276 MEDICAL SECTION 



primipara, both at the time of booking and also 

 shortly before full term. If her test gives an affirma- 

 tive answer, she must continue to test weekly, and 

 meantime the patient must have most careful instruc- 

 tions as to diet and way of life generally. Pronounced 

 cases should also see a doctor, and 1 think it is the 

 vague feeling that a doctor is always hovering 

 mysteriously in the background, midwives being only 

 qualified to attend cases of normal labour, which 

 causes the public to view with equanimity the ignor- 

 ance too frequently shown by the inferior order of 

 practitioner. They forget that in the first place 

 a midwife must detect and diagnose danger before 

 a doctor is called in at all ; if she is too profuse in 

 her recommendations of medical aid she will in- 

 fallibly lose her practice. Moreover, the doctor is 

 probably extremely busy with his own patients, and 

 not acutely interested in hers. He will, therefore, 

 possibly just look in in answer to the summons, and 

 speed on his way with a hasty " All right, nurse, 

 you know how to treat her. Send for me if she has 

 a fit." 



Then, with regard to contracted pelves, it is a 

 great disgrace to a midwife if she is constantly find- 

 ing when her patient is in labour that the child and 

 the pelvis are an obvious misfit. If she has taken 

 full particulars at the time of booking of the patient's 

 history, whether breast-fed, late in walking and teeth- 

 ing, and also, if any had occurred, of her previous 

 labours ; if she carefully measured externally with 

 a pelvimeter every primipara, and every mother who 

 has already had instrumental or complicated labours, 

 it will have been quite simple, in many cases where 

 the contraction is only slight, to recommend such 

 a form of diet as will keep the child of a reasonable 

 size. In cases of greater deformity, she would take 

 the patient herself to some real obstetric authority, 

 such as the surgeons of a good maternity hospital, 



