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Review of 230 Cases The use of radiological methods-usually soft-tissue radiography combined with the effect of gravity upon the feetus-to predict the placental site has been advocated for some considerable time (Snow and Powell, 1934; Dippel and Brown, 1940; Ball and Golden, 1941). However, widespread use of such a method is of comparatively recent adoption and indeed there would still appear to be maternity units where, for one reason or another, it is altogether neglected. Soft-tissue placentography has been in use in the Whittington Hospital since the end of 1954 and is now a standard investigation where a placenta prnvia is suspected. The only exceptions to this are cases where the diagnosis is virtually certain or where, for reasons such as severe hvmorrhage, labour or gross prematurity, X-ray examination is contra-indicated. This paper consists of an analysis of all cases thus examined up to June 1958, and I would like at once to say how much I owe both to Mr. J. M. Scott, who has given me much help and encouragement in this work and, especially, to Dr. G. Osborne of the Department of Radiology, who has reviewed all the relevant X-rays. The total number of cases in this survey is 230-86 primipare and 144 multiparae-and, as already stated, the reason for placentography was in every case a suspected placenta previa. The actual indications for X-ray are shown in Table I. Although hiemorrhage was by far the

Each GP obstetrician would have his own patients, whom he would see regularly with the midwife at antenatal clinics in his practice area and as far as possible both would attend the confinements. As part of his hospital contract, each GP obstetrician would have hospital duty days on a rota basis. This would cover those cases where the GP obstetrician responsible cannot attend, because of absence through holidays, illness, study leave or other reasons. He would be engaged in general practice, preferably in a group or partnership, with responsibility for a smaller than average list and would work in association with GP obstetricians who might well be in other groups or partnerships. The financial aspects of any practice would not be affected by this cooperation.One attractive feature of all this is that it would not require additional money. The midwives would be paid as at present, and the GP obstetricians by salary from funds recovered from the local executive council through forms EC 24. In Bristol in 1966 there were 7,301 live births and an unknown number of miscarriages, for which GP obstetricians may also claim fees. If the present obstetric list was reduced from 160 to, say 50, this would provide enough funds for a salary on a part-time basis, which, if added to fees for hospital work would be about £2,500 per annum. This would be quite a useful sum to bring to any partnership. It all sounds very simple but in human affairs and especially in medicine this is never so. If a cadre of GP obstetricians is set up and no GP outside the obstetric list is allowed to practise midwifery, should not this subject be removed from the qualifying examination? In place of the present course in the curriculum should there not be elementary instruction in the basic principles of conception, pregnancy and labour, as well as contraception and family planning? Midwifery proper would then be made a postgraduate course and admittance to the obstetric list in the future would require a DRCOG or equivalent.Finally, why bother having GP obstetricians at all? All midwifery could be done by midwives, housemen, registrars and consultants in maternity hospitals. I am sure that there is a strong case for keeping the family doctors in the maternity services. Ardrey (1963) shows how the anthropologist fell into great error by basing his views of animal behaviour on observations in zoos, whereas they behave quite differently in their natural jungle habitat. In much the same way, human beings behave quite differently in hospital from the way they behave at home. The GP obstetrician with his interests divided between hospital and general practice is a necessary link between the two worlds.