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full ante-natal supervision, when three weeks short of term showed
signs of toxaemia. On this failing to respond to treatment, labour
was induced and resulted in a stillborn child. Soon after labour
cerebral symptoms developed, the patient becoming comatose and
dying within 48 hours, the death certificate reading: "1 (a) cerebral
haemorrhage, (b) toxaemia, and (c) pregnancy."
One patient gave a very bad obstetric history. At 30 weeks
she was admitted to a small nursing home because of hardening of
the uterus. Owing to a slight external haemorrhage five hours later
she was transferred to a hospital where she was diagnosed as suffering
from a concealed accidental haemorrhage to which she succumbed.
Because of a long second stage, forceps were applied to a
woman who had had full ante-natal supervision. The patient came
round from the anaesthetic and was apparently well but six hours
later she died of a severe post-partum haemorrhage. The
remaining case is that of a single girl, who, failing to get a bed at
hospital, went to a nursing home but while in labour discharged
herself. Four days later she appeared at the hospital where she
was delivered of a dead foetus. She apparently recovered of the
confinement but died suddenly the next day of dystocia, toxaemia,
pregnancy and uterine inertia.
Of these twelve patients two only had made any use of the
local ante-natal services. One was the patient who died of intrapartum
eclampsia—early on she made two attendances at the local
clinic where owing to difficult domestic circumstances, arrangements
were made for her admission to hospital. All her later ante-natal
supervision was performed at the hospital. The other case was the
one who died following a brow presentation. Her medical attendant
referred her to the consultant ante-natal clinic, but the advice she
received there, namely to have her confinement in hospital, she did
not follow.
PUERPERAL INFECTION.
Four notifications of puerperal fever were received during the
year and twenty-three of puerperal pyrexia, the rates per 1,000
total births (i.e., live and still births) being therefore 1.3 and 7.7,
compared with the figures of 3.27 and 9.64 for the country as a
whole.
All four cases notified as puerperal fever recovered. One was
due to pyelitis, the second followed a difficult labour due to a persistent
occipito-posterior presentation in which infection of the
placental site occurred, the third was due to an infection of a ruptured
perineum and in the fourth the labour was normal. Three of
the four cases were removed to hospital for treatment.
Of the twenty-three cases notified as puerperal pyrexia, three
were patients who were confined in and notified from London