1227

.Bristol Royal Infirmary.—Sen. Res. O. £200. Res. Obstet. 0.,H.S’.s and H.P.’s. Each £120. Also Obstetrician.

Cancer hosp., Fulham-road, S.W.—Asst. to Research Dept. £700.Carshalton, Surrey, Queen Mary’s Hospital for Children.-Sen.

Asst. M.O. Also Jan. Asst: M.O. £645 5s. and £515 6s..

respectively.Dezvsbu.ry anll, District General Infirmary.—H.S. £200..East.ern Dispensary, Leman-street, E.—Gynæcologist.East London Hosp. for Children, &c., Shadwell, E.—Asst. S. £50._Elizabeth Garrett Anderson Hosp., Euston-road, N.W.—Clin Assts.Exeter, Royal Devon and Exeter Hospital.-Asst. H.S. £150.Exminster, Devon Mental Hospital.-Third Asst. M.O. £300.Gartloch l6Tental Hospital, Gartcosh, near Glasgow.-Locum

Tenens. £350.General Lying-in Hospital, York-road, Lambeth, S.E.--Res.

M.O. £100.Grimsby and District Hospital.—H.S. £300.Hampstead General Hospital, Haverstock Hill, N.W.—Gynæc.Hellingly, Sussex, East Sussex County Vlental Hospital.-Jun.

. Asst. M.O. £350.Hospital of St. John and St. Elizabeth, 40, Grove End-road, N.W.

Asst. P.Kingston, Canada, Queen’s University.-Chair of Preventive

Medicine.$3500.00.Leeds City Infectious Diseases Hospital, Seacroft.—Second Asst.

M.O. 250.Leeds Township Infirmary.—Asst. M.O. £380.Lenham Sanatorium, Kent.—A.M.O. 8400.Lewisham Hospital, S.E.-Fourth Asst. M.O. £400.Lincoln County Hospital.-Jun. H.S. £150.Macclesfield General -Tnftrm4ary.-Sen. H.S. £200.Manchester, Ancoats Hospital.-Hon. Radiologist.-Alanchest.er Royal Infirmary.-Surg. Reg. £150.Ma.nchester, St. Mary’s Hosp.for Women and Children.-H.S. £100.Metropolitan Hospital, Kingsland-road.—Asst. Physician.Newcastle-on-Tyne Dispensary.—Res. M.O.—£350.Newcastle-upon-Tyne, Hospital for Sick Children.-Jun. Res.

M.O. 2e 15 0.Newport, Mon., Royal Gwent Hospital.-H.S. £200.Nottingham General Hospital.-Two H.P.’s .&bgr;200. ’

- Queen Charlotte’s Lying-in Hospital, Marylebone-road, N.W.—Asst. Res. M.O. £860.

-Queen’s Hospital for Children, Hackney-road, E.-Cas. H.S.£100. Also Asst. S. and Asst. P.

.Royal London Ophthalmic Hosp., City-road, E.C.-Sen. H.S. £150.Royal National Orthopcedic Hospital, 234, Great Portland-street,

W.—H.S. £150.Royal Northern Hospital, Holloway, -,V.-Cas. O. £200..,Salop County Council.—A.M.O. £550.dSamarita.n Free Hospital for IVoiaen, Marglebone-road, N.W.-H.S. £100.

Sheffield Royal Infirmary.—Two H.P.’s, H.S., Ophth. H.S., andAsst. Cas. 0. Each 150.

Southampton, Royal South Hants and Soutlzampton Hospital.H.P. £150.

.South London Hospital for Women, Claphana Common, S.iJ’.-H.S. and H.P. Each £100.

.south Shields, Ingham Infirmary.—Sen. and Jun. H.S.’s. 200and £150 respectively.

University College Hospital, Gower-street, W.C.- Half-timeM.O. 8250.

West London Hospital, Hammersmith-road, JJ’.-Two H.P.’sand H.S. Each £100.

West Middlesex Hospital, Isleworth.—Asst. Aled. Supt. £300.Westminster Hospital, Broad Sanctuary, S.W.-Asst. H.P. and

Asst. H.S. 52.West Riding of Yorkshire County Council.—Chief Tubere. O. £750.Winchester, Royal Hampshire County Hospital.-H.P. :&bgr;150.The Chief Inspector of Factories, Home Office, London, S.W.,

- announces the following vacant appointments : a Chirnside(Berwick), New Southgate (Middlesex), Royton (Lancaster),Wainflect (Lincoln).

.

Births, Marriages, and Deaths.BIRTHS.

BOYD.—On June 5th, at Belsize Park-gardens, N.W’., the wifeof Sidney Boyd, M.S., F.R.C.S., of Harley-street, W., ofa son.

HOLMES.—On June 5th, at Harley-street, W., the wife ofGordon Holmes, C.M.G., M.D., F.R.C.P., of a daughter.

