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4. Multipara (3), age 24. Confined in hospital, normal
delivery. On ninth day developed symptoms of endometritis. In
hospital six weeks. Sent for two weeks convalescence. Good
recovery.

Thirteen mothers recovered. The fatal case of septicaemia
occurred in a primigravidae, aged 28. Father and sister died of
pulmonary tuberculosis. Patient had influenza one month before
confinement. Normal delivery at home by doctor and trained
maternity nurse—3 vaginal examinations by maternity nurse and 2
by doctor—neither gloves nor masks worn—slight perineal tear—
one suture—rigor on second day after delivery—seen by obstetric
consultant—Temp. 104 deg. P. 160—tenderness in lower abdomen
—erythematous rash on abdomen and thighs—clinically diagnosed
as virulent acute puerperal primary septicaemia (probably infection
with hemolytic streptococcus)—prognosis grave. Removed to
hospital—hæmolytic streptococci grown from blood stream within
24 hours of admission—physical signs of generalised peritonitis—died
five days later.
There was one stillbirth, and one child died following Cæesarean
section.
The stillbirth was in a case where the child was born before
the mother realised she was in labour, although she had had pains
for several hours. This was her first child. The mother had a