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22
The figures seem to indicate that the fatality is not greatly dependent upon
parity. The Aberdeen figures for 1918-1927 appear to show that, while relatively
to other causes of death, puerperal fever is of less importance in first confinements
than later, the mortality per 1,000 births is considerably higher. The deaths
according to parity (Table X, p. 43) were as follows:—
First confinements. Subsequent confinements.
Deaths per Deaths per
Deaths. per cent. 1,000 births. Deaths. per cent. 1,000 births.
Sepsis 20 22 .23 49 31 .17
Abortion 3 3 .03 10 6 .04
Albuminuria and convulsions 26 28 .30 13 8 .04
Haemorrhage 6 7 .07 20 13 .07
Phlegmasia, etc., uncontrollable
vomiting, ectopic gestation 6 7 .07 14 9 .05
Other causes in pregnancy 7 7 .07 18 11 .06
do. do. childbirth 6 7 .07 13 8 .04
do. do. puerperium 18 19 .21 23 14 .08
92 100 .05 160 100 .55
If the sepsis deaths per 1,000 births had been the same in first as in subsequent
confinements, there would have been 15 deaths from this cause instead of 20 under
the heading of first confinements on the above figures.
The case-mortality from puerperal fever according to the age of mother in the
1,424 cases notified in London during 1911-14 was found to be as follows:—
Age of mother. Case mortality -per cent.
15— 18.3
20— 25.3
25— 31.0
35—45 33.7
The figures show clearly the tendency of the resistance to puerperal fever to
diminish markedly with age. The lower mortality of primiparae (among the same
cases see above) is consistent with the higher resistance at younger ages and lends
support to the view already expressed that resistance to the infective process,
rather than the severity of the confinement, is the predominant factor.
Considerable differences are found in the proportion of cases of puerperal sepsis
notified in 1911-14 by midwives and doctors respectively in different metropolitan
boroughs. In Poplar, for instance, 44 cases were notified in midwives' practices as
compared with 26 notified by medical practitioners while in the neighbouring
borough of Stepney 90 cases were notified by doctors and 21 by midwives. Grouping
together the four boroughs in which the midwives' cases are highest (A) and those
in which doctors' cases are highest (B) the following contrast is obtained:—
Puerperal fever cases notified in practice of Deaths per 1,000 births.
Borough. Other acci-
Doctors. Midwives. Others. Puerperal dents of
fever- childbirth.
Group A
Fulham 40 40 25 1.7 1.5
Shoreditch 15 14 6 1.1 1.6
Poplar 26 44 10 1.7 1.3
Southwark 25 25 26 1.0 1.4
106 123 67 1.37 1.45
Group B
Stepney 90 21 17 1.5 1.3
Bermondsey 38 4 9 1.0 1.1
Lambeth 66 14 13 1.6 1.4
Lewisham 23 3 2 1.2 1.8
217 42 41 1.32 1.40