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foetus—placenta adherent, no hemorrhage—transferred to hospital
at 7 p.m. Temperature 99 degs., pulse 90—no vaginal loss—uterus
contracting well—placenta removed manually (anaesthetic—ethyl
chloride and ether)—very adherent—no haemorrhage—patient
pale and shocked on return to ward—pulse thready—died 6 a.m.
Cause of death—retained placenta (without haemorrhage).
(j. Age 23—no previous pregnancies—circumstances good—
doctor called because of abdominal pain—temperature normal, pulse
70—constipated—no vomiting—abdomen not distended—pain and
slight tenderness in lower abdomen to left of middle line—no
amenorrhoea. On the following morning there was increase of
pain with vomiting. Temperature normal, pulse 104—tenderness
in right iliac fossa—transferred to hospital—immediate laparotomy
—ruptured left tubal pregnancy four.d. Developed intestinal
obstruction on the day following operation—second operation to
relieve obstruction—died on second day after admission to hospital.
7. Primigravida, age 25. Circumstances good. Ante-natal
examinations by midwife—advised to attend ante-natal clinic—
did not do so—no reported abnormality until two days before labour
when husband of patient called on midwife and stated that his wifo
could not sleep on account of severe cramp. She was seen by her
panel practitioner who reported that the case was normal. The
urine was not examined on that day nor was the blood pressure
recorded. The midwife had examined the urine three days earlier
and reported that it was normal. An eclamptic fit occurred as the
patient was being admitted to a maternity home for labour. She
was transferred to a maternity hospital within 40 minutes. On
examination on admission she was found to be well-nourished—
heavy build—conscious—good colour—very talkative and fidgety—
very little disturbed by uterine contractions—head engaged.
Pulse 100—good volume—slight oedema of legs—light cloud of
albumen in catheter specimen. B.P. 184/90. She gave the history
that she had had very little sleep for a week on account of painful
abdominal cramp. She was treated with morphia and alkaline
calcium mixture with glucose by mouth. The second fit occurred
4 hours later and after a series of four fits the patient became
comatose in spite of complete routine treatment of eclampsia.
Delivery by forceps was effected by an obstetric consultant 71
hours after admission to hospital. There was a slight degree of
disproportion. The baby weighed 10 lbs. 3 ozs.—length 23 ins —
comative. The mother was very collapsed after delivery and died
13 hours later.