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Statistics published in America last May placed New Zealand in a very unenviable position as regards maternal mortality, and when this was discovered here it was exceedingly unwise to ventilate the whole question in the lay press and create exaggerated and false opinions. It was clearly a matter for immediate and thorough investigation, and, rather too late, it was referred to a Committee of the Board of Health.

First of all, as to the accuracy of the figures, the Committee is doubtful of their comparative value as regards the maternal mortality in the different countries for which figures are available, and is doubtful of the complete reliability of our own New Zealand bills of maternal mortality, but it is certain that the maternal death-rate has increased in New Zealand since the year 1914.

The Committee was not in a position to give a definite and complete answer when asked the cause of the increase, but after exhaustive enquiry, which showed remarkable fluctuations in the figures from year to year and from period to period, various causes were cited which in the present state of medical knowledge are known to increase the dangers of childbirth. The committee suggested that an investigation of the mortality figures of phthisis, pneumonia, scarlet fever and diphtheria would disclose fluctuations corresponding to those of maternal mortality, and, since the report of the Committee was published, this investigation has confirmed in a very remarkable way the anticipations of the Committee, and the graphs are very instructive.

The Committee finally made numerous recommendations with a view to reducing maternal mortality, and, if there is a better and more practical plan than the Committee’s recommendations, it has not yet seen the light of day. In this connection we had almost overlooked the didactics of a correspondent in the last issue of this Journal, who favoured us with what was styled “A Criticism of the Report of the Special Committee,” but which is more accurately a travesty, its incontinence brightened with a little lambent irony.

Our correspondent thinks that the “net result” of the Committee’s report is to give the general public “the impression the practitioners of New Zealand are on the whole rather dirty and incompetent.” How, then, does he account for the fact that public unrest on this question was allayed with the publication of the report? His assumption has no foundation in the report, as our readers can see for themselves, and is part of a reactionary and obstructive tendency in an earlier stage of obstetric reform. Our correspondent fires a fusillade of questions he wants answered about all the circumstances surrounding death from puerperal fever, and yet he objects to any official inquiries being made with a view to the compilation of statistics and the collection and collation of data. He argues as if it is the duty of a medical officer of health in a case of infectious disease not to discharge his special function, but to act as a consultant, and help clinically the medical practitioner in charge of the case. The perversity of this conception is suggestive, and akin to the principal aberration already noted, namely, that the Committee’s report brands the practitioners of New Zealand with the stigma of being dirty and incompetent.

Several instances have come to our notice in which a few doctors in New Zealand have illegally, and perhaps feloniously, refused to notify septicæmia, a refusal which might be considered “infamous conduct in a professional respect,” but it is painfully surprising to see in cold print the statement: “There will be few notifications except in cases likely to die, and every effort will be made to postpone notification as long as possible.” We have had cause to criticise the Health Department on occasion, but, if our contributor’s views are correct, the Health Department has good cause to impeach the honour of our profession. For our part we prefer not to be awakened from that pleasant dream, if dream it be, in which generally the doctors in New Zealand appear not only highly competent, but strictly honourable. It is just possible there may be a very few practitioners in New Zealand who do not exercise ordinary skill and care in their obstetric work, a possibility which the experience of the Medical Board may refute or confirm. It is difficult to follow the criticism of the report through a maze of misrepresentation and negations interspersed with the confident affirmation of a few axioms and platitudes. When any medical practitioner, knowing the exigencies of general medical practice, suggests that there is little or no meddlesome midwifery we suspect that he has his tongue in his cheek. When he suggests that sepsis hardly ever comes from without in puerperal cases, and that it is doubtful if it is carried by doctors and nurses except in the rarest instances, we wonder if we are still dreaming that we live in this century, and not in the middle of the last century.

It is easy for our correspondent, on the outlook for a bugaboo, to envisage “a rapidly increasing army of officials of the usefulness of whose ministry we may entertain some doubt,” but on investigation the army of medical officers of health is little more than corporal’s file!

The Committee on maternal mortality has great opportunity for weighing the value of documents and evidence, and has heard extreme views on both sides, on the one hand witnesses advocating that every confinement should be treated like a major abdominal operation, and on the other, there is the person who thinks that all is well and who looks upon any suggestions for improvement as an attack on the cleanliness and skill of himself or the profession, such opposition as Semmelweis and Oliver Wendell Holmes encountered. The Committee took a middle course, where truth usually is found, and confined itself mainly to general principles, leaving questions of technique for the consideration of the British Medical Association at the Annual Conference. In the investigation of cases of puerperal sepsis it is unfortunate that apparently too much stress has been laid on the use of rubber gloves, but that is a departmental matter outside the scope of the Committee, and no doubt can be easily adjusted.

