MATERNAL MORTALITY.

Otago Daily Times, Issue 19203, 20 June 1924, Page 8

MATERNAL MORTALITY.

ELECTORAL SYSTEMS.

TO TUB EDITOR. Sir, — Several loiters have appeared in .your paper lately on the subject of maternal mortality, criticising the methods used at St. Helens Hospitals and making statements about them which are not according to fact. For example, one correspondent says: “I see that regret is expressed that very few women t.vail themselves of the privilege of ante-natal clinics; no woman expecting her first, or even her twelfth, child cares to go into intimate details of her condition with, say, a ymuig girl who knows nothing beyond knowledge received from charts and diagrams.’ I should like to ask this correspondent to which St. Helens Hospital in New Ze.a land she refers'.' I know of none to which such a■ remark could possibly apply. What St. Helens Hospital has at the present moment for its medical superintendent, “A young girl who knows nothing beyond knowledge received from charts and diagrams”'! This correspondent must verify her facts before appearing in print, even if it entails a visit to the registrar s office lor a peep at birth certificates. Dr Agnes Bennett and myself are the only two women in charge of St Helens Hospitals; both of ■ us are middle-aged (though, perhaps, sorry to confess it), and both of us flatter ourselves that we certainly do possess a little knowledge beyond that received from charts and diagrams. We have both been in charge of our respective hospitals for close on 18 years, a.nd have entire charge of the ante-natal clinics, supervising the health of every woman who cares to apply to us from the day she knows she is pregnant till full term. Owing >to this system of close observation we are ixmtimially enabled to reclifancl treat both minor complaints and more npuh complications. Frequently patients are brought in for a week’s treatment at any time throughout the pregnancy.' Ihe clinic is open to all women, whether they desire to be confined at St. Helens or privately, but, though extensively used and appreciated by our owm patients advantage of it is not much taken of by the patients of private doctors. This is natural, as every doctor prefers to do his own supervismig of hi s own patient, but the Health Department made the clinic open to all, so that no woman could say she could not afford to present herself regularly to her medical attendant for supervision throughout her pregnancy when, of course, lees have to bo paid. . , , , . This same correspondent would like to see “medical practitioners who are also mothers” in charge of these hospitals. There, is a prickly problem! When a woman marries, the Government and tne whole male population howl at her it she dares to continue to' earn her living, and so take the bread and butter out, ot the mouths of married men who have-wives and children to keep. Tdo know medical women who have refused marriage in order to continue their medical career without their work being looked at askance by then mule confreres, and I also know medical women who, being married, prefer to look after their own homes, husbands, and children and And it quite sufficient too. I do not think medical women would care to face the opprobrium involved ing mothers without the incubus of a busied so once again I sky youv oorrespondent touches on a pnckly problem ! Another correspondent, a married doctor, criticises ihe St. Helens, system without knowing facts. She ine^ t °.. l four main points m this svslcm. iio ono of which is accurate. YVhy do people go into print without knowing tneir facte? I can only speak for the . Dunedin . t. Helens Hospital, not knowing how I ti e others are conducted. Her first point is that “all cases save the most complicated shall be conducted by a midwife only. In correction, 1 say, “All cases a™ those with even the most trivial complication arc conducted by a midwife cny Every complication._ no matter how trivial Is immediately referred to me ’ and my advice >s sought. Second point; “No anaesthetics of any kind shall be administered at any stage ot labour, unless a doctor is summoned ior a midwifery operation.’ Let me correct. Neither chloroform nor ether may be given without a doctor’s presence, and quite rightly so, as they aro dangerous anaesthetics, but morphia and hyoseme (so-called twilight sleep) are constantly administered in suitable cases, the details of the case, end the condition of the patient being referred to me on the telephone, and my consent or refusal being given accordingly. After administration, the patient is never left for a minute without the,matron or sister watching her. Fh© experience of these trained sisters is, therefore, fuller m this respect than that of many doctors who give the anaesthetic and then go on their rounds. 1 think everyone will agiee that these are very careful precautions; Third point: “Stitches, if required for lacerations, shall be inserted by the sisters without any anaesthetics, the patient being hold down'during the process.”' Let mo correct. Under no'circumstances, except, perhaps, for the most trivial abrasion occurring during my annual holiday, has a stitch, for oven the smallest laceration ever been inserted by a sister, or even the matron. 1 have attended to that porson- ■ ally in every case, my discretion being used as to whether an anaesthetic shall bo administered or not. Fourth point: “If there is any remote prospect of tho patient delivering herself she shall be left unaided in labour as long as three days. Only when God, Nature, and the widwito fail, shall tho doctor be summoned.” Tho facie ■ aro these: , Apart from contracted pelves which are discovered before labour and treated accordingly, complications begin only in tho second stage, and if this lasts longer than a few hours, ■ without quick and satisfactory progress, I am at once called to assist Many of these trained matrons and sisters aro more skilful in detecting complication early than inexperienced doctors. Thus a close arid skilled observation is kept on ©very patient, and at the slightest sign of a complication, or undue delay, my advice is Sought and given. Our nurses also arc veiy. carefully , trained to detect such complications early, so that when they go into, practice they may report all such to the doctor in charge. Thus this correspondent’s four main points of what she calls the St. Helens system' fall to the ground. Tho question of giving anaesthetics more frequently has been discussed by the department, but it is a question of pounds, shillings, and pence; the country’s finances are at a low ebb; it requires either special fees for every ease in which an anaesthetic is administered only for the relief of pain and not because of a complication, or else tho extra salary for a resident medical officer. This lady also wants tho Government statistics of mortality, etc. These were available to hor if she had sought the information. They arc published annually in the Government Gazette. I can give her the Dunedin ones; not for the last 10 years, but for the 18 years in which the hospital has existed. Out of over 4000 cases there were 11 deaths, os follow Sepsis, 2; acute yellow atrophy, 1; hemorrhage (following long present heart disease), 2; eclampsia, 2 (both brought in moribund); pneumonic influenza (during epidemic), 2; phthisis (of old standing), 1; ruptured appendix (as diagnosed by post mortem examination), 1. These statistics compare more than favourably with tho general New Zealand statistics, and I think the Government is to bo congratulated on having instituted such fine hospitals. Certainly a fnll-limo medical officer, with a salary of £IOOO a year, would get over some of the difficulties met with in this system, instead of a part-time officer at less than one-sixth of that. Until tho country is rich enough to afford that, no improvement on the present system (as correctly slated by me) can be instituted.—l am, etc., Emily IT. Siepeberg.

TO THE EDITOR. Sir. —You conclude your leading article on “Electoral Systems” thus: "There are valid objections to the formation of the huge constituencies that would bo necessary if the system were to be applied to country districts, and. though we have no desire to be regarded as endorsing the Government’s proposals, we suggest that the idea of testing the system of proportional representation in urban constituencies is not without its recommendations.” Admitting the test could bo made most conveniently in the urban constituencies, what would be the object of the feat? Would it be with the view to its permanent, adoption in urban constituencies only, or to its adoption in both urban and rural constituencies? If the former, then the Labour Party is right in objecting; if the latter, how is the test in the, city constituencies going to be of any value in regard to its application to country constituencies, where (he hugeness of the constituencies ie the great objection? In the event of proportional representation being tried in urban constituencies, are yon prepared to support, as an offset, the abolition of the country quota? I think this would be a fair teat of disinterestedness, as no party has a right to an advantage in the country, while desiring full represents!ion in the cities,—l am, etc., Voter. fWc are ccrtainlv not concerned about the maintenance of the country quota.—En. O.D.T.]