Maternal mortality and morbidity : an address / by Edward Mellanby.

  • Mellanby, Edward, Sir, 1884-1955.
Date:
[1930?]
Catalogue details

Licence: In copyright

Credit: Maternal mortality and morbidity : an address / by Edward Mellanby. Source: Wellcome Collection.

    3/18 (page 87)
    If we now analyse the case of death of these women we find that in 1928 it was as follows:— Causes of Death as Recorded by Registrar General, in 1928. Abortion Ectopic gestation Other accidents of pregnancy Puerperal haemorrhage Other accidents of childbirth . Puerperal sepsis Puerperal phlegmasia alba dolens not returned Puerperal embolism and sudden death Puerperal albuminuria and convulsions Childbirth not assignable to other headings Puerperal diseases of breast as septic Per cent. 2.60 2.90 3.60 11-3° n.30 40.50 1.00 6.40 19.00 0.72 0.27 It will be seen that the two main causes of death resulting from childbirth are sepsis and eclampsia, the two together being responsible for nearly 60 per cent, of the total. What makes these figures so galling is that sepsis accounts for 40.5 per cent., for if ever there was a branch of knowledge which medical science has claimed to have advanced, and with good reason, it is the control of sepsis. Yet, here we have a condition in which sepsis flourishes in spite of all endeavour. As regards eclampsia, all medical men feel much more modest, and it will be generally agreed that at the present time we have but little know¬ ledge of its aetiology. The general problem with which we have to deal to-day may be viewed from two main standpoints: (1) the patient herself, and (2) the environment of the patient as she is affected by doctors, midwives, antenatal clinics or lack of any or all these adjuncts. With regard to the patient herself we must ask ourselves : (1) Why is she subject to puerperal haemorrhage?; (2) Is she more susceptible to infection at these times, and, if so, why?; (3) What is the cause of eclampsia? As to the external influences brought to bear on the patient in childbirth, we want to know whether defective skill and knowledge of the doctors and mid¬ wives is the crux of the problem as some think, also, whether antenatal treatment is as good as it should be. I admit at once that I am incompetent to discuss the second series of problems, namely, the relative importance of the skill of doctors and midwives and the part played by antenatal clinics in fighting this dreadful scourge. I must leave this part of the subject to others. Incidentally, I might point out that it is on these particular problems that the Maternal Mortality and Morbidity Committee has concentiated almost all its attention. You may remember that the Maternal Mortality Committee made a close study of 2,000 cases of death in childbirth and the puerperium and came to the conclusion that about n;o per cent, of these cases could be accounted for l|y what they call a primary avoidable factor. This primary avoidable factor was in turn divided up in the following