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H.—3l.

Ante-natal Clinics. Accessory to the State and public hospitals there are 37 ante-natal clinics available for free advice and attention to all women applying. Table 111 gives the attendances at these clinics, and shows their gradual extension over a period of eleven years.

Table III.

6,725 women who attended these clinics represent 27-5 per cent, of the total confinements. The clinic records show that the following conditions were detected and, when necessary, treated or referred for treatment: Albuminuria, 205; pre-eclamptie toxaemia, 439; goitre, 475; varicose veins, 1,212; dental deficiencies, 1,147; hyperemesis, 62; hydramnios, 70; multiple pregnancy, 84; suspected contracted pelvis, 100; malpresentations, 150. General Hospitals (Medical and Surgical). Public and private medical and surgical hospitals also admit maternity patients in the case of emergency or complications arising in private practice, and pyrexial or septic cases transferred for isolation purposes from maternity hospitals. The cases, both European and Maori, admitted to the medical and surgical hospitals are classified as follows:— Admissions before delivery— For ante-natal treatment .. . . . . . . 34 For delivery—Emergency cases without complications . . . . 33 For Complications arising before or during labour . . . . 269 Admissions after delivery— For complications of the puerperium . . .. . . . . 204 One hundred and twenty-five of the 269 patients admitted before delivery were delivered by Cesarean section, 138 by obstetrical methods, and 7 died undelivered. The extreme gravity of the conditions dealt with in these hospitals is shown by the fact that 22 of the above-mentioned 269 patients died, giving a death-rate of 818 per cent. Of the 204 patients admitted after delivery for complications arising during the puerperium, there were 9 for eclampsia, 10 for post-partum haemorrhage, 81 for puerperal sepsis, and 104 for other pyrexial conditions not diagnosed as puerperal sepsis and recorded as mastitis, pyelitis, pneumonia, tuberculosis, &c. Eighteen of the 204 patients admitted after delivery died, 11 (including Maoris) from puerperal sepsis, 3 from tuberculosis, 1 from pneumonia (non-septic), 2 from post-partum haemorrhage, and 1 from eclampsia. The above record shows the very grave nature of the cases admitted to these hospitals, and that they require a very high degree of obstetrical knowledge and skill both by the medical attendants and nurses to give them adequate treatment. The majority of the public hospitals admitting cases prior to delivery do so for the reason that they have no maternity hospital attached to them, but most of them have made fairly adequate provisions by the appointment of obstetric specialists and midwives and the establishment within the hospital of small obstetrical departments. There are, however, two outstanding cases of hospitals admitting such patients which have failed to make this provision. Endeavours have been made and will continue to be made by the Department to remedy this deficiency by persuading the Boards to appoint obstetric specialists to the staff and, where possible, to establish special wards staffed by midwives for attendance on these patients. This matter will be again referred to in discussing the treatment of patients by Csesarean section. Supplementary to the maternity hospital services which provide for over 75 per cent. of deliveries, and to the ante-natal clinics, which in conjunction with the patient's medical attendant, give advice to 27-5 of expectant mothers, the remainder being dependent upon their private medical advisers alone, there are 28 District Nurses employed by the Health Department and 28 employed by Hospital Boards. The details of this branch of the obstetric services are shown in the report of the Director, Division of Nursing. In spite of the deficiencies noted above, New Zealand has a well-organized maternity hospital service, and the majority of Hospital Boards and the licensees of private hospitals are

52

Nnmhpr nf T t l Average Number Year - Clinics. New Cases. Return Visits. Atten^lces . of Attendances Live Births. per Jratient. I ___L • 1925 .. .. 16 2,289 7,816 10,105 4-41 28,153 1926 .. .. 20 3,238 12,554 15,792 4-88 28,473 1927 .. .. 20 3,919 15,406 19,325 4-93 27,881 1928 .. .. 21 5,050 20,740 25,790 5-11 27,200 1929 .. .. 24 5,177 17,555 22,732 4-39 26,747 1930 .. .. 25 6,027 22,078 28,105 4-66 26,797 1931 .. .. 28 6,306 22,869 29,175 4-63 26,662 1932 .. .. 31 5,882 22,594 28,476 4-84 24,884 1933 .. .. 33 5,978 25,794 29,772 4-98 24,334 1934 34 6,191 24,929 31,120 5-03 24,322 1935 .. .. 37 6,725 26,662 33,389 4-96 23.935

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