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cases in expected normality, as when a general practitioner considers
a woman unsuitable for delivery either at home or in a
nursing home he refers her either to the municipal clinic or direct
to hospital. It is of course possible that a general practitioner
occasionally books a case against his better judgment when the
woman refuses to go to hospital, but in the relatively small proportion
(viz., 6 per cent.) of women who book a doctor for home confinement,
and the smaller proportion who book a doctor for nursing
home delivery it is reasonable to assume that the patient is accustomed
to accept that doctor's advice.
Maternal Deaths.—Out of 38 total maternal deaths in the
twelve years, 7 followed abortion and 1 was due to a ruptured
ectopic gestation. These had no ante-natal supervision and deaths
from abortion are not likely to be directly influenced by maternity
and child welfare services, although it is encouraging to note that
5 out of the 7 deaths occurred in the first six years under review,
and only 2 in the second half of the period. There were therefore
30 deaths of women who had ante-natal supervision from some
source, the causes of death being :—
Toxaemia 7
Haemorrhage 6
Shock 5
Infection 6
Cesarean Section 4
Heart Disease 2
30
Of the 6,515 women who had been under supervision at the
municipal ante-natal clinics there were 7 deaths—a mortality of
1.07 per thousand. Four of these were emergency admissions
to hospital (2 toxaemias, 1 shock with retained placenta, and one
puerperal septicaemia). The other three had been admitted to
hospital during pregnancy on account of their unsatisfactory general
condition—one a decompensated mitral stenosis, the second an
elderly primipara who was referred to hospital at 34 weeks as a
toxæmia and who subsequently died of parametritis following
Cæsarean section at 39 weeks, and the third a multipara of 41 years
who was referred to hospital at 32—34 weeks because of unsatisfactory
general condition. She was admitted to hospital three weeks