NORMAL DEATH-RATE OF LYING-IN WOMEN IN ENGLAND.

In the Registrar-General's Thirtieth Annual Report, 1867, there is an instructive series of tables, giving approximately the present normal death-rate among lying-in women in England.

One of these tables (abstracted on Table I.) shows that, including deliveries in lying-in hospitals, there were in England, during the year 1867, 768,349 births, and that 3,933 women died in childbed. This gives an approximate total mortality of 5.1 per 1,000 from all causes.

TABLE I.-Mortality after Childbirth in England, 1867
(Registrar-General's Thirtieth Annual Report).

The causes of mortality are also given in Table I. as follows:

1. There were 2,346 deaths by accidents of childbirth (hæmorrhage, convulsions, exhaustion, mania, &c.).

2. There were 1,066 deaths due to puerperal diseases (puerperal fever, puerperal peritonitis, metritis, pyæmia, &c.).

3. Of the remaining 521 deaths, 137 were due to nonpuerperal fevers and eruptive fevers; 230 were occasioned

by consumption and other chest diseases, and 154 by other

causes.

4. By adding together deaths from puerperal diseases and those from fevers, we find that, out of a total mortality of 3,933, the deaths from diseases more or less connected with what is called blood-poisoning' amounted to 1,203, or rather more than 30 per cent. of the total mortality.

6

per 1,000

5. The mortality per 1,000 deliveries (or rather births) from each class of causes in England, in 1867, stands

The same Report gives the following puerperal deathrates for all England during 13 years, 1855 to 1867 (see Table II.).

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.

per

England, 64 healthy districts, 312,402 deliveries 4.3 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 deathrates 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 deathrates 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.

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, Leipzic, 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.

TABLE III.—Table Showing the Death-rate from all Causes amongst Women Delivered in their own Homes. (Abstracted from Dr. Le Fort's Tables.)