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the number of dead-born infants and of deaths during the first few
days after delivery would be enormously reduced, the deaths of
women in labour and the puerperium would be reduced to a fraction
of the present rate, and the numerous disabilities that handicap
women as a result of child bearing would almost disappear. Apart
from the mortality from puerperal sepsis, exhaustion, shock, rupture
of the uterus, &c., how many women would be saved from misery
and disability if prolapse, ruptured perineum, torn cervix, and
partial incontinence of urine became rare instead of filling every
gynaecological out-patient department! The majority of these
troubles are due to difficult labour, most of them are preventable,
and it is our business to see that they are, as far as possible, prevented."
Prevention of Difficulties.—The old proverb that "prevention
is better than cure" is never more true than in difficult
cases of midwifery. The old method was to find out the difficulty
only when it was actually present, when mother and child, one or
both of them, were in some degree of danger, and when it was too
late to avoid the difficulty, the only possible course being to overcome
it with all the skill possessed by the accoucheur. Only too
often skill was not enough, and a good deal of brute force had to be
used, with consequences more or less disastrous, not necessarily
because of the inherent difficulties of the case, but because they
were present in an emergency case. It used to be quite common
to hear a doctor talk almost as if he had a grievance against Providence,
for having been singled out to be afflicted with the care
of a large child with the breech in advance in a fat primigravida, or
with an occipito-posterior position persistent to obstinacy, or some
degree of contraction of the pelvis in an otherwise well-built woman,
not apparent until labour had been in progress several hours. It is
no exaggeration to say that in a great many of these causes the
doctor, honestly reviewing the case afterwards, was able to satisfy
himself that he was in no way to blame for a dead baby, and the
more or less severely damaged mother. In the ideal conditions at
which we are all aiming, a man who complains that he has had a
very difficult labour case will be less likely to get sympathy than
to be asked: Why did you allow yourself to have such a difficult
case ?
Convalescent Home Treatment.—During the year 13
children have been sent away for Convalescent Home treatment
making an aggregate stay of 29 weeks. In 11 cases this Convalescent
Home treatment was arranged direct by the Committee at suitable
Homes. In the remaining cases advantage was taken of the Homes
under the control of the National League for Health, Maternity and
Child Welfare. Speaking generally, these children derived