Robert Boxall
1893 The Lancet  
ASSISTANT OBSTETRIC PHYSICIAN TO, AND LECTURER ON PRACTICAL MIDWIFERY AT, THE MIDDLESEX HOSPITAL. Current views mt deat7t-rate of childbirth. -The mortality of childbirth has of recent years been considered mainly from a hospital standpoint. The monographs of Sir W. O. Priestleyl and Dr. Cullingworth are instances in point. They have shown how in lying-in hospitals (where but a few years ago the mortality was so grave that demands were actually made for their extinction) it has been possible
more » ... as been possible both in this country and abroad to reduce the death-rate to a point even less than that of obstetric practice generally. In these institutions puerperal fever now and again caused frightful havoc and always remained a fertile source both of illness and of death. To a diminished mortality under this head the greater part of the improvement is due. It is clearly traceable in the main to the adoption of antiseptic measures. But even where the principles of asepsis and antisepsis were from the outset recognised the full benefit of the recognition of these principles was not immediately felt, for the means adopted were at first somewhat crude and often little calculated to meet the exigencies of the case; however, as the outcome of increased experience in the use of antiseptics in obstetric practice still further improvement has since been effected ;3 for, in addition to a diminishing mortality, septic processes have now been all but completely eliminated from the category of illness in childbed. This, I repeat, is a matter of hospital experience ; yet, as the result apparently of such observations, an impression has gained currency that the improvement has been widespread and has affected the childbirth mortality in the country at large. Recently a medical colleague, in his capacity of physician to I an assurance society, appealed to me for facts bearing on the decreased mortality of childbirth, particularly as regarded puerperal fever. The society, in view of the supposed declension in puerperal mortality during the last ten or twenty years, had in contemplation a remission of the extra 1 per cent. which had hitherto been levied on women expecting the first confinement. For this purpose the statistics of lying-in hospitals and maternities were obviously ill-adapted ; but, having at hand more extended data, I was able to give the desired information almost immediately. I must confess that the result came upon me at first somewhat as a surprise. Further, several physicians, when aked for their views on the matter, though unable to afford direct information on the point, one and all expressed a decided opinion affirming a widespread decline in the mortality from puerperal fever during the last decade at least. I have also heard the same remark received without question in a medical debate. The object of this communication is to correct this erroneous impression and to arrive at the true facts of the case. The assurance offices, as the result of independent research amongst their own statistics, have arrived at identically the same conclusion as that to which my own observations point. Statistical data.-Of illness unattended with a fatal result no statistical record on a sufficiently extensive basis is at the present moment available and though by the Infectious Diseases (Notification) Act of 1889 means have lately been provided for the collection of evidence with regard to puerperal fever, yet the doubts which on all hands exist as to what should and what should not be included in that category, particularly in the lighter forms of the disease where the illness does not terminate fatally, nec( ssarily serve to render any such return less complete than could be desired. But of mortality ample evidence exists in the reports of the Registrar-General. The statistics for a lengthened term of years, both for England and Wales and for London, are accessible and deal with sufficiently large numbers to eliminate the disturbing element of chance.
doi:10.1016/s0140-6736(00)65008-0 fatcat:sbtwhhlcgrfcrelq6ivodh37zi