If the status of obstetric work can be raised, and the fees also raised for this terribly responsible occupation, we think it will be to the benefit of the public and the profession, and we must not forget that the risk of childbirth is a public, as much as a medical question.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

NZMJ

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

Nil.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Statistics published in America last May placed New Zealand in a very unenviable position as regards maternal mortality, and when this was discovered here it was exceedingly unwise to ventilate the whole question in the lay press and create exaggerated and false opinions. It was clearly a matter for immediate and thorough investigation, and, rather too late, it was referred to a Committee of the Board of Health.

First of all, as to the accuracy of the figures, the Committee is doubtful of their comparative value as regards the maternal mortality in the different countries for which figures are available, and is doubtful of the complete reliability of our own New Zealand bills of maternal mortality, but it is certain that the maternal death-rate has increased in New Zealand since the year 1914.

The Committee was not in a position to give a definite and complete answer when asked the cause of the increase, but after exhaustive enquiry, which showed remarkable fluctuations in the figures from year to year and from period to period, various causes were cited which in the present state of medical knowledge are known to increase the dangers of childbirth. The committee suggested that an investigation of the mortality figures of phthisis, pneumonia, scarlet fever and diphtheria would disclose fluctuations corresponding to those of maternal mortality, and, since the report of the Committee was published, this investigation has confirmed in a very remarkable way the anticipations of the Committee, and the graphs are very instructive.

The Committee finally made numerous recommendations with a view to reducing maternal mortality, and, if there is a better and more practical plan than the Committee’s recommendations, it has not yet seen the light of day. In this connection we had almost overlooked the didactics of a correspondent in the last issue of this Journal, who favoured us with what was styled “A Criticism of the Report of the Special Committee,” but which is more accurately a travesty, its incontinence brightened with a little lambent irony.

Our correspondent thinks that the “net result” of the Committee’s report is to give the general public “the impression the practitioners of New Zealand are on the whole rather dirty and incompetent.” How, then, does he account for the fact that public unrest on this question was allayed with the publication of the report? His assumption has no foundation in the report, as our readers can see for themselves, and is part of a reactionary and obstructive tendency in an earlier stage of obstetric reform. Our correspondent fires a fusillade of questions he wants answered about all the circumstances surrounding death from puerperal fever, and yet he objects to any official inquiries being made with a view to the compilation of statistics and the collection and collation of data. He argues as if it is the duty of a medical officer of health in a case of infectious disease not to discharge his special function, but to act as a consultant, and help clinically the medical practitioner in charge of the case. The perversity of this conception is suggestive, and akin to the principal aberration already noted, namely, that the Committee’s report brands the practitioners of New Zealand with the stigma of being dirty and incompetent.

Several instances have come to our notice in which a few doctors in New Zealand have illegally, and perhaps feloniously, refused to notify septicæmia, a refusal which might be considered “infamous conduct in a professional respect,” but it is painfully surprising to see in cold print the statement: “There will be few notifications except in cases likely to die, and every effort will be made to postpone notification as long as possible.” We have had cause to criticise the Health Department on occasion, but, if our contributor’s views are correct, the Health Department has good cause to impeach the honour of our profession. For our part we prefer not to be awakened from that pleasant dream, if dream it be, in which generally the doctors in New Zealand appear not only highly competent, but strictly honourable. It is just possible there may be a very few practitioners in New Zealand who do not exercise ordinary skill and care in their obstetric work, a possibility which the experience of the Medical Board may refute or confirm. It is difficult to follow the criticism of the report through a maze of misrepresentation and negations interspersed with the confident affirmation of a few axioms and platitudes. When any medical practitioner, knowing the exigencies of general medical practice, suggests that there is little or no meddlesome midwifery we suspect that he has his tongue in his cheek. When he suggests that sepsis hardly ever comes from without in puerperal cases, and that it is doubtful if it is carried by doctors and nurses except in the rarest instances, we wonder if we are still dreaming that we live in this century, and not in the middle of the last century.

It is easy for our correspondent, on the outlook for a bugaboo, to envisage “a rapidly increasing army of officials of the usefulness of whose ministry we may entertain some doubt,” but on investigation the army of medical officers of health is little more than corporal’s file!

The Committee on maternal mortality has great opportunity for weighing the value of documents and evidence, and has heard extreme views on both sides, on the one hand witnesses advocating that every confinement should be treated like a major abdominal operation, and on the other, there is the person who thinks that all is well and who looks upon any suggestions for improvement as an attack on the cleanliness and skill of himself or the profession, such opposition as Semmelweis and Oliver Wendell Holmes encountered. The Committee took a middle course, where truth usually is found, and confined itself mainly to general principles, leaving questions of technique for the consideration of the British Medical Association at the Annual Conference. In the investigation of cases of puerperal sepsis it is unfortunate that apparently too much stress has been laid on the use of rubber gloves, but that is a departmental matter outside the scope of the Committee, and no doubt can be easily adjusted.

If the status of obstetric work can be raised, and the fees also raised for this terribly responsible occupation, we think it will be to the benefit of the public and the profession, and we must not forget that the risk of childbirth is a public, as much as a medical question.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

NZMJ

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

Nil.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Statistics published in America last May placed New Zealand in a very unenviable position as regards maternal mortality, and when this was discovered here it was exceedingly unwise to ventilate the whole question in the lay press and create exaggerated and false opinions. It was clearly a matter for immediate and thorough investigation, and, rather too late, it was referred to a Committee of the Board of Health.

