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108
temperature 103.4 deg.—no uterine tenderness—lochia normal,
no cough, no rigors—in the subsequent four days the record of
four-hourly temperature showed a swinging temperature reaching
a maximum of 102 deg. on0ce in 24 hours, pulse 90-100. At first
rise of temperature (3rd day) patient received salicylates—on
5th day given sulphonamide, gr. XV. four-hourly—on 6th day
10 c.c. intrauterine glycerine—haemoglobin 68 per cent.
Consultant summoned on 7th day following delivery—clinical
examination failed to reveal any abnormal physical signs other than
intermittent pyrexia, some tachycardia, slight increase of respiration
rate, pain and tenderness in left loin, a few moist crepitations at
bases of both lungs—lochia normal—uterus well involuted—no
abnormal physical signs in pelvis—initial differential diagnosis
between left-sided pyelitis and mild puerperal sepsis—catheter
specimen negative—cervical swab culture grew sporing aerobic
bacilli with a few non-haemolytic streptococci—patient transferred
to Queen Charlotte's Hospital Isolation Block on 8th day following
delivery—remained there three weeks and was considered to be
suffering from puerperal septicaemia with tuberculosis of the urinary
tract—no improvement in her clinical condition and she was transferred
for further investigation to St. Mary's Hospital, Paddington,
where she was finally diagnosed as a subacute bacterial endocarditis,
with streptococcus viridans grown from the blood culture.
She died two and a half months after confinement. This last was
a particularly interesting and puzzling case. It was investigated
fully from the standpoint of puerperal infection but the subsequent
history pointed to the old heart lesion as the primary cause of
the patient's condition.
Maternity Mortality.
There were two maternal deaths of Leyton residents during
the year—one from toxaemia of pregnancy at 20 weeks ; and the
second from puerperal septicaemia following instrumental delivery
of a post-mature stillborn macerated foetus.
The details of these cases were as follows:—
1. Multipara—aged 38—4th pregnancy. Home circumstances
fair—admitted to hospital at 14 weeks with history of severe
vomiting—albumen, bile and acetone in urine—slightly jaundiced—