London's Pulse: Medical Officer of Health reports 1848-1972
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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
London County Council 1913
[Report of the Medical Officer of Health for London County Council]
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Report of the County Medical Officer—General
83
The number of fatal cases of puerperal fever which followed abortion or miscarriage was 27.
The classification of these cases is shown by the figures in brackets in the last column of the above
table.
The age incidence of the 393 cases was as follows:—
| Total. | 15-20 | 20-25 | 25-35 | 35-45 | Over 45 | |
|---|---|---|---|---|---|---|
| Recovery cases | 254 | 9 | 61 | 130 | 52 | 2 |
| Fatal cases | 139 | 2 | 35 | 70 | 31 | 1 |
In each 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; 254 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 163 cases it was found that the temperature
had fallen, or that no further symptoms of puerperal fever had 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. | 7 th day. | 8th day. | 9th day. | 10th day. | After 10th day. | Not stated, | Total. | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Recovery cases | 2 | 8 | 4 | 12 | 11 | 5 | 5 | 3 | 2 | 1 | 6 | 8 | 67 |
| Fatal cases | 1 | 2 | 3 | 6 | 1 | 3 | 1 | 2 | - | - | 4 | 1 | 24 |
| Recovery cases | 5 | 5 | 4 | 11 | 8 | 6 | 5 | 4 | 4 | 4 | 7 | 4 | 67 |
| Fatal cases | 3 | 2 | 1 | 3 | 3 | 3 | 1 | 3 | - | - | 4 | 1 | 24 |
| — | — | — | 1 | - | 2 | 1 | 3 | 1 | 1 | 15 | - | 24 | |
The parity of women who contracted puerperal fever was ascertained from the midwife to be:—
| Total | Primipara. | 2 para. | 3 para. | 4 para. | 5 para. | 6 para. | 7 para. | 8 para. | 9 para. | 10 para. | Over 10 para. | Not stated | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Recovery | 67 | 18 | 11 | 10 | 9 | 3 | 2 | 4 | 3 | 0 | 1 | 1 | 5 |
| Fatal | 24 | 7 | 6 | 1 | 2 | 1 | 3 | — | - | 1 | 1 | 1 | 2 |
The following conditions were noted among the cases of puerperal fever attended by midwives:—
| Recovery. | Fatal. | |
|---|---|---|
| Laceration of perineum | 10 | 2 |
| Retained or adherent placenta | 1 | 2 |
| Ante partum haemorrhage | 1 | — |
| Post partum hæmorrhage | 4 | 2 |
| Prolonged labour | 2 | 1 |
| Macerated infant | 1 | - |
| Domestic trouble after confinement | 4 | - |
| Phthisis | 1 | — |
in nine cases or puerperal fever, birth took place before the arrival of the midwife.
23610 m 2