MARRIAGES. ’

COMPTON—HILL.—On June 10th, at the British Embassy I

Church, Paris, Arthur Compton, M.B., D.So., to Ellen Hill,eldest daughter of Mr. and Mrs. James Hill, Manchester.

WAYLAND-SMITH—BUTLER.—On June 7th, at St. John’s Church,Devizes, Richard Wayland-Smith, M.B., F.R.C.S. Edin.,to Gladys Marjorie, only daughter of Sir Reginald Butler,Bart., and Lady Butler, of Old Park, Devizes.

DEATHS.GAINER.—On Whit Sunday, at Belmont House, Thrapston,

Northamptonshire, Joseph William Gainer, ILD., J.P., aged 63.

LEVER.—On June 6th, at Denton House, Ifliey, Oxford, ReginaldCroft Lever, Major, late R.A.M.C., aged 83.

THORBURN.—On the llth inst., very suddenly, at Newbury,Victoria Park, Manchester, Augusta, Lady Thorburn, wifeof Sir William Thorburn, Surgeon, and daughter of thelate W. E. Melland, Esq.

TURTLE.—On June 6th, at Kirkmead, Woodford, E.18, FrederickTurtle, M.D. St. Andrews, M.R.C.S. Eng., L.S.A., in hisninetieth year.

N.B.—A fee of 7s. 6d. is charged for the insertion of Votices ofBirths, Marriages, and Deaths. ,

Notes, Short Comments, and Answersto Correspondents.

THE ORGANISATION OF THE CARE OFMATERNITY.1

By FRANCES IVENS, M.B., M.S. LOND.

IN view of the fact that present-day statistics of puerperalmortality show so little improvement on the past, it is clearlyevident that midwifery has so far failed to make the sameprogress that medicine and surgery have made in the lastfew decades. But those of us who practise gynaecology arestruck rather by the later results of puerperal morbidity, asthey present themselves in overwhelming numbers in theout-patient departments. The organisation of a satisfactorymaternity service is accordingly a very pressing need.Coördination and cooperation are required ; also furthereducation of public opinion as to the advantages of ante-natal care.

Instruction of Students in Ante-natal Care.Ante-natal care involves the health education of the

pregnant woman and careful medical examination andsupervision, so that abnormal conditions can be recognisedand preventive measures adopted in good time. There isalso scope in this work for the trained health visitor. It isobvious that special training is necessary, and it is unfor-tunate that many municipal maternity schemes have been

started apart from training schools of midwifery or medicine,so that (except in the rarest instances) all this valuableteaching material is lost. There is a danger that a largeamount of the care of midwifery may be isolated from thefield of instruction of the medical student. The municipalmaternity homes and the ante-natal clinics are not utilisedto any extent for teaching, or at any rate not for the teachingof medical students. The lack of institutional facilities andthe curious contempt for midwifery hitherto shown byexamining bodies has pushed the practice of this subjectuntil recently into a rushed, scrambling fortnight. Thisregrettable state of affairs should be remedied. Thecrowded student curriculum makes it a matter of urgentnecessity that teaching facilities should be grouped togetherby the establishment and extension of teaching maternityhospitals, where all the branches of the work can be studiedin their relation to each other, and in the greatest perfectionof cletail.We begin, then, with the education of the mother in her

home and in the ante-natal clinic. Her natural repugnanceto examination must be overcome and the advantages to beobtained from pre-maternity care must be brought into ahigh light.

Destination of Ante-natal Clinic Cases.

The careful examination of the pregnant women, includingpelvimetry, if performed by skilled persons with scientificexactitude, will make the ante-natal clinic into a clearing-house where the cases are sorted and grouped. The normalcase will, if home conditions are favourable, stay at homeand be attended by her own midwife or doctor, or both ; ifshe prefers it, or if home conditions are adverse, she will gointo the maternity home. where there will be somewhatextended facilities. The midwife will be trained to utilisethe clinic to her own and the patient’s advantage. In eachmaternity home will be provided beds for the use of pregnantwomen who require rest or treatment of a simple kind, butit need not be elaborately equipped.

(’ases of abnormal pregnancy will be directed on to thecentral teaching hospital, where wards will be detailed fortheir reception where exhaustive observations can be made,and suitable treatment given. Such pathological conditionsas glycosuria, oedema, albuminuria, hyperemesis, pre-eclamptic conditions, and toxæmias would be best studiedin the fully-equipped teaching maternity hospital. Anambulance service must embrace the whole district servedby the central maternity hospital, unobstructed by thered tape of conflicting local authorities. The scope ofthe present teaching maternity hospitals must be extended,if they are fully to meet the needs of their district andsupply satisfactory teaching to the large numbers of studentsrequiring instruction. The teaching maternity hospitalshould be situated in large centres of population providedwith specialists prepared to deal with complicated condi-

Abstracted from a paper read at the Congress of the RoyalInstitute of Public Health held at Plymouth, May 31st toJune 5th, 1922, which will appear in full in the Journal of theRoyal Institute.