436 



MEDICAL SECTION 



births. Six died from other conditions. This would 

 give a rate per 1,000 births of 22-9 stillbirths, which 

 compares favourably with Boston's rate of 39*8 and 

 Borough of Manhattan's 48 '6. 



As this paper 'is limited in length, I will not go 

 fully into the statistics of the patients delivered in the 

 hospital, but I feel obliged to state that this rate of 

 stillbirths is not so satisfactory. The total for all 

 these 839 cases delivered in the hospital and the 

 out-patient department combined is 35*3 per 1,000 

 births. Three patients seen in pregnancy clinic 

 subsequently developed eclampsia in the hospital, and 

 one of these died. None of these three showed any 

 symptoms of toxaemia "while under observation in the 

 pregnancy clinic. 



On the other hand the seventeen cases showing 

 symptoms of toxsemia and referred to the hospital 

 escaped without serious trouble. It is only fair to 

 state that of these 230 cases followed by the 

 pregnancy clinic, for various reasons only sixty-five 

 were visited by the pregnancy nurse. 



On the previous pages I have described in detail 

 the workings of an actual institution and the results 

 obtained. Now I want briefly to sketch a more 

 nearly perfect system. In this ideal pregnancy 

 clinic all patients should apply without reference to 

 the subsequent confinement, being guided as far as 

 they are willing by the physician in charge. The 

 nurse who receives the patient and assists the 

 physician in making the examination should be in 

 each and every case the nurse who will make the 

 follow-up visits. This nurse should be trained to 

 take the blood-pressure and make the nitric acid test 

 for albumin, and carry with her on her visits to the 

 patient's home the necessary apparatus for taking 

 these observations. From the date of application the 

 patient should be visited by the nurse or report to 

 the clinic at least every two weeks. Patients failing 



