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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Report of the County Medical Officer—General.
39

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Year.Case-rate per 1,000 living.Case-rate per 1,000 births.Death-rate (a) per 1,000 living.Death-rate (a) per 1,000 births.
19070.062.090.031.25
19080.051.860.031.11
19090.062.460.041.54
19100.062.530.041.40
19110.072.700.03b1.27b
19120.083.440.04b1.44b
19130.083.100.03b1.23b

Some interest attaches to the account of cases of puerperal fever occurring in the practice of
midwives. During the year 1913 two midwives had three cases of puerperal fever in their respective
practices and 14 had two cases each. The circumstances of these cases were as follows :—
A. had a case in June which developed on the third day of the puerperium. The midwife was disinfected
and resumed practice. In August she had another case and was again disinfected. Both these
cases recovered. Towards the end of October she had a third case which terminated fatally. From the
past history of this case it is probable that some latent tubal trouble was present.
B. had a case in April, which terminated fatally. She was disinfected and resumed work.
Another fatal case occurred in her practice in July when she was again disinfected. There was a third
case in her practice during November, but in this instance the patient recovered.
C. had a case in April and was disinfected. The second case in her practice occurred in September
and both patients recovered.
D. delivered a patient on 23rd April and continued in attendance until 30th April, when the
husband called in a doctor, who found patient with a high temperature and delirious. Case was notified
on 1st May and midwife was informed by doctor of notification. She had conducted another delivery
on 30th April and continued in attendance without disinfection until 10th May. The patient in this case
contracted puerperal fever and was notified on 4th June. The facts were in due course brought to the
notice of the Central Midwives Board, and the Board removed the name of the midwife from the roll.
Both patients recovered.
E. had a case on 24th April which was delivered for her by another midwife. Patient's condition
was never satisfactory owing to domestic trouble and on the fourteenth day she had a rise in temperature
and was removed to the infirmary. The second case of puerperal fever in this midwife's practice
occurred on 5th May. Both patients recovered and in neither instance could any blame be attributed
to the midwife.
F. had a case in October and after disinfection resumed work. The second case occurred in
December. Neither case was fatal.
G. had a case in her practice which was notified on 3rd March. The midwife was disinfected
and resumed work. The second case occurred in a patient who was confined on the 24th March ; temperature
rose on the third day. The nurse in attendance upon this patient was at the time suffering from a
poisoned hand and arm. This case terminated fatally, but the first patient recovered.
H. had a case in May and attended another urgent call after she had been informed by the doctor
who had been called to the first case that he intended to notify it; she was accordingly cautioned. The
second case occurred in July and there appeared to be no connection between it and the first case.
Both patients recovered.
I. had a case in January and another in April. No connection could be discovered between
the two cases ; both patients recovered.
J. had two cases, one in July and one in August, between which no connection could be traced.
Recovery ensued in each case.
K. had two cases in November, one of which terminated fatally. She was disinfected and
six other patients on whom she was in attendance all did well.
L. had two cases, one in March and one in June. Both patients recovered.
M. had a case on 4th May at which she was assisted by a pupil who a few weeks previously had
accompanied another midwife from the institution to a case which was eventually notified. The pupil
had, however, been thoroughly disinfected. The second case in this midwife's practice occurred on
60th May and was visited by her on account of patient's condition until the thirteenth day of the
puerperium when the temperature was found to be 101.2 deg. and medical aid was obtained.
N. had a case in July and another in December. Both patients recovered.
O. had a case in October and another in November. As this midwife appeared to be neglecting
her patients the case was reported to the Central Midwives Board.
P. had two cases in February, but there was apparently no connection between them.
Influenza, Bronchitis and Pneumonia.
The deaths (b) attributed to influenza, which in 1912 numbered 534 (52 weeks), rose to 863 in
1913 (53 weeks). The deaths from bronchitis numbered 5,792 in 1913, as compared with 5,479 in
1912. In 1913 there were 5,887 deaths attributed to pneumonia, as compared with 5,337 in 1912.
(a) See footnote (b), page 28. (b) See footnote (c), page 6.