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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Caesarean section was performed on 136 patients with 9 deaths. The indications for which the operation was undertaken were as follows

Indications.No. of operations.Deaths of mothers.
Contracted pelvis and disproportion843
Heart disease191
Placenta prsevia130
Concealed accidental hæmorrhage20
Obstruction due to ovarian cysts31
„ „ tumours11
„ „ hydrocephalus10
Other forms of toxaemia63
Epilepsy, phthisis, extended breech, contraction ring40

The stage at which the operations were performed was as follows:—
Before labour 74—5 deaths.
Early in labour 30—2 deaths.
Late in labour 32—2 deaths.
The mortality rate was lower than in the two previous years (1931—3 per
cent. 1932—8.5 per cent., 1933—8.6 per cent. 1934—6.6 percent.), 6.6 percent. of
the children were stillborn and 9-6 died within 10 days. The deaths of the mothers
in this year's series showed some curious features. Four of the nine were due
entirely to the condition for which the operation was performed and the remainder
were all due to sepsis.
Of the four patients who died from concomitant disease, one had very severe
heart disease, another had chorea gravidarum, a third fulminating toxaemia (acute
yellow atrophy of the liver) and the fourth (an emergency case) a large pyelonephrosis.
Her kidneys were found post-mortem to be riddled with abscesses. In
none of these cases could any other course have been taken to save the patient.
The five deaths from sepsis occurred as stated below.
Two followed complicated operations. In one case a huge fibro-neuroma of the sciatic
nerve was found blocking the pelvis. It was dissected out with difficulty and the disturbance
of tissues involved made sepsis a likely sequence. In the other case a cyst of the broad ligament
was the obstructing factor, and was removed at the time of the operation. Three deaths
followed simple operations for contracted or deformed pelvis.
Cask 1.—An emergency case in a primipara of 19 who had been in labour for two days and
had had many examinations by doctor and midwife before admission. She died with an acute
hsemolytic streptococcal infection.
Case 2.—At the same hospital a fortnight later an operation was performed on a primipara
of 27 with scissor-like deformity of the legs. The time elected was the beginning of spontaneous
labour. Acute sepsis developed, as in the previous case. The two cases had never been in
contact, there was no other sepsis in the ward, and the source of infection could not be discovered.
Case 3.—Delayed labour in an 8-para of 38, who had had ante-natal care. No difficulty
was anticipated at the confinement and the cause of the delay was never clear. After three days
in labour an operation was performed, but abdominal sepsis developed.
The figures for eclampsia and for toxaemia are watched with eager interest as it
is now accepted that this group of diseases is to a large extent preventable, and the
rate serves as an indicator of the efficiency of ante-natal care. It is possible that
this argument may be pushed too far. Two complicating factors have always to be
considered—the patient may fail to recognise the significance of early symptoms
however clearly she is instructed, or the disease may be of the rare fulminating type
which gives little or no warning and is resistant to all treatment. Where the
incidence of a disease is now approximately 1 in 1,000 among clinic patients and the
mortality 1 in 6,000 (as is the case with eclampsia), it is no easy task to improve the
In 1934, 41 cases of eclampsia were admitted to the wards. Every parturient
woman who had convulsions however transient was included, except one oldstanding
case of diabetes.