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108
months some six years previously. She admitted that she had
tubercle bacilli in her sputum at that time, but now considered she
had bronchitis only in the winter, and stated that she was having
treatment from her private practitioner. She was obviously gravely
ill when she attended the ante-natal clinic, with rapid pulse (120130),
slightly raised temperature, and an almost complete absence of
subcutaneous tissue. She was referred to the Tuberculosis Dispensary,
and was found to have a strongly positive sputum. She
died five weeks later after a sudden haemoptysis. ,
The second case was a woman, age 34 years, who attended when
she was 20 weeks pregnant, and was found drowned ten days later.
She was not in any obvious mental distress when she attended the
clinic, and nothing was known of her history apart from the fact
that she had suffered from what she described as epilepsy since the
birth of her first child 15 years ago. Her second pregnancy was in
1933, and the child had died at 7A- weeks from marasmus.
Analyis of Abnormal Cases.
(Report by: Dr. Menzies).
(a) Instrumental Delivery (14 cases).
All the instrumental deliveries occurred in primigravidae, Four had
arranged to go into hospital for their confinements and a fifth who had
booked with a midwife was referred to hospital because of general contraction
of the pelvis, and was subsequently admitted for labour. One
case booked with a general practitioner and therefore ceased attendance
at the clinic. Of the remaining eight who had booked with midwives, two
failed to attend in the last two months in spite of notifications sent to the
midwives of their patient's non-attendance—one of these resulted in an
oecipito-posterior presentation. The remaining six were under supervision
from the early months of pregnancy. Four were watched for disproportion,
but did not show definite evidence of it in pregnancy. Two were
almost certainly 2-3 weeks overdue, and probably ought to have been
induced. In a third case there were mild pre-cclamptic signs, and the midwife
was advised to send for medical aid. A fourth case had low blood
pressure and complained of faintness on standing. In three out of the six,
the head was in the pelvis 2-4 weeks before labour commenced.
The ages of these 14 primigravidae ranged from 19 to 35. Five were
under 25 years, and only two were over 30 years of age.
All the babies were born alive, but in one of the hospital cases, the baby
died seven hours after delivery.
(b) Miscarriage (8 cases.)
Of the eight patients whose pregnancies terminated in miscarriage, two
were primigravidae. One was attending hospital, was thought to have a
fibroid, and had a miscarriage at five months. The second was a twin