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dying on the fourth day. Post-mortem examination revealed
multiple areas of degeneration in the liver. Two deaths were
due to post-partum haemorrhage due to adherent placenta, both
of patients confined in hospital. The death certificate in one
case read—1 (a) Exhaustion, (b) prolonged labour, (c) premature
rupture of membranes ; 2 Primary uterine inertia ; 3 Rigid cervix.
The patient had a perineal and cervical repair performed in 1933.
She was a booked hospital case, but sought admission five days
after the rupture of the membranes. Another hospital case,
who had also had full ante-natal supervision, showed signs of
sepsis some few days after a normal confinement and died on the
eleventh day from pulmonary embolism. The sepsis was apparently
due to infection of a retained cotyledon of the placenta. A patient
confined at a hospital died under an anaesthetic shortly after
forceps delivery under anaesthetic, performed on account of prolongation
of labour. Post-mortem examination revealed myocardial
degeneration. The remaining fatal case was due to (1)
(a) myocardial failure, (b) puerperal mania.
Enquiries into maternal deaths were previously undertaken in
all three districts by members of the staff of the Middlesex County
Council, but are now carried out by the Medical Officer of Health.
Puerperal Fever and Pyrexia.
Twenty-one notifications of puerperal fever were received
during the year, 16 being of puerperal pyrexia and five of puerperal
fever. Per thousand total births (i.e. live and stillbirths), the
rates for these conditions were 7.1 and 2.2, the corresponding
figures for the country as a whole being 9.6 and 4.0.
One of the cases of puerperal fever proved fatal, the patient
developing general peritonitis after a full-term normal delivery at
home.
Two of the 21 confinements took place in hospitals, and five
in nursing homes. Twelve cases were removed to hospital for
treatment.
Work of the Health Visitors.
Routine visits are paid to infants as soon as possible after
the tenth day, and special visits are paid to cases of ophthalmia
neonatorum, puerperal infection, stillbirths, infants' deaths, etc.
Each Health Visitor is now appointed Infant Protection Visitor
for her own area. The Health Visitors also attend the various
clinics, the officer in charge of the session being, as far as possible,
the visitor for the section from which the mothers attend.