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for much of that part of the service in which fatalities might occur. A study
of the local deaths constantly brings home the fact that no provision by,
or act of, the welfare authority could have avoided the issue of so very
many of these cases.
Four deaths occurred which were classed as being from or associated
with pregnancy, giving a maternal mortality rate per thousand births
of 1.24 comprised of a rate of 0.31 for puerperal sepsis and 0.93 for other
puerperal causes. The one death from sepsis was the result of general
peritonitis following a septic abortion brought about by a fall. Two of
the other fatalities were due to eclampsia. One of these patients died
in a London maternity hospital of acute eclampsia, following twin delivery
in the hospital. The other patient who for some long time had not been
in this district was admitted to a hospital in an eclamptic fit. She was
about six months pregnant and had had no ante-natal supervision. The
remaining patient was admitted to hospital when about seven weeks
pregnant suffering from a threatened abortion or ectopic pregnancy.
When operated on, it was found the abdomen was filled with blood and
there was generalised thrombosis of the pelvic veins. She made satisfactory
though slow progress until the ninth day when her condition
suddenly and very rapidly deteriorated.
PUERPERAL INFECTION.
Puerperal fever, undefined, was notifiable under the Infectious
Diseases (Notification) Act. It acquired an ominous significance
with associated culpability. For this reason and perhaps too because it
was not defined, it seemed that many cases were not notified. It was
sought to remedy this unsatisfactory state by introducing the term
" puerperal pyrexia, " a condition separately notifiable under Regulation,
being defined as any febrile condition other than the condition required
to be notified as puerperal fever occurring in a woman within 21 days of
childbirth or miscarriage in which a temperature of 104° F. had been
sustained for 24 hours or had recurred. Whereas, then, puerperal fever
was considered to be a pyrexia arising from an infection of some part of
the birth canal, puerperal pyrexia might be the result of a variety of
causes of which some, e.g. influenza, might be completely unassociated
with the delivery. Puerperal fever was not included in the list of notifiable
diseases in the consolidating Public Health Act 1936, so the only
condition notifiable to-day is the puerperal pyrexia of the Regulations.
Some forms of puerperal infection are transmissible and liable to
cause an illness of grave nature. Until then, an innocent cause of the
pyrexia is determined, it is safer to assume a febrile patient is infective,
and so should not be attended by anyone who is attending on other
maternity cases. For this reason, by arrangement with the District
Nursing Association, patients suffering from pyrexia if retained at home
are treated by the staff of the Association. More severe cases needing
treatment are admitted to hospital. Before the war, admission was
usually to the isolation block of Queen Charlotte's Hospital, or failing
that, to the puerperal block of the L.C.C. North Western Hospital. At
times, admission could be obtained only to one of the isolation hospitals
with which the Council has an agreement. It is desirable that the infant