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.
| 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.