The same Report gives the following puerperal death-rates for all England during 13 years, 1855 to 1867 (see Table II.).
| Accidents of childbirth | 3·22 | per | 1,000 |
| Puerperal diseases | 1·61 | „ | „ |
| Total, exclusive of other deaths | 4·83 | „ | „ |
An important element in the analysis of these death-rates is their relative prevalence in town and country. This is abstracted on Table II. from the Registrar-General’s Report for a period of ten years, as follows:—
| Deaths from Accidents of Childbirth and Puerperal Diseases. | |||
|---|---|---|---|
| England, 64 healthy districts, 312,402 deliveries | 4·3 | per | 1000 |
| Ditto, 11 large towns, 1,402,304 deliveries | 4·9 | „ | „ |
In other words, out of every 5,000 deliveries in towns there are three more deaths from accidents of childbirth and puerperal diseases than occur among the same number of deliveries in healthy districts.
These facts, with a small deduction for the higher death-rates in lying-in hospitals, give the present mortality in English homes. They appear to show that puerperal women are subject to something of the same law of increase of death-rates in towns as other people, but part of the increase is no doubt due to the higher death-rates in delivery wards in these towns. The facts also appear to indicate a probable reduction of death-rates among lying-in women in England, from the extension of public health improvements both in town and country.
| Table II.—Table Showing the Mortality per Thousand after Delivery from Puerperal Diseases and Accidents of Childbirth. | ||||
|---|---|---|---|---|
| Places | Mortality Per Thousand Deliveries | |||
| Puerperal Diseases | Accidents of Childbirth | Puerperal Diseases and Accidents of Childbirth | ||
| King’s College lying-in ward, 5 years | 29·4 | 0 | 29·4 | |
| 12 Parisian Hospitals | 1861 | 75·2 | ||
| 1862 | 56·7 | |||
| 1863 | 60·6 | |||
| Queen Charlotte’s Lying-in Hospital, 40 years | 14·3 | 5·3 | 19·6 | |
| 27 London workhouses, in which both deliveries and deaths have taken place | 4·1 | 2·1 | 6·2 | |
| 40 London workhouses, including those without deaths, 5 years | 3·3 | 1·7 | 5·0 | |
| Liverpool Workhouse lying-in wards, 13 years | 3·4 | 2·2 | 5·6 | |
| All England, 13 years | 1·61 | 3·22 | 4·83 | |
| Ditto, 64 healthy districts | ||||
| (312,402 deliveries), 10 years | 4·3 | |||
| Ditto, 11 large towns (1,402,304 deliveries), 10 years | 4·9 | |||
| 8 military lying-in hospitals, 2 to 12 years | 3·9 | 3·4 | 7·3 | |
NORMAL MORTALITY AMONG LYING-IN WOMEN IN DIFFERENT COUNTRIES.
The next step in the enquiry is to ascertain, so far as it may be possible to do so, what is the death-rate among lying-in women delivered at their own homes in different European countries. Besides the mortality statistics for healthy districts in England, already given, the only available data for this information are reports of public institutes having outdoor midwifery practice, and any records of private practice which may have been published. In adducing these data, however, it is necessary to do so with the reservation already made that their accuracy is only approximate.
The most extensive series of data of this class is given by Dr. Le Fort in his able treatise ‘Des Maternités,’ for a number of institutions in different European countries. The facts from Dr. Le Fort’s book are abstracted on Table III., in which it is shown that out of 934,781 deliveries at home, in Edinburgh, London, Paris, Leipzig, Berlin, Munich, Greifswald, Stettin, and St. Petersburg, there were 4,405 deaths, equivalent to a mortality of 4·7 per 1,000. When compared with the Registrar-General’s returns for town districts, this rate is apparently somewhat too low; it is only an approximation, but still sufficiently near the rate given by the Registrar-General to show that there is a true death-rate for home deliveries not far removed from the Registrar-General’s figure.