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21
It will be seen that the mortality rate in respect of all other causes than sepsis
in which contagion can necessarily play no part is, in institutions, twice that of the
rate among doctors and six times that among midwives, and thus the "excessive
mortality from sepsis occurring in the practice of maternity institutions "in Aberdeen
which "has been largely due to gross contagion" is actually no greater than
that of non-contagious causes. Clearly the institutional cases are "selected "and
not comparable with those delivered by either doctors or midwives.
Sir Shirley Murphy initiated systematic inquiries into all cases of puerperal
fever in London, and detailed statements of the facts elicited both in regard to
puerperal fever and other accidents of childbirth occurring in the midwives' practice
are given in the Annual Reports of the Medical Officer since 1904.
The result of routine inquiries in London during 1911-14 into deaths certified
as due to puerperal fever showed that 196, or 30 per cent. of the total deaths from
this cause had not been notified. Similar records for 1921-24 showed 27 per cent.
not notified.
Under regulations of the Ministry of Health issued in 1926, any febrile condition
other than puerperal fever, occurring within 21 days of confinement, is notifiable
as puerperal pyrexia of these pyrexias, many which prove to be puerperal fever,
escape notification as such. This is evident from the fact that in 1927, 57 per cent.
of the fatal cases of puerperal fever were not notified.
The records for 1911-14 show that 23 per cent. of the deaths from puerperal
fever occurring in deliveries by doctors and medical students were not notified, as
against 48 per cent. of cases in hospitals and poor law institutions, and 80 per
cent. of cases which were either unattended or were attended by uncertified women
(mostly miscarriages).
Puerperal
fever in
London,
1911-14.
Among notified cases the case mortality was as follows:—
Doctors and medical students 31.2 per cent.
Midwives 24.7 „
Hospitals and poor law institutions 43.0 „
Miscarriages and uncertified women in attendance 23.9 ,,
All cases 30.1 „
Case
mortality .
In the above figures, cases in which the midwife was unable to deliver without
the assistance of the doctor are included among doctor's cases and excluding these,
it is found that 26.4 per cent. of the total notified cases occurred in the practice of
midwives. The total still births notified in the same period under the Notification of
Births Act was 10,179, and the number reported by the midwives in their practice
was 2,561, or 25.2 per cent. The close approximation of these two percentages
suggests that there is no markedly smaller incidence of puerperal fever in the midwives'
practice and that the higher fatality in cases delivered by doctors and in
institutions results from the transfer by the midwife to a doctor or to an institution
of cases in which there are indications of difficult or complicated labour. The duty
is laid upon the midwife of transferring such cases by the rules of the Central Midwives
Board.
Relative
incidence in
midwives'
and doctors'
practice.

Case-mortal
ity in
relation to
parity and
age.