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75
PUERPERAL INFECTION.
Puerperal fever ceased as from September 30th to be a notifiable
disease, so since that date any conditions which would previously
have been notifiable as puerperal fever will be notifiable as
puerperal pyrexia. During the year five notifications of puerperal
fever were received and twenty-nine of puerperal pyrexia, the total
rate being, therefore, 10.6 per 1,000 total births compared with a
figure of 13.93 for the country as a whole.
Eight of these notifications were in respect of women confined
in institutions in London.
The cause of pyrexia in those who were confined in this district
was not ascertained in five instances. In six it was due to some
lesion other than that of the genital tract (e.g., mastitis, phlebitis,
infection of the urinary tract etc.), but in the remaining fifteen
instances infection was of the genital tract. Three patients had
normal confinements at about the same time in the same maternity
home. Mild uterine infection followed on a normal confinement in
six cases, most of them primiparae. In two other cases of normal
delivery infection of a perineal tear occurred, one of these cases
subsequently proving fatal. In three cases some operative interference
was required at the confinement: in one for manual removal
of the placenta; in the next, persistent occipito-posterior-presentation
resulted in laceration of the genital tract with subsequent
infection of the wound, while in the third case craniotomy was
required for an impacted head resulting in trauma of the birth
canal, subsequent infection and death. One of the cases of puerperal
infection followed on a miscarriage.
The Council's provisions for the treatment of those suffering
from these conditions is to arrange for admission either to the
isolation block of Queen Charlotte's Hospital or to the London
County Council's North Western Isolation Hospital, or to arrange
for home nursing by the staff of the local nursing association.
Apart from those who were notified while already in-patients
at London institutions, 19 of the notified cases were removed to
hospital for treatment, and for two, home nursing was provided
under the Council's arrangements.