H.—3l.

Table V.

Obstetrical Research. The year 1939 saw the appointment by the Medical Research Council of a Committee of Obstetrical Research. Dr. F. 0. Bennett was appointed Obstetrical Research Officer and began his work with a statistical inquiry into the incidence of toxaemias of pregnancy in New Zealand. His report fills 72 typewritten pages and was based on the examination of 7,286 charts drawn from forty-seven hospitals and Plunket ante-natal clinics which have for many years past provided free antenatal care to the women of New Zealand. Space does not permit of even a summary of the report. One hundred and three copies have already been distributed and others will be sent, as long as the limited supply is available, to those specially interested on application to the Department. At the suggestion of the Obstetric Officer, arrangements have already been made to make alterations in the Department's ante-natal charts used in these clinics to ensure greater accuracy and more specific information of certain points. Research in the fimiliary or hereditary incidence of toxaemias of pregnancy and other aspects of the problem is proceeding. In addition to this organized research by the Obstetrical Research Committee the medical staff of St. Helens Hospitals have done very useful work by paying special attention to the best methods of relieving pain of normal labour and the institution of systematic maternity exercises. Dr. Chapman, of St. Helens Hospital, Wellington, continues to report favourably on the use of Dr. Small's apparatus for the administration of ether by the patient herself under the supervision of the nursing staff. Dr. Paterson, St. Helens Hospital, Auckland, has used nitrous oxide and air and nitrous oxide and oxygen to a limited extent, but states that the patients prefer the Murphy's inhaler. Dr. Averill, St. Helens Hospital, Christchurch, relies on the Junker chloroform method, which, if manipulated by the patient herself, is regarded as safe, but if used otherwise it is only safe in the hands of a skilled anaesthetist. He reports that in many instances the patient cannot manipulate it, and it is administered by the midwife. I regard this as unsafe, unless in the hands or under the supervision of a skilled medical anaeathetist. Dr. Mac Gibbon, St. Helens Hospital, Invercargill, relies chiefly on the selfadministration of chloroform by the Murphy inhaler in conjunction with various hypnotic and amnesic drugs. The use of systematic exercises based on the Margaret Morris system first introduced into the St. Helens Hospital, Wellington, by Dr. Chapman has again proved so advantageous that the Director, Division of Nursing, has arranged for as many midwives as possible to be taught to act as instructors in these exercises. To this end Professor Dawson, in conjunction with Dr. Sylvia Chapman and others, have drawn up a system of exercises which will be adopted as standard for the training of nurses and midwives in New Zealand. Dr. Chapman, the Medical Superintendent, reports as the result of these exercises a forceps rate of 1-8 per cent, in the 322 patients practising the exercises last year, as compared with a forceps rate of 9-76 per cent, for the 215 patients who did not take advantage of them. This confirms the result reported by her for the previous year and may be regarded as showing that these exercises have a very definite usefulness in obstetrics. Section II. —Maternal Mortality and Morbidity. PART I.—EUROPEAN. The increase in the number of live births from 27,249 in 1938 to 28,433 in 1939 caused an increase in the birth-rate from 17-93 to 18-73. In the same period the still-births increased from 743 to 900, causing an increase in the still-birth rate per 1,000 live births from 27-3 to 30-27. Over the same period the infant deaths in the first fortnight of life, which should be taken into consideration in considering any return of still-births as the factors causing them are almost identical, were 600 (rate, 21-44) in 1938, and 585 (rate, 19-67) in 1939. The total maternal deaths due to causes attributed to pregnancy or childbirth, other than deaths from septic abortion, in 1939 were 85, giving a death-rate of 2-95, compared with 2-97 for the previous year. A comparable rate for England and Wales for 1938, the last year available, was 2-80. This fall in the total maternal mortality was contributed to by a slight fall in the deaths from toxaemia and eclampsia, producing the lowest rate since 1937. These reductions were offset by a very considerable rise in the deaths grouped under the heading " Accidents of labour.'' In this group there were 42 deaths, giving a rate of 1-46, the highest total and the highest rate since 1927. Four of the 42 deaths in the group classed as due to " Accidents of labour " followed delivery by Caesarean Section. Table VI gives the numbers and rates under the different classification groups for each year from 1927 to 1939, and in the same table are included death-rates from septic abortion, which, for obvious reasons, are, as in England and other countries, considered separately, as they are not influenced by measures taken to prevent the incidence of sepsis following childbirth. There as a 33-per-cent. reduction in the number of deaths, and a corresponding reduction in the death-rate from this cause. The information in this table is displayed in the graph on page 39, and Table VII gives particulars in greater detail for 1939 under each classification group.

38

Year. 1932. 1933. 1934. 1935. 1936. 1937. 1938. 1939. _____ I Number of cases .. .. 193 277 269 316 365 510 468 Death-rate, per cent. .. 11-19 8-28 5-78 8-18 5-69 6-47 3-92 7-47