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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In only one case of sepsis was there evidence of the source of infection. This
patient had been in contact with two other patients suffering from heemolytic streptococcal
infection who recovered. This small "outbreak" was mentioned in last
year's report. There was fortunately nothing of the nature of an epidemic of sepsis
in any hospital in 1934, but the prevalence of mastitis in certain localities (not
confined to the Council's hospitals) continues to give rise to anxiety. In no case
was infection of any sort traced to an attendant, though very thorough investigation
is made in every instance.
It will be noted that, so far as the much-discussed cause of sepsis—" instrumental
interference"—is concerned, the Council's service is blameless. The forceps rate
in the hospitals is remarkably low (average 3.54 per cent.). In the only two fatal
cases in which forceps had been applied after admission, other factors present
were undoubtedly responsible for the development of sepsis.
Probably one of the most important factors in the prevention of sepsis is the
early detection and isolation of all cases of pyrexia or other suspicious signs of early
sepsis occurring in a maternity ward. Improved accommodation is permitting this
precaution to be carried out with increasing success in the Council's hospitals.
There were 86 cases of accidental haemorrhage admitted to the wards. Only
one mother died (a woman who arrived moribund and died in 35 minutes), 37 of
the children were stillborn, and 33 of the patients had some degree of albuminuria.
There were 98 cases of placenta prcevia and 3 deaths. One patient had had
several vaginal examinations before she came into hospital and died of sepsis.
Another patient, an 8-para, had been bleeding only 3½ hours before admission, was
admitted exsanguinated and died in 2 hours. The third patient, 6-para, had been
admitted to the wards at the 32nd week for slight bleeding which soon ceased
completely. She fell into labour a few days later and had a violent haemorrhage
from which she never rallied. Thirteen Cæsarean sections were performed for this
condition without a death.
Six deaths were attributed to postpartum haemorrhage, but three patients
were delivered outside the hospital and were admitted in a shocked and exsanguinated
state with the placenta in situ and died in a few hours. One of these proved to
be a case of the rare condition, placenta accrela.
Of the three patients whose delivery was entirely conducted in the hospitals, one had a
severe degree of acute thyrotoxicosis which was as much responsible for the fatal result as the
haemorrhage. One patient, a 10-para of 43, had marked hydramnios and a persistent occipitoposterior
presentation necessitating a forceps delivery. The third fatality occurred in an
8-para of 35, who had neglected all advice during pregnancy and, when admitted to the antenatal
ward, took her own discharge. She had marked debility and very septic teeth. Delivery
was normal, but the placenta required manual removal; sharp postpartum haemorrhage
followed, from which she was unable to rally.
"Accidents of
Excluding the deaths already noted under the heading of "puerperal sepsis,
there were four fatalities included in the category "accidents of childbirth." Only
one occurred in a patient who had ante-natal care from the Council, i.e., a woman
of 28 who died of shock after craniotomy. The other three patients were admitted
in extremis. Two were "failed forceps" of a familiar type, and one patient was
found to have a shoulder presentation and a ruptured uterus on arrival.
One death attributable to anaesthesia occurred during the year. The patient
was a primipara of 27 with a small round pelvis, who was about to have a Csesarean
section performed early in the second stage of labour. She was given percaine
and a gas, oxygen and ether mixture was administered by an experienced anaesthetist.
Death took place five minutes later, without warning, and before the operation
had begun. The cardiac muscle showed degeneration microscopically.
Out of 13,061 deliveries in the wards, 4,424 are reported as being given light
intermittent anaesthesia (mainly by means of chloroform capsules), 850 had a general
anaesthetic, 58 had local anaesthesia. Analgesia by drugs was given to 325 patients
in association with some form of anaesthetic and to 837 patients who had no
No untoward effects are recorded with the exception of the death abovementioned.