TROPICAL PUERPERAL FEVER 



1947 



When the racial incidence was investigated it was found that the 

 sociological and hygienic factors influencing this incidence were 

 marked, as the percentage of the total annual racial deaths attribut- 

 able to childbirth and principally caused by puerperal fever was 

 only o-i per cent, for Europeans, while it was i-2 per cent, for 

 Sinhalese, who form the bulk of the population, o-8 per cent, for 

 Tamils, the next largest native community, i-i per cent, for a 

 mixed native and European race known as burghers, under which 

 heading also come those inhabitants of pure Dutch descent from the 

 settlers of two hundred years ago. Many of these burghers are 

 very poor, and nearly all inhabit towns and mostly live under more 

 insanitary conditions than the a.verage European. The Moham- 

 medan communities of Arabs and Malays have a mortality of 1-2 per 

 cent, and i-i per cent, respectively. 



The disease is known to have been not uncommon in Bengal since 

 Twining wrote in 1833, while its death-rate in Calcutta for 1906-07 

 was 1-2 per cent, of the total deaths. 



With regard to Egypt, the first medical accounts of the fever are 

 contained in Pruner's writings published in 1847, where it is stated 

 that it was not so common as in Europe, but an epidemic, extending 

 from Alexandria to Luxor, is mentioned as taking place in 1844. 



The peoples of the Anglo-Egyptian Sudan are peculiarly interest- 

 ing from the point of view of our present study, because they contain 

 very primitive tribes, semi-civilized natives, and civilized peoples. 



As examples of the primitive tribes we may consider the Nyam- 

 Nyam, who live in the southern part of the Bahr-El-Ghazal Province, 

 and the Jur or Gour tribe, which occupies a limited area of that 

 province between the River Gell and the Rumbek-M'volo road. 

 In these tribes, according to Anderson, childbirth is usually a simple 

 physiological process taking place for the first time when the woman 

 is in her teens, and managed by a midwife, who is simply any other 

 woman who has given birth to a child, and who sees that everything 

 connected with the parturient woman is strictlyclean, and placing her 

 on a bed of freshly cut leaves, allows Nature to do the rest, with the 

 sole exception of such rare cases as require assistance, when, accord- 

 ing to the same authority, she calls in the aid of some small boys. 

 Under these primitive conditions puerperal fever must be rare. The 

 same easy childbirth can be observed among the Bedouins of Syria. 



Among the semi-civilized Arabs and Sudanese of Kordofan and 

 other parts of the Sudan every young girl is circumcised as described 

 above. This procedure, as already stated, is followed by the forma- 

 tion of scar tissue, which renders it almost always necessary to en- 

 large the vulvar orifice by means of a razor, not merely at the time of 

 marriage, but again at the birth of a child, when otherwise it would 

 be difficult for the head to emerge. The enlarged orifice is again 

 partially closed some little time after the birth of the child, and 

 therefore the incision has to be repeated at every succeeding birth. 



If this second cutting is performed carelessly and the resulting 

 wound becomes septic, then fever ensues, and in a case of thi^. nature 



