified in London:—

Delivery conducted byCases.Deaths.
(a)Medical practitioners (including cases attended by medical students and also cases in which a medical practitioner was in charge of the case, but the birth took place before his arrival)23679
(b)Certified midwives (including cases in which birth took place before the arrival of the midwife)9124
(c)Medical practitioner and certified midwife, i.e., cases in which a midwife was unable to deliver and called in a medical practitioner21
(d)Hospitals and poor law institutions4826
(e)Cases of miscarriage or abortion where no attendant was engaged159
(f)Uncertified person acting in emergency1-
393139

The cause of death as stated in the death certificates in the 139 fatal cases occurring in London is shown in the following table:—

Cause of death.Notified cases.Unnotified cases.Total.
Puerperal septicaemia, toxaemia, and septic absorption632487 (11)
Puerperal peritonitis81119(9)
Pyæmia6410 (1)
Sapæmia5-5
Puerperal fever (not defined)9-9(1)
Metritis, perimetritis, parametritis and endometritis224(1)
Pelvic cellulitis01-
Salpingitis112(2)
Septic pneumonia123(2)
9544139