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By Michael J O'Dowd; Elliot Elias Philipp

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Sample text

At th a t tim e, th e p rin cip a l causes o f p e rin a ta l mortality were docum ented as m aternal toxaemia, a n te p a rtu m h a e m o rrh a g e , d ifficu lt lab o u rs, congenital m alform ations and p rem ature birth. It was later recognized that o th er factors such as rhesus isoim m unization and teratogenic drugs were also involved (H ibbard, 1988). In the 1940s D ugald B aird, P rofessor o f Midwifery at A berdeen University in Scotland, H ISTORICAL OVERVIEW n o ted the association o f low social class an d poor n u tritio n w ith hig h o b stetric a n d p e rin a ta l mortality.

They included low m olecular w eight chemicals, horm ones, enzymes, naturally o c c u rrin g a n tib io tic s , p la n t a lk alo id s a n d cytokines. C horiocarcinom a was the first danger­ ously m alignant disease to yield to chem otherapy. T he drugs being used by 1970 were am ethopterine (m ethotrexate), m ercaptopurine, actinomycin D, and vinblastine. They had all been used sepa­ rately, in com bination or sequentially. T he drugs were dangerous because they depressed bone m arrow function, causing a fall in leukocyte and platelet counts and sometimes also dim inished erythrocyte form ation.

By the 1990s medical m alpractice claims had becom e a multi-million p o u n d ‘industry’. O ne response o f the profession was to en g ag e in defensive m ed icin e. T he realization th at obstetrics an d gynaecology was a high-risk area fo rced m any p ra c titio n e rs to ab a n d o n estab lish ed positions o r prom ising careers in the profession (Varian, 1991). Gynaecology Cancer Cervix T he earliest form o f cervical cancer was described by R udolph Virchow in 1858 and Jo h n Williams in 1886 (Ricci, 1945).

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