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April 15, 1933


JAMA. 1933;100(15):1196-1197. doi:10.1001/jama.1933.02740150054027

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To the Editor:  —The contribution of Drs. DeLee and Siedentopf in The Journal, January 7, offers irrefutable evidence of the fact that institutional care of parturients is accompanied by an increased incidence of morbidity and mortality over that of the community as a whole. They ignore the fact that practically all hospitals, whether they are called "general" or are conducted for some special field of medicine or obstetrics, are subject to the same laws of human necessity—the really sick enter them—therefore, the mortality rate is higher than for the community as a whole.When the specific cause of a disease is known (as diphtheria, varicella or tetanus), many influences operate to affect the incidence and virulence of the malady: the virulence of the bacterium, the resistance—immunity—of the individual, regional conditions, social and economic environment, climate, food and water supply, each has its weight. In such a complex problem as puerperal

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