First of all, as to the accuracy of the figures, the Committee is doubtful of their comparative value as regards the maternal mortality in the different countries for which figures are available, and is doubtful of the complete reliability of our own New Zealand bills of maternal mortality, but it is certain that the maternal death-rate has increased in New Zealand since the year 1914.

The Committee was not in a position to give a definite and complete answer when asked the cause of the increase, but after exhaustive enquiry, which showed remarkable fluctuations in the figures from year to year and from period to period, various causes were cited which in the present state of medical knowledge are known to increase the dangers of childbirth. The committee suggested that an investigation of the mortality figures of phthisis, pneumonia, scarlet fever and diphtheria would disclose fluctuations corresponding to those of maternal mortality, and, since the report of the Committee was published, this investigation has confirmed in a very remarkable way the anticipations of the Committee, and the graphs are very instructive.

The Committee finally made numerous recommendations with a view to reducing maternal mortality, and, if there is a better and more practical plan than the Committee’s recommendations, it has not yet seen the light of day. In this connection we had almost overlooked the didactics of a correspondent in the last issue of this Journal, who favoured us with what was styled “A Criticism of the Report of the Special Committee,” but which is more accurately a travesty, its incontinence brightened with a little lambent irony.

Our correspondent thinks that the “net result” of the Committee’s report is to give the general public “the impression the practitioners of New Zealand are on the whole rather dirty and incompetent.” How, then, does he account for the fact that public unrest on this question was allayed with the publication of the report? His assumption has no foundation in the report, as our readers can see for themselves, and is part of a reactionary and obstructive tendency in an earlier stage of obstetric reform. Our correspondent fires a fusillade of questions he wants answered about all the circumstances surrounding death from puerperal fever, and yet he objects to any official inquiries being made with a view to the compilation of statistics and the collection and collation of data. He argues as if it is the duty of a medical officer of health in a case of infectious disease not to discharge his special function, but to act as a consultant, and help clinically the medical practitioner in charge of the case. The perversity of this conception is suggestive, and akin to the principal aberration already noted, namely, that the Committee’s report brands the practitioners of New Zealand with the stigma of being dirty and incompetent.

Several instances have come to our notice in which a few doctors in New Zealand have illegally, and perhaps feloniously, refused to notify septicæmia, a refusal which might be considered “infamous conduct in a professional respect,” but it is painfully surprising to see in cold print the statement: “There will be few notifications except in cases likely to die, and every effort will be made to postpone notification as long as possible.” We have had cause to criticise the Health Department on occasion, but, if our contributor’s views are correct, the Health Department has good cause to impeach the honour of our profession. For our part we prefer not to be awakened from that pleasant dream, if dream it be, in which generally the doctors in New Zealand appear not only highly competent, but strictly honourable. It is just possible there may be a very few practitioners in New Zealand who do not exercise ordinary skill and care in their obstetric work, a possibility which the experience of the Medical Board may refute or confirm. It is difficult to follow the criticism of the report through a maze of misrepresentation and negations interspersed with the confident affirmation of a few axioms and platitudes. When any medical practitioner, knowing the exigencies of general medical practice, suggests that there is little or no meddlesome midwifery we suspect that he has his tongue in his cheek. When he suggests that sepsis hardly ever comes from without in puerperal cases, and that it is doubtful if it is carried by doctors and nurses except in the rarest instances, we wonder if we are still dreaming that we live in this century, and not in the middle of the last century.

It is easy for our correspondent, on the outlook for a bugaboo, to envisage “a rapidly increasing army of officials of the usefulness of whose ministry we may entertain some doubt,” but on investigation the army of medical officers of health is little more than corporal’s file!

The Committee on maternal mortality has great opportunity for weighing the value of documents and evidence, and has heard extreme views on both sides, on the one hand witnesses advocating that every confinement should be treated like a major abdominal operation, and on the other, there is the person who thinks that all is well and who looks upon any suggestions for improvement as an attack on the cleanliness and skill of himself or the profession, such opposition as Semmelweis and Oliver Wendell Holmes encountered. The Committee took a middle course, where truth usually is found, and confined itself mainly to general principles, leaving questions of technique for the consideration of the British Medical Association at the Annual Conference. In the investigation of cases of puerperal sepsis it is unfortunate that apparently too much stress has been laid on the use of rubber gloves, but that is a departmental matter outside the scope of the Committee, and no doubt can be easily adjusted.

If the status of obstetric work can be raised, and the fees also raised for this terribly responsible occupation, we think it will be to the benefit of the public and the profession, and we must not forget that the risk of childbirth is a public, as much as a medical question.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

NZMJ

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

Nil.

Contact diana@nzma.org.nz
for the PDF of this article

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