A British Medical Association Lecture on SOME ANTE-NATAL PROBLEMS

Abstract

A perusal of the now vast literature on ante-natal care, including tomes and textbooks, propaganda pamphlets and handbills, might lead the undisccrning to surmise that it was not until within recent years, or even months, that the general practitioner engaging in midwifery practice had become aware of the possible existence of, for example, contracted pelvis ; of the significance of albumin uria in pregnancy, or of heart disease, or of tumour complications. Indeed, some of the less responsible of such publications, short, it is true, of actual delineation, would appear to imply a ludicrous picture of the general practitioner who, having casually accepted the respon sibility of attendance, arrives all too late, bearing a small bag?usually faded black in exterior and indescribable in content?and is surprised and distressed to find the con tracted pelvis case exhibiting the classical signs of ruptured uterus ; or an albuminuria case in the throes of eclampsia ; or the cardiac in articulo mortis. Let us extend to him, poor fellow, our heartfelt sympathy, for he has further to bear the reproachful demeanour of the ideal midwife and the fraternal greetings of the junior consultant, for whom, let us hasten to add, by way of giving a touch of colour to the unhappy scene, the enterprising local authority has provided a not unreasonable fee. I have exaggerated this picture with the set purpose of saying that, whilst wise propaganda is undeniably essential to the much-needed wider submission of pregnant women to ante-natal examination, the kind of propaganda directed to undermining confidence in the general prac titioner is as unwise as many or most of the allegations to that end are, emphatically, untrue. It is not thus that Ballantyne, perhaps the earliest and certainly one of the most distinguished of the pioneers in urging the neces sity of ante-natal care in this country, initiated his mission, and it is assuredly not the manner in which he would have had it supported. The truth is that as yet the sum total of knowledge concerning the causes of many of the ante-natal conditions which give us anxiety is limited, and that more effective lines of treatment can only be the product of further knowledge and of more experience in its application. This observation notably applies to the toxaemias of pregnancy, which afford, as a whole, a very complex biochemical problem, toward whose solution much intensive effort is now being directed. I was deeply interested to hear, for instance, in the course of a lecture recently delivered by Sir Frederick Gowland Hopkins, the distinguished President of the Royal Society, before the Cardiff Medical Society, that there is some hope of the identification of a certain vitamin which may be proved to play an important part in the toxaemias, and in the capacity of resistance to infection. But some of the day-to-day ante-natal problems lie much nearer to the surface than these biochemical delvings, hopeful and imperative though they be.