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all right he would like to see her at the seventh month to make sure that everything was going well
and did so, also arranging that if everything was not perfectly all right, she was to let him know.
The mother, like all mothers now-a-days, reads the daily press, and felt that neither of the two Doctors
who she consulted were to be trusted in view of the lack of interest that was exhibited in her condition
as compared to the original Doctor, who, she felt was doing what was right. In circumstances such
as these, is it to be wondered at that the general public, who through the daily press are becoming
more and more informed, in fact in some respects I think over informed of what some people call
the perils of parenthood, should seek advice from sources other than the general practitioners, and
if so is there anyone to blame but the general practitioners themselves ?

Dr. Wrigley's report is as follows:—
The attendance figures show another rise. Last year stress was laid upon the fact that whereas
this increase undoubtedly can be taken as an index of the public appreciation of the work, it could
only continue up to a certain point, beyond which work would be hurried and inefficient to the great
detriment of those patients who attend. Saturation point has been reached, but, at the time of
writing, relief is in sight. Arrangements have been made to provide a centre at Isleworth for the
convenience of patients resident in that part of the Borough. Enormous benefit will accrue, not
only in the direction of convenience and of lessening the congestion at Clipstone House, but also, and
this is more important, prospective mothers at or near term will not have to undertake a long journey
at this critical time.
The routine of the work remains unaltered. All patients who state that they have already
engaged a doctor to attend them in their pregnancy and confinement are referred back at once to their
medical attendant. A note is sent at the same time informing the doctor that the patient would only
be examined again at the clinic if she brought with her a written request to that effect. It is most
gratifying to be able to report that in 1933 for the first time there has been an increase in the number
of those patients who are referred back to the clinic by their private doctor for the purpose of supervision
in the pregnancy. In addition, the clinic has been used in 1933 to a greatly increased extent
by practitioners in Hounslow, and apparently regularly in two instances, for purposes of consultation.
Perhaps it is in this capacity that it fulfils its real function. The use of the clinic by the private
practitioner in Hounslow is an entirely new feature and was apparent for the first time in the year
under consideration.
It appears also that full use is made of the clinic by every midwife in Hounslow. Some accompany
their patients on their visits with unfailing regularity. They are able to examine the patient
with the obstetrician. When this is done it results in inestimable benefit to the patient and the
midwife. The patient appreciates that her attendant is fully acquainted with the exact state of
affairs ; and, as one midwife put it, " for the first time since I finished my training I am beginning
to regain the feeling that I know a little about my work and am reasonably up to date."
Midwives use the clinic for another purpose that is certainly not mentioned in the definition
of ante-natal work. They never appear without a series of questions upon the difficulties and doubts
that arise in the course of their daily practice, and frequently an inquisition is held upon some troublesome
case that they have attended in the last few days. Such co-operation with the doctors and
midwives in practice in the Borough adds greatly to the value to the community of the ante-natal
clinic.
During 1933 as a direct result of the energy of the Nurse in charge of the ante-natal clinic,
a system is now in operation whereby the non-attendance of the patient is at once noticed. Whereas
the majority of the women attend regularly, sometimes perhaps too often, a small minority fail, either
as a result of sickness, ignorance, or laziness. These cases are visited personally and the circumstances
are inquired into there and then.
Co-operation with the Dental Department continues unhindered and many mothers must,
as a result, emerge from pregnancy in a greatly improved state of health, as compared to their condition
before treatment.
In conclusion, it is to be hoped that 1934 will be able to show such a good record.
A. J. WRIGLEY, M.D., F.R.C.S.
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