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sometimes lying more or less latent or causing only
slight local symptoms, and the condition may be lighted
up during childbirth by injury to the womb or by
lowered resistance to infection due to prolonged and
difficult labour. The septic organisms instead of being
present before the confinement may be introduced from
outside. Thus a septic throat or a septic finger occurring
in any member of the household, in the patient herself,
or in any person attending or assisting at the labour
may conceivably be the cause of the infection. Dirty
bedding and dressings may also be causes.
There is much uncertainty in the minds of the
medical profession (1) as to the exact causes of puerperal
sepsis, and (2) as to the proportion of cases in
which the infection is already present in the womb
prior to the confinement, compared with those in which
the condition is derived from an outside source. Much
research is required on this question which is important
from the point of view of prevention. There is, however,
a prospect that efficient ante-natal work and
good midwifery will reduce the number of cases. Antenatal
examinations will lead to early diagnosis and
treatment of abnormalities and to proper provision for
confinements which are likely to be prolonged or difficult,
such as those of contracted pelvis. Attention to
cleanliness in the home and to personal hygiene on the
part of the patient and the members of the family as
well as those in attendance on the case are obviously
indicated.
Next to sepsis the commonest causes of maternal
deaths are the toxaemias of pregnancy, including (1)
those due to disease of the kidney, and (2) convulsions
or eclampsia accompanied by temporary loss of kidney
function. Those two conditions together caused over
500 deaths in England and Wales in 1926. Examination
of the urine and treatment when necessary
before the confinement are of superlative importance in
preventing calamities due to such conditions. It has
been found in many instances that septic teeth and
gums were the origin of the toxaemia of eclampsia and
that efficient dental treatment is a preventive factor.