H—3l.

special experience are required to fill the positions of private midwives, district nurses, district nurses to Natives, Matrons of public and private maternity hospitals, and positions in which they are responsible for training maternity nurses. Without a. sufficiency of well-trained maternity nurses it would not have been possible for New Zealand to have reduced the death-rate from puerperal sepsis to the extent that has been done, and to maintain that low rate it is essential that the practice of these nurses should be kept to a very high standard. St. Helens Hospitals. The tabulated results of the work of the St. Helens Hospitals are shown in Table IV, pages 47 and 48, and consideration of this shows the very excellent results obtained. I would particularly call attention to the low forceps rate, 4-64, as compared with 9-45 in the maternity hospitals listed in Table I. There were three deaths of mothers confined in these hospitals, only one of these being due to a puerperal condition—namely, puerperal septicaemia due to infection with B. Coli and Staphlococcus— the other two were due to causes associated with pregnancy. One was an emergency case in the second stage of labour who died after transfer to a general hospital from tuberculous peritonitis. The other case was a multiparae, aged 38, 15 para., ten living children, who was suffering from myocarditis and died five hours after delivery. The puerperal death-rate was, however, 0-50 per 1,000 confinements for puerperal conditions and for non-puerperal conditions 1-01.

Table IV. —St. Helens Hospitals Statistics.

47

— i I i i i ! m £3 OQ d ® g a i I _J_ 1 5 I ' A. Intebn Department. Total deliveries .. .. 646 521 406 163 247 1,983 Primiparae .. .. .. 219 156 122 41 76 614 30-96 Multiparae .. .. .. 427 365 284 122 171 1,379 69-54 Presentations — Vertex normal rotation .. 586 438 373 152 230 1,779 89-71 Ocoipito posterior (persistent) ..30 26 20 6 13 95 4-79 Face .. .. .. 1 5 2.. 1 9 0-45 Brow .. .. .. .. .. 1 .. .. 1 0-05 Breech .. .. ..29 17 10 8 5 70 3-53 Transverse .. .. .. 2 .. 1 .. 1 4 0-20 Twins (sets) .. .. .. 9 4 5 2 3 23 1-16 Complications of pregnancy — Hyperemesis .. .. 1 2 .. .. .. 3 0-15 Hydramnios . . .. .. 2 2 .. 3 3 10 0-50 Pre-eclamptic toxaemia .. 21 44 5 .. 20 90 4-54 Eclampsia .. .. .. 4 .. 2 .. 3 9 0-45 Nephritic toxaemia .. .. .. .. 1 .. .. 1 0-05 Haemorrhages— Unavoidable (placenta praevia) .. 1 6 4 2 3 16 0-81 Accidental, external .. .. 1 3 1 2 2 9 0-45 Accidental, internal .. . . ! 1 .. . . .. .. 1 0-05 Post-partum, atonic .. .. I 9 2 8 1 2 22 1-11 Post-partum, traumatic .. .. .. 1 1 .. 2 0-10 Lacerations of genital tract — Perinaeum .. .. .. 56 31 59 40 25 211 10-64 Cervix .. .. .. .. .. 7 .. .. 7 0-35 Uterus Contracted pelvis, inlet .. .. 2 .. .. 2 5 9 0-45 Contracted pelvis, outlet .. .. .. 9 .. 1 10 0-50 Prolapse of cord . . . . 3 1 . . . . .. 4 0-20 Complications of puerperium— Sepsis, local .. .. .. .. 6 8 .. 4 18 0-91 Sepsis, general .. .. .. .. .. 2 1 3 0-15 Pulmonary embolism Insanity .. .. .. 2 .. .. . . .. 2 0-10 Crural phlegmasia, venous . . 1 .. . . .. .. 1 0-05 Crural phlegmasia, lymphatic . . . . .. | Mastitis .. .. .. .. 2 m 2 j .. 115 0-25