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delivery at term the placenta was adherent. There was no
hæmorrhage, but one hour later the patient became restless and
cyanosed. Post-mortem examination showed toxic degenerative
changes in the liver and the kidney in an advanced state of
autolysis.
PUERPERAL INFECTION.
34 notifications of puerperal pyrexia were received, being a
rate per thousand total births of 10.6 compared with a figure of
14.4 for the country as a whole.
10 of these notifications were in respect of women confined
in institutions in London.
Of 21 patients confined in this district the cause of pyrexia
in 11 was apparently genital tract infection. In seven of these
labour was normal but in the case of the other four there was some
operative interference. In another three the raised temperature
was due to pyelitis, in one to femoral thrombosis, in another to a
localised peritonitis, while in the remainder it was apparently not
due to infection of the genitary tract.
None of these notified cases proved fatal, though two death
certificates were received of patients who died in institutions
outside this district in whom the cause of death was puerperal
infection.
The Council's provisions for the treatment of those suffering
from puerperal infection are to arrange for their admission either
to the isolation block of Queen Charlotte's Hospital or to the London
County Council 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
in London institutions, eight of the notified cases were removed
to hospital for treatment, while home nursing was provided for
two patients. In addition seven cases of suspected infection were
taken over from the Council's midwives.