H— 31.

Table III.—Ante-natal Clinics.

Public Ante-natal Clinics. Table 111 shows the comparative attendances for each year from 1925 to 1930 with the average number of visits per patient. I regret to say it is a record of increased work, apparently with little, if any, result upon the death-rate from eclampsia for New Zealand as a whole, which remains deplorably high, as will be shown when discussing maternal mortality. The question of how to obtain better results from the large amount of work done in these clinics will be a matter for special inquiry and special endeavour during the coming year. The increased advantage taken of the facilities for obtaining sterilized labour and puerperium outfits as shown by the increased number sterilized each year in these clinics has no doubt helped to reduce the puerperal-sepsis rate for New Zealand which will be referred to elsewhere. Inquiries into Puerperal Septic Cases. Of the 157 cases of puerperal sepsis notified in 1930, 140 cases were investigated by the Medical Officers of Health of New Zealand by means of special inquiry forms supplemented when possible by personal investigation. The result shows that 22, or 15-71 per cent., of these cases died and 84-29 per cent, recovered. The case mortality for the 157 cases notified was 17-20 per cent., some of these not being included in the inquiry. The total days' illness resulting from the 140 cases investigated was 2,441, an average of 17-44 days per week. This by no means represents the full period of illness in each case, as it was not found practicable to obtain particulars of the days' illness beyond twenty-eight days for any one case. Labour was returned as normal in 57-15 per cent, of cases and abnormal in 42-86 per cent. In 35-71 per cent, of the cases the infant was delivered artificially, and in 17-86 per cent, of the cases delivery of the placenta was manual. Vaginal examinations were made in 47-14 per cent, of the cases. At present I am unable to draw any definite conclusions from these reports regarding the causes of these cases. The causes in many cases are necessarily obscure, and in still more cases are difficult to determine owing to fear on the part of those concerned that complete frankness with regard to matters being investigated may lead to the person questioned being perhaps blamed. My personal investigation of a considerable number of cases convinces me that a very large majority of them are preventable. This is borne out by the conclusions of practically all independent observers, and by the results already obtained.

Puerperal Mortality. Table IV.—Showing Comparable Death-rate per 1,000 Live Births for the Years 1927-30, classified according to the International Classification.

5—H. 3]

33

Number of Tntnl I Average Number Year - Clinics. New Cases. Atten ° d anc e s of Attendances by Outfits sterilized. each Patient. 1925 .. .. 16 2,289 7,816 3-0 1926 .. . 20 3,238 12,554 3-8 401 1927 .. .. 20 3,919 15,406 4-5 515 1928 .. .. 21 5,050 20,740 4-11 728 1929 .. .. 24 5,177 17,555 3-39 924 1930 .. 25_ 6,027 22,078 i 3-66 ],106

1927. 1928. 1929. 1930. New Zealand. Accidents of pregnancy . . .. Total 7 11 12 13 Rate 0-25 0-40 045 049 Haemorrhage and accidents of labour . . Total 27 19 18 18 Rate 0-97 0-70 0-67 0-67 Puerperal septicemia—Ordinary . . Total 56 42 30 27 Rate 2-01 1-54 142 1-01 Abortion septicaemia (not including criminal Total 14 14 19 30 abortion) Rate 0-50 0-51 0-71 142 Thrombosis, phlegmasia, and embolism .. Total 6 9 14 15 Rate 0-22 0-33 0-52 0-56 Toxaemia, albuminuria, and eclampsia .. Total 26 38 34 33 Rate 0-93 140 1-27 1-23 Following childbirth (not otherwise defined) Total 1 1 2 Rate 0-04 0-04 0-07 Totals .. .. .. .. ..137 134 129 136 Puerperal-mortality rate, all causes .. 4-91 4-93 4-82 5-08 Puerperal - mortality rate, excluding septic ! 441 442 441 3-96 abortion England and Wales. All puerperal causes .. .. .. Rate ! 441 442 4-33 * Septic abortion only .. .. .. Rate j 0-33 0-34 0-37 i * All causes, excluding septic abortion . . Rate 3-78 4-08 ' 3-96 * * 1930 figures not yet available. 5-—H. 31.