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). | ||||||
| Total Births | Deaths from Accidents in Childbirth | Deaths from Puerperal Diseases | Deaths from Miasmatic Diseases | Deaths from Consumption and Chest Diseases | Deaths from all Other Causes | Total Deaths |
| 768,349 | 2,346 | 1,066 | 137 | 230 | 154 | 3,933 |
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, pyæemia, &c.).
3. Of the remaining 521 deaths, 137 were due to non-puerperal 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.
5. The mortality per 1,000 deliveries (or rather per 1,000 births) from each class of causes in England, in 1867, stands thus:—
| Accidents of childbirth | 3 | per | 1,000 |
| Puerperal diseases | 1·4 | „ | „ |
| Others, including non-puerperal fevers | ·7 | „ | „ |
| ——— | |||
| Total | 5·1 | „ | „ |
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 | |