H.—3l

It is to be regretted that such a large number of cases for ante-natal care only and uncomplicated emergency cases are being admitted as they would be better in maternity hospitals. When the maternity hospitals in the larger centres provide sufficient beds the general hospital will be relieved of such cases to their own and the patient's advantage. The following table shows the increasing use of these hospitals and decreasing, though still high, death-rate: —

The decrease in the death-rate may probably be ascribed to two main factors—greater obstetrical skill available, and the admission of cases in a sufficiently early stage. In other words, the general practitioners are to their credit recognizing the advantages to their patients and themselves of the help of the obstetrical specialist in a hospital staffed and equipped to deal with the graver emergencies. Ante-natal. • The following Table (No. IY) gives the returns from forty-eight public ante-natal clinics. Four of these are connected with St. Helens Hospitals, twenty-nine with other public maternity hospitals, ten conducted by nurses of the Plunket Society, and five by the licensees of larger private hospitals.

Table IV.

In the St. Helens Hospitals and most of the public hospitals the work of the nurses is supplemented by examination of every patient by a medical officer, while patients attending Plunket clinics are referred to their own doctor. I would again draw attention of those hospitals that do not provide such medical attention to the fact that they are not giving efficient ante-natal care and are subjecting the patients to grave risks by permitting a patient who has not been certified as suitable by a medical practitioner to have an anesthetic or analgsesic drug administered during labour by a nurse ; furthermore, in allowing their nurses to administer anaesthetic or analgesics they are conniving at a breach of the Nurses and Midwives Regulations. I have had to call the attention of several hospitals to this, and do so again. SECTION lII.—CESAREAN SECTION. Reports on 202 cases delivered by Caesarean Section are summarized in Table Y. The reports show that 073 per 1,000 total confinements were delivered by this method, as compared with 0-59, 0*64, 0-59, 0-53, and 0-44 in the five preceding years, The case-mortality rate for the mothers was

82

Year. 1932. 1933. 1934. j 1935. j 1936. 1937. 1938. Number of cases .. .. • • 193 277 269 316 365 510 Death-rate, per cent. .. .. 11*19 8*28 5*78 8*18 5*69 6*47 3*92

Number of Average Clinics „ _ , „. Total Number of Year. supplying New Cases. Return Visits. Attendances . Attendances Returns. per Patient. 1925 . 16 2,289 7,816 10,105 4-41 19 26 .. 20 3,238 12,554 15,792 4-88 1927 20 3,919 15,406 19,325 4-93 1928 . ■■ 21 5,050 20,740 25,790 5-11 1929 " . .. 24 5,177 17,555 22,732 4-39 1930 . 25 6,027 22,078 28,105 4-66 1931 " 28 6,306 22,869 29,175 4-63 1932 " .. 31 5,882 22,594 28,476 4-84 1933 .. 33 5,978 25,794 29,772 4-98 1934 .. 34 6,191 24,929 31,120 5-03 1935 . 37 6,725 26,662 33,389 4-96 1936 .. .. 39 7,069 29,103 36,272 5-13 1937 .. 38 6,746 28,769 35,515 5-28 1938 .. .. 48 8,221 33,808 42,029 5-11 I " "