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appear to be the fourth group. In the first case referred to one
regrets that advantage was not taken at an early stage of the
consultant service offered by the Council.
Of the deaths due to causes other than sepsis again only three
occurred at full term. (1) Caesarian section was performed at the
seventh month on account of toxaemia for which the patient had
already been in hospital on two occasions for investigation and
treatment. Death was due to pulmonary embolism. The antenatal
supervision of this case was carried out at the clinic. (2) Heart
failure followed on childbirth in a woman with a severely damaged
heart for the treatment of which she had already been in hospital.
(3) A patient died of intestinal obstruction following Caesarian
section performed at full term on account of contraction of the
pelvis. The following notes relate to the remaining four fatalities
which occurred from causes other than sepsis in patients some
time before term. (1) A patient attended the out-patient department
of a hospital on account of bleeding following seven weeks'
amenorrhœa. She refused to be admitted, but two days later she
went in as an emergency case on account of severe bleeding. The
uterus was evacuated under gas anaesthesia, but the patient died
shortly afterwards. (2) A patient was admitted to hospital in the
thirty-first week of pregnancy suffering from pyelitis and sub-acute
endocarditis. On her fourth day in hospital she was normally
delivered of a premature living child, but during administration of a
general anaesthetic for the removal of the placenta she collapsed.
Post-mortem examination showed signs of recent acute endocarditis,
bilateral pyelo-nephritis and a morbidly adherent placenta. (3) A
patient was admitted to hospital on April 12th on account of headache
and vomiting, and pus and albumin in the urine. In a few
days she developed in turn thrombosis of the left femoral vein, the
iliac veins and the right femoral vein. She later miscarried and
died suddenly on May 27th of right pulmonary embolism. (4) From
June when she was in her second month of pregnancy to September,
this patient was admitted to hospital on three separate occasions
for investigation and treatment of her vomiting. Later in
September she was again admitted aborting—but died nine hours
after admission, the cause of death being "hepatitis, hyperemesis
gravidarum."
In addition to these cases in which the death was allocated to
causes due to or associated with pregnancy, there were four other
fatalities in which pregnancy was a related factor though no reference
was made to it on the death certificate, or in accordance with the
registrar general's allocation the deaths were referred to other causes.
One was a woman who, while pregnant, suffered from marked
varicosity of the left leg and complained of cramp. In her seventh
month of pregnancy she died of "thrombosed varicose veins,
coronary thrombosis." In another patient pregnancy probably
helped to over-tax a heart damaged by toxic goitre—when near full
term she suffered from an attack of breathlessness for which she