The Treatment of Severe and Persistent Uterine Haemorrhage by Radium
Authors: S. Forsdike
Journal: BMJ (1926)

_I: MEnCL JOUi:AL fair'ly well.Wliat we 'Want to kniow is the cause of the Cu1((dginous valriety.If this could b)e (liscovered we might reduice mia.lterinal mortalitv by ole-third.This is ani object upon whliel expenidituire is W'ortth whvliile.The savinig of 1.100 wvomnell's Jives is nao small matter.fth.The -exi'stinig -organlizationi of mi-Jidwifory is miior-e oi lss ehaotic, anid there is a lack of cohesion bettween the loc.al authorities oni the onie lianid .andmiiedical practi- tioiiers and imiidwives oni the other.The miiidwife cani call in any doctfo she thiniks fit.He mav) be experienced or .maylnot, anid thlere is nio adequiate supervision by thie medical l)rofession of the miiidw-ifery service as a whole.Panlels of medical piractitioiel s specially-experienced in miidwifer-v shlouild be set u1p, and except in cases of emer- e-nicv the miiidw-ives shiould be restricted to thice mlembers of these l)aliels.Each patieiit shlouldel be seen byv a mehlical practitioner at least once clUuring.hier-prleginanlcy.There shoild also be attachied to every paniel one or more specialists whose opinion could be sought iMl cases of exceptional difficulty-.Every e.l-ase of death iM (childlirth-should be r-eported anid investigateid, so as dlefiiitelv to ascertain the cause alid whlethier the treatimenit has been as it shiould.Ante-aid p)ost-liatal clinies anid clilld w-elfare cliniics should be co-ordiniated.More beds shiouldl( he provided for difficult cases, and arri angements maide to l)as.s on from the ante- uatal clilics those women whose conifineenients are likely to he difficult.Cases of sepsis should miot be treated in fever hospitals, buit in open-air isolationi wiards of materniity hospitals.That the miiortality rate is excel)tionially Iiighi in sparsely populated( districts proves the advantages of skilled and pronipt attenidance.Steps shiould(I be takeni to remedv these conditions by a more comnirehen sive system of administra- tioni; anid here againi the value of anilt-natal work is apparent.If every expectanit mothe-}r-were to p-.seint lherself for anite-natal examination by a meidical pr-actitioiner, arrangemients could be made, eveni in sparsely popiulated areas, to provide hier with the necessary assistance.In coiciliusion, let nme say that tle, Ae is no occasion for despondence, but every reason for hope.Statistics are dangerous things.For instance, tlhe .Scottishl figures are ost depressilig, sholwiing as tiey (10) that (leathis from ptuerperal cauises iii Scotland have inicreased sincee 1855 from 4.9 to 6.2 pcei 1,000 births.I do lnot believe that these figures accurately shlow the stiite of affairs.I cainnot bnelieve thiat more w%vomen (lie froml (chil(hbirth to-day in Scotlanid than in 1855.These figures depend on classifica- tioIl :-ld know-ledge on the part of the medicalattendant.Eveni in an obstetric lhospital we find( it (iffictilt to tabulate tihe diseases of p)reginanc, notw-ithistanding an elaborate c steii of cross-indexinig.This applies particularly to 'venereal diseases.These miatters demand uIr-genit practical attenitionl.What- ever criticism there may be oni eitliei' side, w-e all liave the same object in view.We are all ainxious to imiprove tile Ji(ldwifery service and to save hI1umai11n lives.