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The second case referred to was stated in the death certificate,
dated January, 1898, to have died from " puerperal fever," and as I
had received no notification I wrote to the certifying practitioner
for an explanation of his failure to comply with the law. He
replied that he had already notified the case to me, and blamed the
postal authorities. I investigated the circumstances and discovered
that the friends were unaware that the deceased woman had suffered
from any infectious disease, and that the two nurses who had
attended upon her were at the time of my visit nursing two other
women who had been recently delivered, and that as they also were
unaware of the infectious nature of the deceased woman's illness
they had undergone no process of disinfection. The fact that these
two parturient women escaped puerperal fever is providential.
The above particulars were reported to the Sanitary Committee,
but after our unfortunate experience in the previous case it is not
surprising that they declined to prosecute.
With reference to the first case I had some correspondence with
Dr. Tatham, the statistical superintendant at Somerset House. In
one of his letters to me this gentleman remarks, " As the name
puerperal fever occurs in the Public Health (London) Act, 1891, I
should have thought that a definition of that term ought to have
been appended to that Act." In this opinion I certainly concur.
In a poor district like Eethnal Green, with an enormously high
birth rate, the practice of midwifery provides a large proportion of
the income of medical practitioners. Now a case of childbed fever
is justly regarded by prospective patients as a blot on the reputation
of the doctor in whose practice it occurs ; the temptation is, therefore,
great on the part of a medical man to conceal the existence of
such a disease, and to call it by some of the less known synonyms;
and this may safely be done as if ultimately fatal the death may be
truly certified without the use of the obnoxious term. Under such
circumstances no precautions as to the spread of the disease are
likely to be taken, though the disease under consideration is
eminently a preventible one, and urgently requires that proper
means of disinfection should be used in order to prevent conveyance
of infection.
C