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two-fifths—presentation normal—foetal heart normal—no evidence
of disproportion—medical methods of stimulation increased rate
of labour at home—to be admitted to hospital if reasonable progress
not made, but baby born normally less than 12 hours later.
4. Primigravida, age 34—home circumstances good. Instrumental
delivery after four days labour—stillbirth-—9 lb. baby—
severe lacerations of lower genital tract—considerable post partum
haemorrhage and some anaesthetic complications. Consultant
called in five days later—patient showing evidence of severe general
debility from recent shock and haemorrhage and in addition some
toxaemia from infection of the lacerations of the lower genital
tract—no clinical evidence of a blood infection or of infection of
the upper genital tract—patient made a satisfactory recovery
at home.
5. Multipara, age 35 years—home circumstances fairly
good. Developed mastitis of right breast on ninth day of puerperium—one
abscess opened under general anaesthetic on 11th day
—second abscess opened under local anaesthetic six days later—
whole breast became brawny and unsatisfactory. Seen by Consultant
nine days later—evidence of defective drainage of infected
tissues in the lower and outer quadrant of right breast—left breast
normal—child had been weaned—patient unwilling to go to hospital—patient
eventually recovered.
6. Multipara, age 32—fifth pregnancy in four years—home
circumstances good. Normal labour—pyrexia of 100.6 deg.,
P. 100 with general pains developed on evening of fourth day—
intravaginal glycerine given—no localising symptoms or signs in
pelvis—on fifth day patient complained of pain in chest. Kaolin
poultice applied—evening temp. 103 deg., P. 126. Seen by Consultant
on seventh day—heart, lungs and throat clear—nothing
abnormal discovered in abdomen—some subinvolution of uterus—
lochia slightly purulent—no clinical evidence of septicaemia.
Diagnosis ? purulent endometritis. ? puerperal pyelitis—patient
refused hospital treatment—massive alkalis advised—bacteriological
investigations of blood, genital secretions and urine recommended
if pyrexia continued. The pyrexia was subsiding by the
time the Consultant saw the patient and although it rose to 101 deg.
on the evening of the tenth day, it was normal again by the twelfth
day and there was no further rise. When the urine was examined
microscopically on the fourteenth day, no pus was found.