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1930
40
(3) Single woman admitted as a married woman to Hammersmith
Maternity Hospital, Ducane Road.
Attended pre-natal clinic.
Admitted to Hospital September 1st, baby born September
2nd. Date of death, September 19th.
Cause of death— Puerperal Sepsis.
(4) Single woman admitted to Hospital for uncontrolled vomiting
of pregnancy.
Under present conditions it is difficult to see how these four
deaths could have been prevented. The difficulty of eradicating
puerperal fever lies in the fact that there is very much yet to
discover in connection with the disease. Although it is known
that certain microbes cause puerperal fever, it is possible that
more than one variety may be capable of doing so. At one time
it was thought that the disease was due to the germ called
haemolytic streptococcus, but now it is possible that another
strain called the anaerobic streptococcus may also be an occasional
cause.
Of more importance is the mode by which these dangerous
types of streptococcus reach the woman who is giving birth to
a child. Some are convinced that the woman carried these
dangerous microbes on her own person, and is therefore selfinfected.
It is known that a few women, about 25 in every 1,000,
do carry streptococci, which are indistinguishable from those of
puerperal fever, but most of these women, in spite of having
potentially dangerous microbes do not get puerperal fever after
their child-birth. Why some women are able to resist the attack
of microbes while others do not is still a matter which awaits
further research. One of the advantages of pre-natal examination
and investigation is the possibility of remedying any focus
which may result in auto-infection, and also in detecting any
abnormal condition which may result in a long difficult labour.
Great fatigue docs diminish the power of the blood to kill microbes.
In the majority of cases of puerperal fever, though, the
infecting organism is introduced from an outside source by those
in attendance during labour. An improvement in this respect can
only come from better midwifery. Not only will this result in less
exhaustion of the mother, and therefore in less diminution of her
powers to resist infection, but it will mean greater vigilance in
guarding against the transference of dangerous microbes to the
mothers during and after child-birth. The improvement may
mean a revolution in the. practice of both doctors and midwives.
It was formerly taught that extraneous infection was usually
brought about by the transfer of streptococci from an infected
patient to an uninfected one. This, of course, is still a source
of infection and prevention here is largely a question of the
sterilisation of the hands and instruments. There is much
more room for improvement in the sterilisation of the hands apart