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because of lack of positive physical signs to allow of an alternative
diagnosis—catheter specimen of urine examined for B. Coli—result
negative. Patient improved on administration of potassium citrate
and made a complete recovery.
5. Multipart (13), age 44. Severe bronchitis for 14 days and
shivering attack on day before delivery—premature birth—no
excessive haemorrhage—attended by doctor—raised temperature
during puerperium. Seen by Consultant on sixth day—Temp.
101 deg. P. 100—moist crepitations in lower lobes of both lungs,
especially left—nothing in pelvis to indicate diagnosis of any form
of puerperal sepsis—pulmonary condition regarded as primary—
hospital treatment advised but refused. Mother and baby both died
subsequently.
6. Primigravidae, age 40. Six days overdue—in Maternity
Home—seen by Consultant after 30 hours' labour on account of
(1) slow progress, (2) failure of head to descend into pelvis, (3)
cedema of legs. Hyperpiesis 115/110 oliguria and haematuria—
decided to continue treatment in home for 12 hours—six hours
later labour was concluded successfully with forceps by the general
practitioner. Birth of a live child.
7. Primigravidae, age 39. In labour 40 hours when seen by
Consultant—presentation right occipito—transverse—head engaged
—foetal heart, heard—membranes ruptured—-cervix three-fifths
dilated—patient distressed more mentally than physically. Home
conditions good—trained nurse in attendance—patient reassured—
given one-third gr. Omnipon, 1/150 gr. Scopolomine—labour concluded
successfully with forceps by general practitioner 17 hours
later—living child.
8. Primigravida, age 19. Thirty-six weeks—fairly severe
pre-eclamptic toxaemia (S.B.P. 170)—breech presentation with
extended legs—seen by Consultant—immediate admission to
hospital advised—living child born the following day.
It is encouraging that this service is being used to an increasing
degree by general practitioners, and particularly that in three of
eight cases the advice of the Consultant was sought before the
second stage of labour and therefore before any obstetrical interference
had been undertaken.