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34
last year's annual report, particulars of the maternal deaths were
given and it was difficult to suggest medical means which would have
prevented the deaths. The same remark can be applied to the
deaths which occurred in 1931.
We are used to the statement that most of the maternal
deaths are preventable, but when enquiries are made here into the
circumstances, it is found that prevention is far from easy under
present social conditions.
The first death occurred from Paralytic Ileus following the
operation of Caesarian section. The women had had 4 children previously.
In the course of the previous deliveries, the Cervix had
been extensively lacerated, and during the last confinement the
Cervix became so oedamatous as to obstruct delivery. The patient
had engaged a midwife who at the confinement called in a doctor,
and although the doctor may have not diagnosed the exact cause
of the obstruction, he ordered her removal at once to the West
Middlesex Hospital, where she was operated upon.
In this case, the patient had not attended an ante-natal
clinic and had not been medically examined during the pregnancy.
It is doubtful, though even if the condition of the Cervix had been
detected, that the complication which occurred at the confinement
would have been forseen.
The second death occurred from Puerperal Sepsis, and it
is fairly certain that more than the ordinary precautions were taken
at the confinement. The patient was in good circumstances, and the
family lived in a semi-detached villa with 4 bedrooms. There was
one other child 6 years of age. A doctor had been engaged for the
confinement and he had examined the patient and kept her under
observation during the pregnancy. It was an instrumental delivery,
but strict asepsis had been observed. The doctor ordered a complete
outfit in a sterile drum from Messrs. Bell & Croydon. Swabs
were taken from the throats of both doctor and nurse and no streptococci
were found.
The patient was removed to Queen Charlotte's Hospital on
the fifth day after the confinement, but she died soon after admission
and on bacteriological examination of the discharges the Streptococcus
Haemolyticus was found.
The report of Dr. Bell, the Council's obstetric specialist,
upon the case was that every precaution seems to have beentaken
at the confinement, and the surroundings appeared to be as good
as could be desired. As far as a confinement in a private house is
concerned, it was difficult to suggest in what direction an improvement
could be effected. The case illustrated the importance of the