Preventive Medicine and the Practice of Obstetrics

As Central Government, Hospital, and Local Government Health Services are now developing simultaneously in Northern Ireland (surely a somewhat unique circumstance), it might be deemed a suitable time for this study of preventive practice in midwifery. And it might be asked-Can there be a lot to talk about? We have first-class teaching maternity hospitals in Belfast, with an extremely low maternal mortality rate, a comparative immunity from infection in the nurseries of maternity wings throughout the Province, and an overall maternal mortality rate of 1.9 per one thousand live births for 1947. For the year 1947 the two large maternity hospitals in Northern Ireland-the Royal Maternity and the Jubilee Hospital (dealing largely with complicated cases)-returned maternal mortality rates of 4 per one thousand total births (approx.). During the year 1948 there were only two maternal deaths in the Royal Maternity Hospital, both of which were due to causes associated with pregnancy! There is a great deal for us to think about, however, in the matter of provision of maternity schemes generally, both in and out of hospital. For a study of any breadth and consequence one must rather shamelessly invade the territories of the obstetrician, the physician, the bacteriologist, the general practitioner, and the medical officer of health. There is much of interest in an article entitled "The History of the Belfast School of Obstetrics, 1793-1933," by Professor C. H. G. Macafee.27 Much that is in this paper illustrates the truth of the impression often gained by the student of these matters, namely, that, in common with many another worthy project, the maternity services have developed in the face of oft-recurring opposition and petty obstruction. This is not a fact pertaining to Northern Ireland alone. The Belfast Lying-in Hospital, the early predecessor of the present imposing building, was one of the oldest maternity hospitals in the British Isles, being the sixteenth to be founded between 1736 and 1799. This original hospital (first proposed in 1793) possessed six beds. The training of nurses was first accepted only in 1879, and we are told that Professor Burdon, who played a large part in the development of obstetrical practice in Belfast, "during his eighteen years as professor, accomplished much in the face of narrow-minded opposition." But as a curious anomaly, though many difficulties had been thrown in the way of the obstetricians by the physicians of the times, it was, amongst others, due …