25

11.—31

If we study this graph and consider it along with Dr. Brenkman's remarks we are bound to agree with his inference that, while more can be done in Amsterdam in the way of teaching, training, and helping the mothers to rear and safeguard their children after the first month on some such lines as ours, New Zealand has everything to gain by giving earnest consideration to the lead of Holland and other countries, which have brought down their maternal-mortality rate to less than half our rate, and. possibly as low as a third ; and have apparently reduced their " infantile-mortality rate in the first month " to about half the New Zealand rate.* The following extract from a recent editorial in the journal Maternity and Child Welfare is highly suggestive : —i Maternal Mortality in Childbirth. During the last twenty years the mortality of mothers in childbirth (English) has remained almost unchanged. There was, indeed, during tho years 1920-21 a menacing rise in the maternal-mortality rate. . . . In two American cities the death-rate of motherless babies proved to be three times and five times as great as for babies with mothers. Wo simply must prevent this lamentable loss of lifo and energy. . . . One thing seems fairly certain—that there is a definite connection between hurried midwifery and sepsis. The midwife is bound by her rules to stand by during the whole of the third stage of labour : the busy practitioner is often inclined to save time and trouble to his patient and himself by quickening this stage of labour. A correspondent sends us the following comparison : Maternal mortality is highest in the United States, in Australia, in Canada, and, till a year or two ago, in Scotland, whore there are practically no midwives ; it is lowest in Denmark, Italy, Germany, Russia, and Holland, where the midwives deliver nearly all normal cases. * Dr. L, H. Watt, Acting Deputy Director-General of Health, has drawn my attention to the following remark in the admirable report of over one hundred pages on "Maternal Mortality,". by Dr. Janet Campbell, Senior Medical Officer for Maternity and Child Welfare, Ministry of Health (Great Britain), just published by the Department. Dr. Campbell says, under the heading " International Comparisons " — "We may consider briefly a comparison between the mortality-rate in England and Wales and that of other countries. The difficulty of direct comparison is that in some countries —for instance, France, Holland, and Spain— the annual statistics of live births exclude not only births of infants who never had a separate existence —still-births in the ordinary sense of the word —but also the births of children who, although born alive, did not survive beyond a certain number of days, and whoso births were not registered before death. Consequently, the ratio of deaths in childbirth to total live births, deduced from the statistics of those countries, overestimates their rates of maternal mortality in comparison with our own, because the divisor in our case includes a number of births which would be excluded from their divisors. It is also possible —in some instances even probable —that neither the record of maternal deaths nor that of births is as exhaustive as in England and Wales. This criticism, however, assuredly does not apply to Holland, nor, probably, to Italy. . . . The general sense of this brief and summary international comparison is plainly to confirm the impression derived from an historical retrospect —viz., that our national position in this matter is unsatisfactory." In a table comparing the English maternal-mortality rate with tho European figures Dr. Campbell says, in a footnote concerning Holland, " Their heading ' Still-born ' covers a certain number of births which would be registered as live births in England and Wales, so that the Dutch rates of maternal mortality are slight overstatements [taking the English statistical basis]." Seeing that the English maternal-mortality rate is only 39 per 1,000, compared with New Zealand's 50 per 1,000, our position is more than unsatisfactory. But this is accentuated by the fact that the Dutch rate should be given as below 2 per 1,000 for direct comparison with England or New Zealand. It may be assumed, therefore, that the Dutch maternal-mortality rate is in reality only about a third of ours — not two-fifths, as shown in the above table. On the other hand, the Dutch " rate of infantile mortality in the first month " should be shown higher, for comparison with ours : probably they lose more than half as many babies as New Zealand in the first month —not less than half, as shown in the table. However, the important point to note is that Holland's infantile mortality in the first month has been practically reduced to a half in the course of the last twenty years, while ours has remained stationary. On the other hand the Dutch registered total infantile mortality (viz., 47) is too low for comparison with our 42 per 1,000; it 'should be, say, between 50 and 60.

4-H. 31.