H.—3l.

Table 111 (page 41) gives a summary of maternity cases in the above hospitals, in which 17,548, or 69 per cent., of the confinements during 1932 took place. As before, these hospitals have been grouped into four classes. With the gradual improvement of the smaller maternity hospitals (Group I), and the precautions taken to exclude septic and suppurating cases from the maternity hospitals licensed to admit surgical cases (Group IV, mixed hospitals), satisfactory and fairly even results are shown in each of the four groups. Group V includes the results of all patients (7,919, 31 per cent.) confined in their own homes and/or in the general wards of public hospitals, to the latter of which the cases admitted were mostly unforeseen emergencies occurring during the course of labour commenced elsewhere. The gravity of these emergency cases when admitted may be estimated from the fact that the maternal-death rate in the general wards of public hospitals was 11-19 per cent. It is obviously desirable that such emergency cases should be admitted to obstetric hospitals instead of to surgical or medical wards of public hospitals, in which the facilities for special obstetrical work are seldom available. It is still more desirable that as many emergencies as possible should be avoided by more complete ante-natal care under skilled obstetricians and midwives. The maternal mortality of the whole of Group V is 2-5 per 1,000 confinements, a rate identical with the total of the maternityhospital cases. The rates have been made comparable by excluding cases of abortion and ectopic gestation from Group V, since such cases are not admitted to maternity hospitals. ST. HELENS HOSPITALS. Table IV gives detailed results of patients attended in the internal and external departments of all St. Helens Hospitals and the attendances in the ante-natal clinics attached to these hospitals. It is interesting to note that an increase in the number of maternity outfits sterilized at these clinics for the use of midwives in private practice has corresponded with the decrease in the puerperalsepsis rate. This is a valuable service given at a cost of Is. to Is. 6d. per outfit. The forceps rate for the St. Helens Hospitals is 5-91 per cent., as compared with the rate of 9-76 per cent, for all other maternity hospitals. This low forceps rate can be attributed mainly to the fact that in all these hospitals normal deliveries are attended entirely by midwives. medical effcers only being called in if abnormality is foreseen or arises during labour.

Table IV.—St. Helens Hospitals, General Statistics, 1932.

42

•2 s P - a> g> § J «-3 § Ill 2 S I Total. §£§ «S g P 5 £ £ <2~§ A. —Intern Departm ents. Total deliveries .. .. .. 617 308 138 141 277 165 545 2,191 Primiparse .. . . . . 214 88 39 31 68 36 149 625 28-53 Multipara; .. .. .. 403 220 99 110 209 129 396 1,566 71-47 Presentations — Vertex normal rotation .. .. 595 283 129 139 265 155 489 2,056 93-84 Occipito-posterior (persistent) .. 11 7 7 2 4 6 19 56 2-56 Face .. .. .. .. 4 2 11.. 1 3 12 0-55 Brow .. .. .. 1 .. 1 2 0-09 Breech .. .. .. 15 20 2 5 8 3 20 73 3-33 Transverse .. .. .. .. 1 1 2 0-09 Twins .. .. .. .. 9 5 1 3.... 2 20 091 Complications of pregnancy — Hyperemesis . . .. .. .. .. 1 1 0-05 Hydramnioa .. .. .. .. .. 8 .. .. 1 3 12 0-55 Pre-eclamptic toxeemia .. .. 12 6 1 2 .. " 5 37 63 2-88 Eclampsia .. .. .. 2 .. I 3 0-14 Nephritic toxa'iniu .. .. 3 1 2 4.. 4 14 0-64 Haemorrhages — Unavoidable .. .. .. .. .. .. 1 1 .. 1 3 0-14 Accidental, external .. .. 3 2 1 .. 1 i I 13 0-59 Accidental, internal .. .. .. .. 1 .. ] .. .. 2 0-09 Post-partum, atonic . . .. 15 4 9 14 5 7 45 2-05 Post-partum, traumatic.. .. 1 .. .. .. .. .. .. 1 0-05 Lacerations of genital tract — Perinamm .. .. .. 155 29 11 15 34 17 .. 261 11-91 Cervix Uterus .. .. .. .. .. .. Contracted pelvis, inlet .. .. .. 2 6 4.. .. .. 12 0-55 Contracted pelvis, outlet .. .. .. 5 . . .. 4 .. .. 9 0-41 Prolapse of cord .. .. ..I 2 II !.. 2 5 0-23