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The chief cause of death is Puerperal infection or Puerperal
Fever, or Puerperal Sepsis. Puerperal Sepsis not only easily ranks
as the prime cause of death amongst women in child-birth, but also
leads to more subsequent injury in the case of survival than any
other complication of child bearing. As it is in the nature of an
external infection, it ought to be well within the scope of prevention.
The discovery of the specific germ of septic infection by Pasteur and
the development of the principles and practice of antisepsis by
Lister, made possible the definite progress in the control and management
of puerperal fever. The application of the new knowledge
has led to the practical disappearance of puerperal fever from lyingin
hospitals which were formerly devastated by epidemic infection.
Similar success has not followed in the private practice of midwifery.
Puerperal Fever is one of the compulsory notifiable infectious
diseases, but it is well known that the system of notification
as far as puerperal fever-is concerned has broken down and is
worthless. It is probable that not more than 5 per cent. of the cases
are notified. In some districts the deaths exceed the notifications.
In this district the figures have been as follows in the last 3 years:—
Year. Notifications. Deaths.
1924 5 2
1923 3 3
1922 2 1
The causes of this failure are probably many and complex.
Some difficulty arises in defining clearly what is meant by
puerperal fever as was shown by the discussion on this subject at
the Royal Society of Medicine, and it is admitted that at an early
stage it is not always possible to decide as to the cause of a rise of
temperature.
The chief cause of the breakdown of notification lies in the
want of any means by which effective assistance can be rendered to
the patient. The main object of notification is not so much to
acquire statistical information, helpful though it may be at times,
but to secure specialised treatment for the patient and to permit
the early exercise of preventive measures. With the exception
of the Infirmary, there is no provision for the institutional treatment
of puerperal sepsis. Beds in maternity homes are mainly
intended for non-infectious cases, and the facilities for isolation
are limited. There is an objection on the part of patients to avail
themselves of the facilities offered by the Poor Law authorities.
The most important instrument within our reach to reduce
maternal mortality is ante-natal care. This is true not only of
puerperal sepsis, but more so of causes other than sepsis. Until
ante-natal supervision is accepted by patients and their advisers
as the invariable duty of the professional attendant engaged for the
confinement, substantial progress towards the reduction of