434 MEDICAL SECTION 



away from the hospital, it has not been considered 

 good policy to require all these prospective patients 

 to come to the pregnancy clinic. These patients 

 are visited by the . nurses from the Instructive 

 District Nursing Association, and should any com- 

 plications arise they are referred to the pregnancy 

 clinic, so in this way there is some supervision 

 of the hygiene of pregnancy of all the 2,000 

 patients now delivered annually in the out-patient 

 department of the lying-in hospital and of nearly 

 all the 900 patients that apply to the hospital for 

 confinement within that institution. 



Let us follow a patient through the course of 

 her care in the pregnancy clinic. We urge the 

 patients to come as early in their pregnancy as 

 is possible, but as a matter of fact, few apply before 

 the fifth month, and most of them some time between 

 the sixth and seventh months. The history of the 

 patient is taken, both social and clinical, careful 

 stress being laid on the previous obstetrical history. 

 Should the patient have passed successfully through 

 one or more confinements with normal labour, she is 

 sent into the back room for physical examination. 

 The physician examines the urine, and takes th< 

 blood-pressure. The abdomen is examined, the 

 probable elate of confinement estimated. If preg- 

 nancy has developed sufficiently far, the feet; 

 heart is examined and the pelvis is carefulb 

 measured. The patient is given careful direction: 

 as to the hygiene of pregnancy, and is told t< 

 return in four weeks or sooner if any untowarc 

 symptoms arise. The name is then given to th< 

 nurse who makes the follow-up visits. The out- 

 patients are visited in their homes at regulai 

 intervals by the nurses of the Instructive District 

 Nursing Association. Many of the patients that are 

 to be confined in the hospital are visited, however, 

 by the nurse who is on duty in the pregnancy clinii 



