DR. J. L. HUNTINGTON'S PAPER 435 



and this is the ideal arrangement for the best kind 

 of service. 



Should, however, the patient give a history of 

 previous difficult labour, or should she be a primi- 

 para, she. is referred to the front room, and a careful 

 vaginal examination is added to the examination 

 previously described. Should the pelvis show marked 

 contraction and the patient be nearly at term, she 

 is sent to the hospital for consultation. Should a 

 patient show albumin in the urine or a high blood- 

 pressure, if the symptoms are acute, she is sent to 

 the hospital for treatment. If the symptoms are 

 mild, she is told to return to the clinic for examina- 

 tion in three days, in five days, or at the end of a 

 week, depending on the severity of the symptoms. 



When the patient returns for her subsequent visits 

 her urine is examined and her blood-pressure taken. 



To show the work that we are doing, I have care- 

 fully reviewed the records of 1,000 cases, beginning 

 with the first case that made application after the 

 present system was fully established. 



Of this series 609 cases were delivered in the 

 patients' own homes by student externes and the 

 out-patient staff of the Boston Lying-in Hospital. 

 Two hundred and thirty were delivered inside that 

 hospital by the house staff. 



Turning to the 609 cases delivered in the out- 

 patient department, 608 were married and one only 

 was single ; 157 were pregnant for the first time, 

 while 452 had had one or more previous pregnancies ; 

 545 had normal deliveries. The average length of 

 time that the mothers were under the care of the 

 out-patient department after delivery was twelve to 

 seventeen days ; 600 mothers were discharged well. 



The infants were under the care of the out-patient 

 department for an average length of time of twelve 

 to nineteen days. Five hundred and seventy-six 

 were discharged well. There were fourteen still- 



