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The Problem of Compulsory Notification of Puerperal Septicemia
MATERNAL WEI, FARE
MosHER, GEORGE CLARK,
M.D.:
263
The Problem of Compulsory Notifica-
tion of Puerpera.l Septicemia. Current .American literature contains practically no expression of opinion in regard to compulsory noti1lca tion of puerperal septicemia. No conclusive report on the working of the law was elicited by inquiry sent to boards of health in the states requiring notification. Questionnaires sent to officers of national medical and other interested organizations and a number of leading obstetricians and teachers in medical schools brought replies stating more or less definite opinions and furnish· ing information in regard to the situation. The gist of 16 replies from obatetriciaDB, of 5 from state executives, and of one from a city executive is given. The opinions for and against compulsory notification and the exacting of a penalty are almost evenly divided, so far as deiinitely expressed. It is concluded that if notification is to be required the wording of the law should be considered with regard to the varied conditions that may cause pyrexia. The two main weapons for reducing the mortality due to puerperal septicemia are: 1. Education. The obstetricians who now are in the schools and hospitals must he taught the fundamental principles of asepsis; and prospeetive mothers must learn to demand good care. When women realize that childbearing can be made safer, a powerful public sentiment will be arou~red that can be utilized in redueing puerperal mortality. 2. Publicity. This affects the general praetitioners now doing obstetric work and treating all sorts of suppurating wounds, erysipelas, and other virulent inleetioDB and rushing from the patient with temperature to the clean maternity patient and seldom ehanging their clothes or using sterile gloves in the delivery. Publicity furnishes the only means of impressing upon these men that a woman dying from puerperal septicemia after such needless exposure is doubtless a victim of earelessness or ignorance. It is not to be argued that compulsory notllleation will in itself achieve anything marvelous, and a punitive clause may not aid greatly; nevertheless the publicity coming from notification would make the physician who now scorns the extra precautions urged for the lying-in patient realize that to continue work in his community he must change his tactics even if no other penalty is to follow. Every available means must be used to reduce puerperal sepsis whether or no we resolve that it al10uld be made reportable. We must urge the medical schools to glve due place in the curriculum to prenatal care, to management of normal labor, and especially to asepsis. We should institute a further campaign of education through state boards of health, state and county medical societies, health eenterH, and lay organizations having as its aim better maternity conditions.
MosHER, GEORGE CLARK,
M.D.:
263
The Problem of Compulsory Notifica-
tion of Puerpera.l Septicemia. Current .American literature contains practically no expression of opinion in regard to compulsory noti1lca tion of puerperal septicemia. No conclusive report on the working of the law was elicited by inquiry sent to boards of health in the states requiring notification. Questionnaires sent to officers of national medical and other interested organizations and a number of leading obstetricians and teachers in medical schools brought replies stating more or less definite opinions and furnish· ing information in regard to the situation. The gist of 16 replies from obatetriciaDB, of 5 from state executives, and of one from a city executive is given. The opinions for and against compulsory notification and the exacting of a penalty are almost evenly divided, so far as deiinitely expressed. It is concluded that if notification is to be required the wording of the law should be considered with regard to the varied conditions that may cause pyrexia. The two main weapons for reducing the mortality due to puerperal septicemia are: 1. Education. The obstetricians who now are in the schools and hospitals must he taught the fundamental principles of asepsis; and prospeetive mothers must learn to demand good care. When women realize that childbearing can be made safer, a powerful public sentiment will be arou~red that can be utilized in redueing puerperal mortality. 2. Publicity. This affects the general praetitioners now doing obstetric work and treating all sorts of suppurating wounds, erysipelas, and other virulent inleetioDB and rushing from the patient with temperature to the clean maternity patient and seldom ehanging their clothes or using sterile gloves in the delivery. Publicity furnishes the only means of impressing upon these men that a woman dying from puerperal septicemia after such needless exposure is doubtless a victim of earelessness or ignorance. It is not to be argued that compulsory notllleation will in itself achieve anything marvelous, and a punitive clause may not aid greatly; nevertheless the publicity coming from notification would make the physician who now scorns the extra precautions urged for the lying-in patient realize that to continue work in his community he must change his tactics even if no other penalty is to follow. Every available means must be used to reduce puerperal sepsis whether or no we resolve that it al10uld be made reportable. We must urge the medical schools to glve due place in the curriculum to prenatal care, to management of normal labor, and especially to asepsis. We should institute a further campaign of education through state boards of health, state and county medical societies, health eenterH, and lay organizations having as its aim better maternity conditions.