Puerperal diseases and Puerperal Accidents of accidents of diseases childbirth childbirth All England, 13 years 1·61 3·22 4·83 England (healthy districts), 10 years, 312,402 deliveries 4·3 England, 11 large towns, 10 years, 1,402,304 deliveries 4·9 Liverpool workhouse 3·4 2·2 5·6 27 London workhouses having deaths 4·1 2·1 6·2 8 military female hospitals 3·9 3·4 7·3 Queen Charlotte’s Lying-in Hospital 14·3 5·3 19·6 King’s College Hospital lying-in ward 29·4 none 29·4 12 Parisian hospitals { 1861 75·2 „ { 1862 56·7 „ { 1863 60·6 We have already seen, as a result of Dr. Le Fort’s tables, that the mortality among women delivered at home, as deduced by him, is 4·7 per 1,000; while in the hospital it is 34 per 1,000, or nearly 7½–fold. Making any reasonable allowance for inaccuracy in the data, still we can hardly escape from his conclusions any more than we can rid ourselves from the consequences which follow from the data given above. We must confront the question called up by the data taken as a whole, viz., What can be the reason of this ascending scale of fatality shown on Table VIII.? Why is it that these death-rates from all causes in childbirth, beginning at 5·1 per 1,000 for all England (town and country), successively become, among the same people 9·, 10·9, 14·3, 25·3, 33·3; and if we cross the channel, why should they mount up to 69, 70, and 95 per 1,000? Again, why should fevers and inflammations of the puerperal class, which, as we have seen above, give a death-rate for all England of 1·61 per 1,000, mount up in English hospitals to 3·4, 4·1, 14·3, and 29·4? There must be some reason, besides the fact of childbirth, why diseases and accidents of this condition should be 4 times more fatal in a London lying-in hospital, and 15 times more fatal in Parisian hospitals, than they are in towns of England. What, then, are the immediate causes of these excessive death-rates? _CAUSES OF HIGH DEATH-RATES IN LYING-IN INSTITUTIONS._ The determining causes of these death-rates need to be discussed most cautiously;—our information concerning them being so scanty.