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153
and nervous exhaustion. Moreover, a common result of toothache is that
the sufferer stays indoors to avoid the contact of cold air on the face.
Extraction thus effects a radical change of habit, and one that greatly
benefits the baby as well as the mother.
When the operation results in clearing up a source of chronic sepsis
the main benefits are seen in improved appetite and digestion, and a gain
in strength, vigour and weight. A great change in the complexion is also
often seen. Improvement in the quality and quantity of the milk has
been mentioned. In certain instances the milk of women suffering from
gross dental sepsis may contain large numbers of micro-organisms—
streptococci and even B. coli have been identified.
As soon as these findings were established, the treatment was recommended
to women attending the Ante-natal Department. For clearly
it must be an advantage to obtain a healthy state of the mouth as early
as possible in pregnancy. But here the response has not been so good.
Pregnancy is claimed as an excuse for postponement, though we urge
strongly it is a reason for not admitting delay. Unfortunately the plea
to put off treatment until after delivery seems still to receive a certain
amount of support from both doctors and midwives and sometimes from
dentists. One fancies it is partly out of sympathy with the woman, who
is felt to be sufficiently burdened. There is also in some minds a vague
feeling of apprehension that extraction may provoke the onset of premature
labour. In many hundreds of operations here on pregnant women we
have never once known this happen, no matter at what stage of pregnancy
the operation has been performed. (On the other hand, we have reason
to know that extractions have been applied for in the hope that pregnancy
would thereby be terminated, and quite candid expressions of disappointment
at its failure have followed!) A few troublesome instances
of bleeding have occurred and we now give a mixture containing Calcium
Lactate to be taken for three days before the operation is performed, and
are very satisfied with the results.*
When it is considered how really severe is the condition of sepsis
which the mouth often harbours, it is strange that greater insistence is
not laid on its eradication before childbirth. At present this policy seems
the exception rather than the rule, and we still have to combat a great
deal of popular prejudice in carrying it out. There is little appreciation
that dental sepsis and puerperal sepsis may be connected with each other,
* The formula for the prescription is:
Acidi Lacfc. Cone. grs. 200.
Calcii Garb. ppt. grs. 75.
Aq. Chloroform 8 ozs.
1 Tablespoonful twice daily.
3 ozs. of this mixture is supplied to each patient—the cost is 3d.