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2. Primigravida, age 19.—Homo circumstances poor—normal
labour attended by midwife—laceration requiring three sutures—no
rise of temperature, recorded until tenth day when T. 104 deg.—
rigor—patient transferred to hospital—offensive discharge—on
opening cervix pus escaped—few fragments of tissue—tube inserted
in cervix.
3. Multipara (3), age 38. Home circumstances good—midwife
acting as maternity nurse with doctor. Membranes ruptured
before labour—rapid first and second stages—delay in third stage—
placenta adherent—manually removed with difficulty—no anaesthetic—haemorrhage—pulse
96 after delivery—increased to 112
and remained rapid—obstetric consultant called in on third day,
temperature 103 degs.—no signs of local infection outside genital
tract—provisional diagnosis of severe oxogenous puerperal infection
—admitted to hospital—clinically septicaemia although organisms
could not be isolated from blood stream—in hospital more than four
weeks—complete recovery.
4. Primipara, age 21. Home circumstances poor and dirty.
Husband suffering from influenza at time of confinement. Attended
by midwife (B.B. A.)— although one vaginal examination at
beginning of labour—no laceration—small amount haemorrhage—
temperature rose on fifth day—lochia normal—no tenderness—no
localising signs. Medical attendant suspected tuberculosis—admitted
to hospital on ninth day—diagnosis, uterine sepsis from retained
products.
5. Primipara, age 21. Home circumstances comfortable—
patient ignorant—decayed teeth—refused treatment. Attended
by midwife—no internal examinations—labour normal—no symptoms
until eighth day, but found to be severely constipated—given
01. Ricini without result—patient vomited—temperature 99 degs.
on tenth day temperature 101.4 degs.—rigor—doctor called in—
could find no evidence of pelvic infection and considered temperature
due to constipation—ordered purgatives—patient not complaining
of pain—eleventh day, no symptoms but patient looked ill and had
had rigor—admitted to hospital—much offensive discharge from
uterus—continued rigors—patient died six days later.
In the fourth case the baby died after 3 weeks. In the others
the babies survived.