Puerperal Streptococcal Septicaemia

Abstract

Puerperal Streptococcal Septicaemia SIR,-I welcome the excellent letter of Dr. W. D. Allan in the Journal of October 12th on the question of the apportion,ment of the blame for those cases of puerperal deaths which from time to time all practitioners of obstetrics see. The lay press, taking their cue from some of our leading gynaecologists, have for too long been harping on the theme of the uneducated and negligent general practitioner-and midwife. I have personally conducted over 1,600 confinements in every social class and in every kind of environment. This may not be a vast experience, but it has confirmed me in the unalterable opinion that the fons et origo of puerperal disasters is in the already potentially infected woman herself, or in some other anatomical or biochemical latent disability inherent in her constitution. My experience is exactly the same as Dr. Allan's and countless other practitioners'. I have had, many a time before the district where I practise was supplied with midwives, to carry out difficult obstetric procedures on unclean women on filthy beds alive with fleas, helped by a direct lineal descendant of Mrs. Gamp, the floor area almost completely occupied by the large double bed, one guttering candle, and a limited supply of hot water. Results? A normal puerperium, and the mother well and hard at work in a fortnight. The opposite picture need not be sketched. The incidence of sepsis and other post-natal troubles are evenly divided between the two classes. No, Sir, these clerics and elderly ladies are barking, in chorus up the wrong tree. If these anxious and bewildered committees on maternal mortality wish to see the death rate in childbirth reduced to nil, there must be compulsory attendance of all women of marriageable age at clinics where conception control (to use Lord Horder' s more accurate term) is taught and practised with a view to eliminating those cases which are clearly unfitted to become mothers owing to hereditary or acquired defects, and also in order to regulate the spacing of births. Those women passing the conception control room would then be periodically investigated biochemically and bacteriologically and treated accordingto the findings' before a pregnancy were permitted-a measure, I grant you, unattainable for many generations perhaps and savouring of Mr. Aldous Huxley's brave new world. But this is an appeal, with Dr. Allan, to our honest and generous specialists in obstetrics to uphold -to the public the prestige of us general practitioners who bear the heat and burden of the day and who are no more to be blamed for deaths in childbirth than for deaths from cancer.-I am, etc.,