| Table III.—Table Showing the Death-rate from all Causes amongst Women Delivered in their own Homes. (Abstracted from Dr. Le Fort’s Tables.) | |||||
|---|---|---|---|---|---|
| Places | No. of Years of Observation | Deliveries | Deaths | Deaths per Thousand | |
| Edinburgh | 1 | 5,186 | 28 | 5 | |
| London: | |||||
| Westminster General Dispensary | 11 | 7,717 | 17 | 2 | |
| Ditto Benevolent Institution | 7 | 4,761 | 8 | 1 | |
| Royal Maternity Charity | 5 | 17,242 | 53 | 3 | |
| London population | 5 | 562,623 | 2,222 | 3·9 | |
| St. Thomas’ Hospital | 7 | 3,512 | 9 | 2·5 | |
| Guy’s Hospital | 8 | 11,928 | 36 | 3 | |
| Ditto | 1 | 1,505 | 4 | 2 | |
| Ditto | 1 | 1,702 | 3 | 1·7 | |
| Ditto | 1 | 1,576 | 11 | 6 | |
| Paris: | |||||
| 12th Arrondissement | 1 | 3,222 | 10 | 3 | |
| Bureau de Bienfaisance | 1 | 6,212 | 32 | 5 | |
| Ditto | 1 | 6,422 | 39 | 6 | |
| City of Paris | 1 | 44,481 | 262 | 5 | |
| Ditto | 1 | 42,796 | 226 | 5 | |
| Leipzig Polyclinique | 11 | 1,203 | 13 | 10 | |
| Berlin | „ | 1 | 500 | 7 | 14 |
| Munich | „ | 5 | 1,911 | 16 | 8 |
| Greifswald | „ | 4 | 295 | 6 | 20 |
| Stettin | „ | 17 | 375 | 0 | 0 |
| St. Petersburg | 15 | 209,612 | 1,403 | 6·6 | |
| Total | 934,781 | 4,405 | 4·7 | ||
St. George’s Hospital Statistics for ‘the 6 years preceding 1870 show only one maternal death in every 305 cases’ in the Out-door Maternity Department.
From home records, it is hoped at some future time to give many more data of this kind, and to distinguish the causes of death: puerperal from non-puerperal mortality, as well as that caused by puerperal diseases from that caused by accidents of childbirth. At present the data for doing this are lamentably deficient, if not almost altogether wanting.
One good recorded fact will here be given. Among 1,929 mothers delivered at home by Guy’s Hospital in 1869, 5 deaths only are recorded, and none from puerperal diseases; 2 were from heart disease, 2 from pneumonia, 1 from exhaustion.
OBJECTIONS TO THE DATA.
The value of the Registrar-General’s results, and of those given by Le Fort, has been called in question by Dr. Duncan in his work already cited, partly on the authority of certain results of home practice, quoted from Dr. M’Clintock, who has collected the statistics of 16,774 deliveries exclusively from home practice. There were among these 45 deaths from accidents of labour, 52 deaths from puerperal diseases, and 34 deaths from non-puerperal diseases; giving a total mortality of 131, or nearly 8 per 1,000. On considering these figures, the first impression they convey is not that either the Registrar-General or Le Fort is wrong. But it is a very painful impression of another kind altogether. One feels disposed to ask whether it can be true that, in the hands of educated accoucheurs, the inevitable fate of women undergoing, not a diseased, but an entirely natural condition, at home, is that one out of every 128 must die? If the facts are correct, then one cannot help feeling that they present a very strong prima facie case for enquiry, with the view of devising a remedy for such a state of things. It must be seen, however, that these statistics of home practice are as open to the charge of want of accuracy as those of the Registrar-General or Le Fort. The question can only be settled by enquiry, and by more carefully kept statistics of midwifery practice; but in the meantime here are a few facts, kindly placed at my disposal by Mr. Rigden, of Canterbury, which are by no means so hopeless as those given by Dr. Duncan.
‘An analysis of 4,132 consecutive cases in midwifery occurring in private practice during a period of 30 years, particularly in reference to mortality. Eight mothers died: three from convulsions and coma; 4 from puerperal fever; and one from heart disease, about an hour after a comparatively easy labour.’
The report states 8, but after it was supplied another death took place, the day after delivery, making 9 in all. The cause of death is not given.
Mr. Rigden explains that these figures relate only to the first fortnight after delivery; but he states that if any other deaths had taken place within the month, he must have heard of them.
Assuming the Deliveries at 4,133 and the Deaths at 9, Mr. Rigden’s facts show a total mortality of 2·17 per 1,000, of which less than 1 per 1,000 was due to puerperal fever.