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The Pamphlet Collection of Sir Robert Stout: Volume 77

Three Serious Diseases

Three Serious Diseases.

I wish now to consider briefly three classes of disease the study of which would help to diminish our death-rate. I refer to puerperal fever, phthisis, and cancer. It ought to be possible to reduce the mortality from puerperal fever to a minimum. The number of deaths which resulted from puerperal fever in 1902 was registered as twenty-five in number. Although this does not seem to be very high, it does not in any way indicate the number of women who have been invalided more or less for life as the result of disease brought about by septic infection. In order to minimise as far as possible the amount of disease to which women are liable at childbirth, it is necessary that every woman about to be confined should be given the opportunity of placing herself under the care of a duly qualified and registered nurse. It is, unfortunately, at the present time in New Zealand impossible for any woman to qualify as an obstetrical nurse; she has to go either to Melbourne or Sydney or to Great Britain to obtain the necessary certificates. This entails a much greater expense than most women can afford. An effort should therefore be made to establish either in one or in all the four principal centres of the colony a school for the instruction page 10 of women in obstetrical nursing. For such a purpose it would be necessary either to build a special hospital for the benefit of the poor, or to convert such a home as we have now in Wellington—namely, the Alexandra Home—into an obstetrical hospital. The maintenance of such a hospital might be borne partly by fees paid by the patients, by the fees charged to the nurses for the course of instruction, by public subscription, and possibly the addition of a subsidy from the Government. The period of instruction should be at least twelve months. There should be weekly lectures given by medical men, and daily lectures by a qualified matron. These nurses, before receiving a certificate, should attend at least ten cases in the hospital, and ten cases under medical supervision in private houses. They should also be taught the care of infants, especially relating to the causes and treatment of infantile diarrhoea. The examination of these nurses might very well be held at the same time as the examination of the ordinary medical and surgical nurses, which is held yearly under the Government Nurses' Registration Act. By having thoroughly trained obstetrical nurses, who would have been taught all the more recent methods of guarding against the possibility of septic infection, the dangers immediate and remote attendant upon childbirth would be very materially lessened, and the mortality of new-born infants markedly decreased.

At this point I would like to call attention to the practice among women of artificially feeding their infants, and I feel it my duty as a medical practitioner to state that the natural feeding of the child by the mother does undoubtedly conduce to the health of both. Nor can I abstain from referring incidentally to the subject which at the present time is occupying the attention of all thinking people—that is, the decreasing birth-rate of the Australasian Colonies. The birth-rate in New Zealand in 1903 was 20.61 per 1,000 of population, which shows that in New Zealand there is a very good margin over the death-rate. An ex-haustive report has within the last week been prepared by a Commission specially set up in New South Wales to inquire into the subject, and there seems to be no doubt that if an effort is not made to divert the inclinations of the people from unwholesome channels page 11 the sacredness of the marriage-tie will be jeopardized and the very existence of the race threatened. It is a matter which requires the earnest consideration of both the men and women of our race. So soon as a people begin to consider their own selfish ends to the exclusion of the well-being of the community as a whole it follows that in the end the race must surely suffer; and, moreover, interference with functions that are natural to the body must produce deterioration and disease, and such dreaded diseases as melancholia and other forms of mental disease and cancer.