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126
rotated manually—severe perineal tear. Masks worn by both
doctor and certified midwife in attendance. Not admitted to
hospital. The second was a case of purulent endometritis following
instrumental delivery of a primigravida—manual removal of retained
placenta—perineal tear. Doctor in attendance wore gown and
gloves. Certified midwife wore mask, white cap and gloves.
Swabs were taken from the nose and throat of the midwife and
from the nose, throat and cervix of the patient—no hæmolytic
streptococci were found. The patient was admitted to Whipps
Cross Hospital.

All the mothers recovered and all the babies survived. Six
were confined in hospital and two at home.
Consultations.
The advice of the Council's Consultant Obstetrician was sought
on one occasion during the year, viz.:—
Primigravida—25 years—normal labour—slight perineal tear
—puerperium normal until 17 days after confinement—complained
of sudden severe epigastric pain—temperature 101°, pulse 100—
painful and frequent micturition—seen by Consultant two days
later. Diagnosis—cystitis. Treatment—hot fomentations and alkaline
mixture—to be admitted to hospital in 2 days if not improved.
Made uneventful recovery at home.
Maternal Mortality.
Two women died during the year as the result of childbirth,
giving a maternal mortality rate of 1.33 per thousand births.