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

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London County Council 1934

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

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Laparotomy was performed in 6 cases, the 7th being a case with initial scarlet
fever, which developed bilateral empyema and succumbed following rib resection.
Extensive suppurative peritonitis found at post-mortem examination. (Hsemolytic
streptococci in cervix at onset).
There were 5 cases at term (all normal deliveries—vaginal examinations not
made in 2). Four had laparotomy and hsemolytic streptococci were isolated from
the peritoneal exudate. Hsemolytic streptococci were isolated from cervix in all 5.
Particulars of the 2 abortions are as follows
(i) Cervix and peritoneal exudate: B.coli.
(ii) Cervix : B. coli and non-hsemolytic streptococci. Blood : non-hæmolytic
streptococci. No culture from peritoneal exudate.

Analysis of 7 cases in which general peritonitis occurred:—

Para.Delivery.Vag-inal exam.Cervical swab.Additional diagnosis.Operation.
MultiparaNormalMadeHæmolytic strep.Septic endo- and perimetritisLaparotomy Hæm. strep.
MultiparaNormalMadeHæmolytic strep.Suppurative parotitis (terminal)Laparotomy Hæm. strep.
Primipara.NormalMadeHæmolytic strep.Perineal and vaginal sepsisLaparotomy Hæm. strep.
PrimiparaNormalHæmolytic strep.Scarlet fever Bilateral empyema.Rib resection.
MultiparaAbortionMadeB. coliPelvic abscess Pyelo-nephritis.Laparotomy B. coli.
MultiparaNormalMadeB. coliSepticaemia (staph, albus)Laparotomy Hsem. strep.
MultiparaAbortion Curetted before adm.MadeB. coli and non-haem. strep.Septicaemia (non-haemolytic strep.) Pelvic abscess.Laparotomy (no culture).

6—8. Septicemia.—8 cases (2 occurred plus general peritonitis, and 2 plus
pelvic peritonitis).
(a) Multiparse, 7. Normal delivery 5
Instrumental delivery 1
Abortion 1 (curetted before admission).
(b) Primiparse, 1. Instrumental delivery.
Blood culture was positive in 7 of the cases, sterile in the remaining one, a
clinical septicaemia with generalised septic arthritis.
Two cases recovered. In one pneumococci were cultured from the cervix,
blood stream and pus from a cellulitis of the elbow. In the other hsemolytic
streptococci were obtained from the cervix, blood stream and exudate from
laparotomy wound (drainage of pelvic peritonitis).
Organisms present in 7 positive blood cultures:—
Hsemolytic streptococci 3
Non-hsemolytic streptococci 1
B. coli 1
Pneumococcus 1
Staphylococcus 1
Total 7
The 4 cases classified in sections 7 and 8 are included in the above.