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certain that their lives could have been saved. It would appear
that Cases No. 9 and 10 should not certainly have been allowed
to remain at home after the first haemorrhage, without special
precautions having been taken for immediate active treatment at
the first recurrence of haemorrhage.
Two of the remaining three deaths occurred from general
disease complicated by pregnancy and confinement.
Eclampsia during labour caused the other death. This
patient had undergone regular and complete examination during
pregnancy; at her last examination, two weeks before the onset
of labour, no abnormality was found, and the urine was normal,
which indicates that albuminuria of pregnancy can develop with
great rapidity. Towards the end of pregnancy frequent attendances
for examination should be urged on the patient.
The Handy Woman.
There are still too many medical practitioners who are content
to allow an unqualified woman to attend their patients during
childbirth. It is, of course, assumed that the pregnant woman
who engages a medical practitioner to attend her will send for
him at the onset of labour. But actually this seldom happens in
the type of case I have in mind. The unqualified woman—the
handywoman—is sent for first; on arrival she examines the
woman, and only sends for the general practitioner at the last
moment, or if something is obviously abnormal; frequently she
sends only after the child has been born. The dangers to the
mother and infant of this practice do not need further elaboration.
Under the Amendment of the Midwives Acts, 1902 and
1918 "If any person, being either a male person, or a woman not
certified under this Act, attends a woman in childbirth otherwise
than under the direction and personal supervision of a duly qualified
medical practitioner, that person shall, unless he or she satisfies
the Court that the attention was given in a case of sudden or
urgent necessity, be liable on summary conviction to a fine not
exceeding ten pounds."
Obviously in some cases it is difficult to prove that the handywoman
did not act in an emergency and deliver the patient pending
the arrival of the doctor, but this is not actually the fact in the
majority of such cases.
The following instances have come to my notice this year :
Case 1.
Mrs. A. (2 para, age 31 years), engaged Doctor B. No
antenatal care was given. Mrs. C. was engaged as handywoman,
having no nursing qualifications. At the 39th week
of pregnancy Mrs. A. was delivered of a stillborn child. This
stillbirth was notified by Dr. B., but, on investigation, it was
found that Mrs. C. was called in about 1½ hours before the
birth of the child. She delivered the child as a breech
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