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was delivered by forceps, one case after being packed delivered spontaneously.

There was one case of accidental hemorrhage delivered by version. The baby was stillborn and the mother died soon after delivery.

Of the 505 confinement cases there were 17, 3.4%, recorded as puerperal sepsis although this does not exhaust the list of cases, especially operative, who had some fever during the puerperium. In addition there was one fatal case of puerperal sepsis admitted on the 12th day and therefore not rated as a confinement case. Only three of these cases were delivered in the Hospital, 0.7% of the total number of cases 6 months or more pregnant delivered in the Hospital. Of these three cases one a Caesarean section who developed peritonitis died, the other two were operative deliveries and both made excellent recoveries. There were four deaths, 22%. Only three of these are included among the pregnancy cases, making the mortality from sepsis 0.6%. Ruptured uterus was a complication in one of the fatal cases, one had had an abortion done before admission. Three cases, two of whom recovered had positive blood cultures.

Ruptured uterus was encountered 3 times although occurring only once in those delivered on this division. The mortality was 33%. One case admitted 3 days post partum died septic without operation. One case admitted one hour post partum had a hysterectomy done and recovered. One case caused by manual dilatation in a placenta previa recovered with packing. Cause of rupture in first 2 cases unknown.

Prolapsed cord occurred 7 times, 1.6% of cases 6 months or more pregnant delivered in the Hospital. All the mothers lived. Two babies were already dead on admission. Twice the complication occurred during the forceps operation. Of the 3 that lived 2 were the first of twins breech presenting, 1 was a single vertex in which version was done.

Operations other than obstetrical were done on 49 individuals counting curettages for incomplete abortion, and breast incisions and circumcisions done on the floor. The list:

Hysterectomy right salpingo-oophorectomy, appendectomy,

Curettage, myomectomy, resection of ovaries, appendectomy,
Perineorrhaphy, Gilliam suspension,

Curettage, amputation of cervix, anterior colporrhaphy, perineorrhaphy, Gilliam suspension, appendectomy,

Curettage, left salpingo-oophorectomy, ventral suspension, appen


Ventral suspension, appendectomy (2),

Curettage, salpingo-oophorectomy, appendectomy,

Curettage, oophorectomy, appendectomy,

Curettage, trachelorrhaphy, left oophorectomy, appendectomy,
Curettage, double salpingo-oophorectomy,

Trachelorrhaphy, appendectomy,

Perineorrhaphy, ovariotomy,


Excision of dermoid cyst of anterior abdominal wall, colpotomy,

Stretching of abdominal adhesions,

Repair of malformation of intestine,

Repair of ventral hernia (3),
Trachelorrhaphy, perineorrhaphy (2),

Curettage, trachelorrhaphy, perineorrhaphy,
Colporrhaphy, perineorrhaphy,


Posterior colpotomy,

Curettage and insertion of stem pessary (2),
Curettage and disinfection of genital tract,
Curettage (5),

Breast abscess (3),

Spina bifida (2),

Hare lip and cleft palate,

Hare lip,

Circumcision (5),





Attending Surgeon.

That injury to the head in the new-born may readily produce a fracture of the skull and the effects of such fracture be so trivial as to give little indication of what has occurred, is shown by the following case. An infant seven days old, normal previously in every particular, was rolled from the edge of the bed and fell to the tiled floor three feet below. The infant was stunned momentarily by the impact, which was received upon the vertex of the skull, but quite promptly began to cry violently, and was as promptly soothed by nursing. A large contusion of the scalp rapidly developed, which had subsided sufficiently by the next day to enable the examining fnger to trace across the right parietal bone a definite fissure extending from the coronal to the lambdoidal suture. The fissure was horizontal in direction, passing over the prominence of the parietal bone and dividing this into an upper and a lower fragment. There was a quarter of an inch separation between these fragments and


Fig. 1.-Radiograph showing the line of fracture passing through the parietal prominence with separation of the fragments and the prolongations of the fissure.


Fig. 2. Radiograph showing fissure fracture of the vault of the infant skull, passing across the parietal bone in a horizontal direction from suture to suture.


Fig. 3.

An oblique view showing the "bursting" nature of the fracture.

Fig. 4.

Radiograph at the sixth week, the fissure practically closed with new-formed bone. views no longer indicate the line of fracture.


the abnormal mobility along the line of fracture was easily demonstrated by pressure upon the opposite margins. There was at no time evidence of either brain injury or intracranial bleeding and the infant made an uneventful recovery, having been under observation for six months. Radiographs confirmed and amplified the clinical findings, revealing a fracture of the vault of the skull, evidently of the 'bursting' variety. It is not unlikely that such fractures are not uncommon, occurring, as in this case, without symptoms usually significant of fracture of the skull. Unless the possibility of such an injury is suspected the diagnosis will rarely be made without careful examination of the head, while radiographs may frequently reveal fractures not ascertainable in other ways.



Attending Surgeon.

In June 1914,* I first described an obstetric chair (Fig. 1) which was constructed under my direction by the mechanics in the hospital. The intention was at that time to provide a seat in which a woman in labor could be made as comfortable as possible and at the same time place her in a position so that her expulsive forces would without any strain on her be used to the greatest advantage, not only in hastening her labor but also in directing the forces so that they would overcome any tendency to malpositions of the uterus or the fetus contained therein.

From the point of view of dynamics, the placing of the woman in the upright posture tends to give the natural expulsive forces every chance with the addition of the direct action of the weight of the child plus the fluid contents of the uterus always in a downward direction towards the point of least resistance, that is the softened cervix which nature has already prepared for dilatation. In cases where the membranes are already ruptured the presenting parts act in the same way though naturally somewhat slower. Another feature of the chair is that the arm rests are so placed that the patient is able during her pains to have the greatest amount of pull with the hands in a natural position. It is, in my opinion, essential in order to gain the best results that the patient be made as free from discomfort as possible; to accomplish this pillows and blankets are so arranged that between her pains she can relax the muscles and remain quiet. It is important that the attending physician encourage her to make the best use of her pains by showing her how to rest between them and then when the pains begin by *BULLETIN LYING-IN HOSPITAL, Vol. IX, No. 4.

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