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93
obstetrics, and is subject to fluctuation from external causes such as influenza
epidemics. As the total numbers are comparatively small, a quite extraneous cause
might easily affect the maternal mortality rate, and create fallacious alarm about the
efficiency of maternity services. Secondly, over-meticulous certification might
easily over-weight the figures and give a misleading impression. Instances have been
found of women dying from phthisis or heart disease many weeks after child-birth,
whose death has been allocated as a "maternal death." Adverse comparisons with
a foreign country or with mortality rates of past years might well follow.
The possibility of death having been due to any truly obstetrical cause, including
sepsis, has been definitely excluded in every case allocated to this group, and all
such deaths have been classified as due to pregnancy. The case of "aplastic
amemia," for example, was known to have been gravely ill from this condition long
before she became pregnant.
The close enquiries undertaken into every maternal death in the Council's
hospitals show that no obvious or easily eliminated cause for a high mortality rate
exists. There is very rarely any evidence of failure of ante-natal care, of avoidable
sepsis, of unnecessary interference, or of failure to provide efficient obstetrical aid at
the proper time. Samples of the many and diverse obstetrical problems which defy
easy and automatic solution are now being dealt with. A steady improvement of
staffing, accommodation and organisation, as well as loyal co-operation on the
part of the patient, offer the only possibility of a further reduction in the
mortality rate.
Conclusion.

* One ward of 20 beds additional, used as emergency accommodation. G