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poor subjects for pressure by forceps. Instrumental interference
should therefore be avoided as far as possible.
(2) The earlier in pregnancy induction is performed, the
poorer the chances of a living and viable child, there being
little prospect of this before the 36th week, therefore all
cases should be left as long as possible and as is consistent
with safety; the weight of the child in itself is of little
real importance, the extent of ossification and size of the
foetal head in relation to the maternal pelvis being the most
important factors.
It is now agreed by most modern Obstetricians that induction
is a well recognised and very valuable form of treatment for minor
degrees of disproportion between the foetal head and the maternal
pelvis and that it should be done in preference to Caesarian Section
in all primiparae where a reasonable chance of a living child exists.
Each case is, however, a potential Caesarean Section and the most
careful and skilled medical attention and repeated examination is
required in certain cases to decide when an induction mother after
being in labour for a few hours is likely to deliver herself successfully
of a living child or whether Caesarian Section will be required.
For this reason and for others the presence of a resident medical
Officer who possesses some obstetric knowledge would be of great
benefit.
In any case of induction admitted to the Battersea Maternity
Hospital, I should like to make the following suggestions.
(1) That where a case is referred for a second opinion, the
letter in reply should be sent direct to the Town Hall
and acted on forthwith if necessary without the possible
valuable time lost in awaiting my next attendance at the
Battersea Maternity Hospital.
(2) In the case of every induction the doctor who performed
the operation should see the patient at an interval of not
more than 12 hours after the commencement of labour,
or sooner if need be.
(3) That in every case of. induction, a form containing
certain particulars should be filled in at the time of the
case and a copy should be sent immediately after delivery
to the Medical Officer of Health and myself.
By these measures, I think much may be done to secure
greater co-operation in the treatment of these cases with great
advantage and, I hope, improvement in the results obtained.
In closing I should like to draw attention to the almost complete
absence of Sepsis of any kind in the cases attended in the Battersea
Maternity Hospital, and in the homes of patients and congratulate
all those concerned in this result.
The report of Dr. Alice Bloomfield on the development of AnteNatal
work in Battersea will give some idea of its magnitude and
importance, especially in relation to the Maternity Services, Hospital
and District, of the Council. The great increase in the number of
admissions to the Maternity Hospital and of applications for the