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(3) Consultants. It is recommended that a consultant should
he available for any doctor who needs assistance in difficulties or
complications arising during pregnancy or at or after confinement.
The Consultant attends every fortnight at a building in the
middle of the district, and doctors arc invited to refer to him any
cases of difficulty arising during prcgnancy or any post-natal cases.
The Local Authority in its scheme, has not yet been advised
to include arrangements for the provision of a consultant in
difficulties (luring labour. The reason for this is that in most cases
the Consultant's services would not be available in time. A
further reason is that, were he called, mostly it would be in a case
necessitating some operative procedure. It seems that in general,
the patient would best profit by immediate removal to hospital,
there to have done under suitable surroundings, any operation
necessary, rather than for the Consultant to attempt anything,
mostly after a period of long delay, in the unsuitable surroundings
of the home. There are comparatively few in this district who
could well be dealt with in their own homes, and these would usually
be in a position to make their own arrangements. The vast
majority of residents acquiesce freely in the suggestion of removal
to hospital.
In a district such as this, the provision of facilities for a second
when desired by a doctor, early in labour, could best be met
the selection of the doctors amongst themselves. Usually
amongst a number of doctors some are found with more than
average skill in certain departments, including midwifery. Such
skill comes through a number of circumstances, as liking for the
speciality, and results in a special study with increased knowledge,
The increased skill is recognised and attracts more of that class
of work with resultant gam in experience. In this way the doctor
becomes recognised and accepted amongst his fellow practitioners
as semi-specialist whose opinion they value. One or more in a
district will usually be found to accept this position. Living
the course of labour. would immediately be available, even during
the course of labour. Were such a person elected, the Local
Authority could guarantee the payment of his fee when called in by
his fellow practitioner to a case of complicated labour.
With regard to the provision of the services of Consultant in
cases of Puerperal Fever, the same conditions obtain. Whatever
the circumstances may be that warrant a second opinion, the
question of diagnosis usually necessitates skilled treatment and
nursing. For most of the inhabitants of this district, this can best
be met by removal to hospital where complete diagnosis and
efficient treatment can be insured.