H.-31.

The accompanying graph shows the variations in the maternal mortality-rate for the five-year period following special activities of the Health Department to promote maternal welfare. Before discussing the results shown in the graph, it will be. an advantage.to consider the history of this special activity. In 1921 a committee of the Board of Health inquired into the question of the high maternal mortality-rate in New Zealand and the means of reducing it. Following upon an outbreak of puerperal sepsis in the Kelvin Hospital the Kelvin Hospital " Commission was set up to consider the influence of such maternity hospitals upon puerperal sepsis and to make recommendations with regard to eliminating the risk. Efforts were at once made by the Health Department to put the recommendations into effect, and, as a further effort, in.1924 Dr. H. Jellett was appointed Consulting Obstetrician to the Department, Dr. T. L. Paget, Inspector of Private and Maternity Hospitals, and Dr. Elaine Gurr, Officer in Charge of Ante-natal clinics. The following action was taken : The Private Hospital Regulations were redrafted, the following being the main alterations :— Registers with temperature charts which are required to be entered twice daily were issued to all maternity hospitals. Notification to be given by the hospital licensee to the Medical Officer of Health whenever a case of puerperal pyrexia occurred, and isolation required for such cases as well as cases of morbidity. Disinfection of rooms and equipment used by such patients to be carried out to satisfaction of the Medical Officer of Health before being put to further use. The necessary details were furnished to the licensees. The details of personal disinfection, for any nurse attending such cases before resuming duty were prescribed. The maximum number of patients to be nursed by each midwife and maternity nurse was stipulated. Approved apparatus for sterilizing dressings, utensils, &c., as part of the equipment of every hospital of five beds or over was required. The Midwives Regulations were also revised, the main features being an attempt to secure freedom from infection by the establishment of a standard aseptic technique and the reduction to the minimum of internal examinations and manipulations by midwives and maternity nurses. In 1925 the Nurses arid Midwives Registration Act was passed. This Act places the control of training and registration of midwives and maternity nurses in the hands of a Board consisting of the Director-General of Health, the Director, Division of Nursing of the Health Department, together with representatives of the medical and nursing professions and of the Hospital Boards. The Act provides for the registration of all midwives and maternity nurses, and makes it illegal for any unregistered woman to engage in practice as a maternity nurse except in cases of emergency or under special certificate from the medical practitioner attending the case. Under the direction of the Consulting Obstetrician to the Department, an improved scheme of training for midwives and maternity nurses was adopted. This, together with pamphlets on the general principles of maternity nursing, the aseptic technique and management of labour and the puerperium, and instructions for the disinfection of nurses and hospitals after the occurrence of sepsis, created a uniform standard in the methods of nursing and in the precautions to be taken to prevent the occurrence and spread of sepsis. These methods were taught in training schools and introduced to all maternity hospitals and to practising midwives under the instructions of the Inspector of Hospitals, Medical Officers of Health and Nurse Inspectors. To the Inspector of Hospitals fell the duty of visiting all the private maternity hospitals in the Dominion (some 250 in number) with the object of coordinating the work of Medical Officers of Health and Nurse Inspectors and bringing these. hospitals up to the required standard. Very few of these hospitals had the necessary equipment for sterilizing dressings, basins, bedpans, and other utensils. In the few cases where the sterilization of dressings and utensils was carried out. the sterilized articles were frequently stored in unsterilized biscuit-tins on shelves and tables covered with unsterilized 'cloths or, still worse, were stored on shelves in cupboards under sinks alongside unsterilized bed-pans in sink-rooms where these foecally contaminated articles were emptied and washed. So-called sterilized water was often kept in unsterilized jugs. Bed-pans and chambers were insufficient in number, and were taken round from patient to patient for panning purposes after being roughly cleaned with a mop not kept in disinfectant and admirably, though unintentionally, designed to spread sepsis to other patients in a hospital if a case of sepsis occurred or was admitted. These numerous means of spreading sepsis had to be eliminated, and an idea of what asepsis meant and how to carry it out introduced to hundreds of midwives and maternity nurses, many of whom had had no training. Incidentally, many medical men regarded the practice of asepsis as, at best, a desirable ideal impossible of attainment, and not a few were politely scornful. Finally, the majority of maternity hospitals were brought up to a fairly good standard and a few which did not attain the necessary standard were closed. The Officer in Charge of Ante-Natal Clinics was engaged in training nurses for ante-natal clinic work and organizing and conducting public ante-natal clinics in connection with the St. Helens Hospitals and various branches of the Plunket Society ; also in publicity work regarding the benefit of this branch of obstetrics to the expectant mother.

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