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24
25th, and second white leg on April 4th. Temperature
normal by April 26th.
Case B.
Confined on May 13th (the midwife who attended Cases
1, 2 and 4 examined). Curetted May 29th—retained products
found. Dr. J. Bright Banister, obstetric surgeon, saw
this case and diagnosed parametritis. She was removed to
Chelsea Hospital under his care.
Case C.
Forceps delivery on May 21st—complete tear involving
the bowel—stitched. Seen by Dr. J. Bright Banister on
June 3rd—hæmatoma diagnosed which discharged the following
day—temperature fell.
With regard to these temperature cases, I do not think
that there is any evidence that Cases A and C are connected
with the series of puerperal fever cases.
Case B was examined by the midwife concerned in the
puerperal fever cases, and it appears very probable that she
was the cause of infection in this case. In answer to my
letter, Dr. Banister reports on June 25th, that he saw this
woman at Kingston Nursing Association Home about three
weeks ago. "She then had a temperature of 103 and a
pulse of 110, but in general appeared quite well. The
history that I got was that she had a normal labour, but
had developed fever soon afterwards. When this fever had
persisted for some days, she was examined under an anaesthetic,
and a piece of placenta was removed. The uterus
was then curetted, following which there was a marked
exacerbation of fever. On my examination she appeared to
have a large parametric effusion principally on the left side.
As I thought this was likely to require surgical intervention,
I admitted her to the Chelsea Hospital for Women next day.
Three days after her admission there, she passed another
piece of what appeared to be placenta. The fever has continued,
and the parametric effusion has got firmer. I have
not yet operated, as I am waiting for some sign of pointing."
Now returning to the notified cases of puerperal fever,
I think that it is very doubtful that Case 3 was infected
while in the Nursing Home, and in my opinion there is no
definite proof that infection was introduced while she was
there.
With regard to Cases 1, 2 and 4, the two babies, and