H.—3l

11

It is noticeable that in the last two years most of the hospital districts have been affected. Auckland and Otago, which last year showed a markedly increased number of deaths from this cause, have returned to their former low level, while the deaths in Wellington and Taranaki have increased. Despite the endeavours of medical practitioners and nurses throughout the Dominion to prevent the occurrence of secondary cases of puerperal septicaemia, it is a definite fact that at approximately ten-year intervals an epidemic wave of puerperal septicaemia occurs, causing primary cases in most of the hospital districts and necessitating extreme caution to prevent further spread. Most infectious diseases display this periodicity. It is a loose habit, lacking justification, to ascribe the undue prevalence of puerperal fever in any given year to the coincident prevalence of other diseases, such as scarlet fever. Investigation, however, of the deaths in New Zealand during the last half-century from scarlet fever, influenza, pneumonia, and the other common notifiable diseases shows that a high death-rate from these causes is not linked up with a high death-rate from puerperal septicaemia. The coincident prevalence in the last two years of scarlet fever and puerperal septicemia is an unusual event. Another theory sometimes advanced is that the undue prevalence of some other non-notifiable disease, such as streptococcic or staphylococcic infection, associated with a low degree of acquired immunity among women, causes the epidemic waves of puerperal septicaemia. This theory, though plausible, is unproven. The periodic epidemic wave of puerperal septicaemia may be a separate entity, as apparently is the case with diphtheria, influenza, infantile paralysis, scarlet fever, and other infectious diseases,, which diseases also show periodic variations in incidence. Other Causes of Maternal Deaths in 1928, 78. 1. Puerperal albuminuria and convulsions .. .. .. 38 2. Puerperal haemorrhage . . . . . . . . .. 15 3. Other accidents of labour .. .. .. . . 4 4. Accidents of pregnancy .. . . . . .. . . 11 5. Puerperal white-leg, embolus, and sudden death . . .. 9 6. Following childbirth (not otherwise defined) . . . . .. 1 78 The total number of deaths from these causes in the previous year (1927) was 67. In 1928 items 1, 2, and 3 showed an increase, mainly the first —viz., puerperal albuminuria and convulsions. Items 4, 5, and 6 showed a slight decrease. International List. The following table gives the death-rate from puerperal causes in various countries (a quinquennial average—such an average discounts annual extremes) : —

Death-rate per 1,000 Births from Country. Period. Puerperal Other Puerperal All Puerperal Septicaemia. Causes. Causes. Sweden .. .. .. .. 1920-24 1 15 1-36 2-51 Italy .. .. . • • ■ 1922-26 1-02 1-52 2-54 Netherlands .. .. .. 1923-27 0-59 2-03 2-62 Norway .. .. .. .. 1921-25 0-74 1-91 2-65 Uruguay .. .. .. .. 1922-26 1-67 1-01 2-68 Denmark .. .. 1922-26 0-95 1-81 2-76 Hungary .. .. .. • • 1922-26 1-43 1-57 3-00 Japan .. .. . . • • 1921-25 1-21 2-07' 3-28 England and Wales . . • ■ 1923-27 1-48 2-52 4-00 Germany 1921-25 i 2-80 1-47 4-27 Spain .. .. •. ■ ■ 1922-26 2-25 2-09 4-34 Switzerland .. .. • • 1922-26 2*07 2-57 4-64 Irish Free State .. .. • • 1923-27 1-67 3-05 4-72 New Zealand 1924-28 1-86 2'89 4-75 Northern Ireland .. .. .. 1921-25 1-55 3-21 4-76 Union of South Africa .. .. 1923-27 2-03 2-96 4*99 Australia 1923-27 1-84 3-65 5-49 Belgium .. . • ■ • ■ ■ 1921—25 2*68 2*85 5*53 Canada 1923-27 1-80 3-98 5-78 Scotland 1923-27 1-78 4-47 6-25 Chile .. .. • ■ • ■ 1922-26 1-69 4-98 6-67 United States .. • ■ • ■ 1920-24 2-54 4-36 6-90 Trinidad .. .. .. •• 1923-25 3-58 5*68 9-26 British Guiana .. .. • • 1922-25 2*68 11*55 14*23 Ceylon .. .. ■ • • • 1923-27 7*40 11*75 19*15