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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Twelve of the women had had ante-natal care in the Council's clinics, and of
these two died. (v. inf.).
Twenty-nine had had care from other sources or none, and of these six died.
Two women had been confined at home and were brought in moribund.
Twelve patients were admitted comatose, and of these five died.
Two women died undelivered.
Five patients were under treatment for toxaemia in the wards when the fits
developed. One of this group died.
The time at which the fits developed is of interest as illustrating the very grave
prognostic significance of cases where the first fits were post-partum
Onset before labour 11 cases—2 deaths.
Onset during labour 22 cases—2 deaths.
Onset after labour 8 cases—4 deaths.
Thirty-four of the women were primiparae 6 deaths.
Seven of the women were multiparae 2 deaths.
Five of the patients showed only a "trace" of albuminuria at any time; none
of them died. One woman only never had any albuminuria at all and she died
(v. inf.). The remainder all showed a marked degree of albuminuria once the fits
began, but in some instances the urine had been tested only a few days before and
nothing abnormal had been found. It is clear that periodic urine testing, even if
done weekly, would not provide an adequate warning in every instance. Eight
women still had a "trace" of albumen on discharge.
The blood pressure is a valuable guide in prevention, though this also is not
100 per cent. efficient as a warning. The maximum blood pressures in the 41 cases
varied from 120 to 250, but only one was below 130. The records suggest that, once
above the 130 level, the maximum readings have little prognostic significance, for
patients with blood pressures of 200+ recovered, while others with 140 died.
The two deaths among the 11,436 patients who attended the Council's ante-natal
clinics are worthy of note.
One patient was a primipara of 27 at the 28th week, who had made three
attendances and had been normal in every respect. Her last attendance was fifteen days
before admission. Eight days before admission she began to have oedema and epigastric pain,
but she did not seek advice. She arrived at the hospital badly cedematous, her urine loaded
with albumen, and a blood pressure of 196. Four hours later, in spite of energetic treatment,
she fell into a series of fits, and died in three hours.
The other patient was a primipara of 29, who had attended one of the Council's ante-natal
clinics on nine occasions, and had been perfectly well. Two weeks before term she suddenly
developed a pain in the right side which was diagnosed as diaphragmatic pleurisy. She was
admitted to the ward, and her pulse, temperature and urine were found norma). Next day she
fell into labour, which was delayed from rigidity of the os. Immediately before delivery she
had a mild convulsion lasting thirty seconds, and fell into a coma, from which she never emerged.
She died in two hours. Necropsy showed acute necrosis of the liver.
forms of
Four "booked" patients and four emergency cases died from other forms of
toxaemia, in which group kidney diseases have been included.
Of the booked patients, one had acute yellow atrophy, one had long-standing
diabetes and one developed very acute pyelonephritis. The fourth patient was ill
for three weeks with vomiting and had had anuria for three days before she reported
at hospital.
Of the "emergency" patients two died with chorea gravidarum after in-patient
treatment, one had a large pyelonephrosis, and the fourth had a very acute nephritis
supervening during a miscarriage at the twenty-sixth week. Of the eight patients
only one death could be considered as possibly preventable. The others had all had
full and adequate ante-natal care from the hospital or elsewhere.
The group of deaths associated with pregnancy and confinement includes
every woman who died from any cause between the twenty-eighth week of
pregnancy and four weeks after delivery. It will be noted that the degree of association
varies from those in which child-bearing admittedly played an adverse part,
e.g., pneumonia and heart lesions, to purely coincident deaths, e.g., those due to
neoplasm. Two points here call for comment. This group has little to do with