A British Medical Association Lecture on FORETHOUGHT IN MIDWIFERY
Authors: W. H. F. Oxley
Journal: BMJ (1933)

After a study of the immediate and underlying causes of death in 5,800 cases of childbirth the Maternal Mortality Committee reported that at least half could have been prevenited had due forethought been exercised by the expectant mother and her attendant, a reasonable degree of skill been brought to bear upon the maniagement of the case, and adequate facilities for treatment been pro- vided and utilized.This statement, made to Parliament by a committee composed exclusively of doctors and including among its members professors of midwifery and general practitioners, after an exhaustive inquiry covering many aspects of the subject, is one which the profession can hardly pass over in silence.The first clause especially requires examination, for the doctor's main function in the whole range of medicine is surely to apply his know- ledge of disease in forecasting danger to his patients and so to ward off or delay -the event of death.The statement that this primary function is not being performed con- stitutes a most serious indictment of the midwifery prac- tice of those practitioners concerned. FORETHOUGHT IN GENERAL MEDICINELet us consider for a moment the scope of forethought in general medicinie.The ideal way in which this can be applied is in preventing disease from attacking individuals, and so far as parasitic infections are concerned a fair degree of success has been attained by segregating in- fected persons, destroying the causal agent, conferring immunity, or by increasing the general resistance of the population.But it is only a few diseases which can be prevented in this way.Beyond giving general hygienic advice we can do nothing to prevent a healthy person from becoming attacked by cancer or bronchitis or arterial degeneration maladies which together account for nearly half the deaths in the country.We have therefore been forced to extend our conception of preven- tive medicine to include the early diagnosis of disease after it has attacked the patient, in the hope that early treatment may effect a cure.This is the everyday work of the doctor, which he is doing to the best of his ability against great odds.Very little is known of the origins of disease, the attention of the student being directed to the diagnosis of established disease rather than to its early signs and symptoms.The complaints for which a doctor is consulted can very often not be assigned to any definite ailment.Attempts to sort out from the many symptoms that are due to fleeting indispositions the few that may betoken serious illness are not very successful.Many disorders give rise to no symptoms in their early stages, and in the absence of periodic examinations are not found out until too late.Years may elapse before the doctor can check his prognostications by the actual result: these and a dozen other circumstances often com- bine "in proving foresight may be vain."It is the medicine of the future.Sir James Mackenzie, who spent his life upon this quest, appreciated these difficulties, for shortly before his death he said: " I must warn you against any immediate expectation of achieving the chief aim of medicine, the prevention and cure of disease.A long and weary road has to be travelled, and many of as will fall out before that is achieved."