H.—3l.

A certain number of deaths from eclampsia were due to the neglect of the patient to obtain or follow advice. A considerable proportion of the cases of eclampsia reported showed that there was either no ante-natal care given to the patient owing to her failure to obtain it or that ante-natal care was instituted too late or was deficient in many respects. It will doubtless take many years before it becomes the rule, and not the exception, for women to regard good ante-natal care during pregnancy as essential to their well-being as the provision for adequate attendance during labour. In spite of the lack of satisfactory results up to the present from the increased provisions for ante-natal care, I am confident that eventually it will demonstrate its value as the majority of the medical profession are giving greater attention to this side of obstetrics. Puerperal Sepsis. One hundred and fourteen cases were notified during the year, including 9 occurring among the Maoris ; 107 cases were investigated more or less fully, mostly by means of questionnaires to the medical men attending and the midwife or nurse, these questionnaires being reported upon by the Medical Officer of Health for the district in which the case occurred. It is obvious that a considerable number of the cases reported were of a very mild nature. The following facts are worthy of note : Sixty-seven, representing 62-6 per cent., were delivered in hospitals and 40, representing 37-4 per cent., in private houses. As the proportion of confinements conducted in hospitals to private houses was 70-95 to 29-05, the incidence of puerperal sepsis in the hospitals was lower than that in private houses. I have no doubt from my own investigations that this is a correct reflection of the conditions occurring, as the facilities for carrying out asepsis in hospitals are very much better than those in most private houses, even of the better class. Of the recorded cases 65-7 per cent, had normal deliveries of both infant and placenta, 34-3 artificial delivery of either infant or placenta or both. It is to be regretted that it has not been found possible to carry out fuller bacteriological investigations with regard to these cases. Such an investigation would be of great interest. However, this would be impossible to arrange in the majority of cases owing to facilities not being available as is the case in large obstetric units. Caesarian Section. One hundred and nine patients were delivered by Caesarian section, a rate of 4-4 per 1,000 total confinements. Comparative figures of other countries are not available except those pertaining to lying-in hospitals, and so comment is withheld. Deaths from Septic Abortion. I can only repeat what I have said before with regard to deaths from sepsis following abortion— namely, that in nearly all cases they are due to induced abortion and that the underlying causes are mainly economic and social; these are not easily remedied, and it is noteworthy that the increase in this cause of death is remarked upon by nearly every writer on maternal welfare in the majority of civilized countries. The only useful remark I can make from the medical point of view is with regard to the enormous risk to every woman who has illegal abortion procured or induces abortion herself. ANTE-NATAL CLINICS.

Table III. —Ante-natal Clinics.

48

Number of AT n Total A ™T Outfits Vpar . New Cases. * LJ i of Attendances , A Year - Clinics. eW Attendances. fey eaoh patient _ sterilized. 1925 16 2,289 7,816 3-0 1926 .. ■■ 20 3,238 12,554 3-8 401 1927 .. .. 20 3,919 15,406 4-5 .515 1928 21 5,050 20,740 4-1L 728 1929 " 24 5,177 17,555 3-39 924 1930 25 6,027 22,078 3-66 1,106 1931 28 6,306 22,869 3-63 1,221 1932 31 5,882 22,594 3-84 986 1933 33 5,978 23,794 3-98 914