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to pelvic outlet—perforation of dead fetus followed by moderately
difficult extraction of large shoulders—foetus after perforation
weighed 8½ lbs. and in a state of early maceration—placenta normal
—some general contraction of the pelvis was present, but although
disproportion to some extent contributed to the fetal death, it
was not considered to explain it entirely.
3. Multipara—2nd pregnancy—age 29. Home circumstances
good—normal confinement—one vaginal examination before membranes
ruptured. Temperature 99 deg. on two occasions in first
ten days, but it did not remain up for twelve hours. Medical aid
summoned on 11th day on account of rise of temperature to 100.6
deg. (p. 90), with evening temperature 102.2 deg. (p. 118)—temperature
down for two following days but pulse between 90-116.
On 14th day morning temperature 102.4 deg. (p. 128). Consultant
called—tenderness in right iliac fossa and right-sided hard thickening,
typical of parametritis—rest, hot vaginal douche twice daily,
and prontosil twice daily and fluids prescribed. Patient made
good recovery.
4. Primigravida—age 28. Home circumstances good—
normal full term labour—one vaginal examination—duration of
labour under 12 hours—third stage normal—no P.P.H.—36 hours
after delivery, onset of pyrexia and tachycardia—24 hours later
consultant called. On examination clinical condition very suggestive
of primary hæmolytic streptococcal septicaemia, with punctate
erythematous generalised rash and marked suppression of lochia—
patient received prontosil by mouth from onset of pyrexia—removed
to hospital and was fit to be discharged two months later.
5. Multipara—2nd pregnancy—age 33. Home circumstances
good—history of rheumatic fever with cardiac involvement at 20
years—1st confinement normal—in this pregnancy patient's physical
condition unsatisfactory during last two months—bronchial
catarrh, loss of weight—pulse 90-100, mitral incompetence, slight
rise of temperature—4 weeks before confinement sore throat and
acute pain in left lower costal region—10 days before confinement
acute lumbago and sciatica—baby born two weeks prematurely—
normal confinement—no undue loss of blood—attended by doctor
and midwife, both wearing masks—one vaginal examination—
membranes ruptured artificially shortly before delivery—satisfactory
progress until 3rd day following delivery—patient complained
of return of acute pain in left lower costal region—evening