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Of the 2 multigravidæ who had instrumental deliveries, one was a
woman of 4-1 years having her eleventh child. There were various reasons
why she ought to have been in hospital. She had a varicose ulcer of nine
years' duration on her leg; she had very inadequate and overcrowded
accommodation at home; her blood pressure was raised, and she had
attacks of giddiness; but she refused to follow the advice of either the
medical officer or of the midwife, who would have preferred to give up the
case. She had a long, difficult labour, and the midwife reported that her
general condition was not good ; but she survived.
The second instrumental delivery of a multipart was a second confinement
in hospital of a woman aged 24 years, who had had a normal
first confinement.
(b) CÆsarean Section (3 Cases).
Caesarean section was performed in two primigravidse, and one multigravidae.
One of the primigravidse was referred from the clinic to hospital
with evidence of clinical disproportion. The second consulted her private
medical practitioner because of haemorrhage at 20 weeks, and he
recommended that she should have her confinement in hospital. The
multigravida was a woman aged 32, having her third child. When she
attended the clinic first at 24 weeks she was found to have an indefinite
swelling on the left side above the uterus. She had no symptoms. As
pregnancy advanced the swelling increased in size and was obviously cystic.
The woman was referred to hospital, where Csesarean section was performed,
and a large multilocular ovarian cyst was removed. She was
delivered of a living child weighing 9 lbs.
(c) Induction (4 Cases).
Three of these cases were primigravidse who were not in regular attendance
at the clinics. One (aged 35) came to the clinic at 16 weeks to
obtain a letter for admission to hospital. She was very stout and was
surgically induced at 36 weeks. The other two were in regular attendance
at hospital ante-natal clinics, and attended the municipal clinic once to
obtain free milk. Both had inductions on account of pre-eclampsia.
The fourth case was a multigravida, aged 36, who gave a history of a stillbirth
five years previously. She had not been examined during that
pregnancy (the first) and she was sent into hospital where she was delivered
of a stillborn child weighing 111/2 lbs. She attended the clinic regularly
from 14 weeks, and was under observation at hospital from 36 weeks.
She was delivered naturally, at term, following medical and surgical induction
(Krause's) of a living child weighing 9 lbs. 31/2 ozs.
(d) Stillbirths (8 Cases).
Of the eight stillbirths, one was a premature birth at 32 weeks in a
second pregnancy. Although the woman (aged 31) had attended the clinic
and engaged with a midwife, she did not consult either when she developed
swelling of her feet. A week later she had three eclamptic fits and the