London's Pulse: Medical Officer of Health reports 1848-1972

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Kensington 1937

[Report of the Medical Officer of Health for Kensington Borough]

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Maternal Mortality.
There was an unfortunate rise in the maternal mortality rate for the borough from 0.9 per
1,000 in 1936 to 3.3 per 1,000 in 1937, seven women having lost their lives as a result of pregnancy
and childbirth during the year. The rate for England and Wales was 3.2. Three of the Kensington
deaths occurred among the class who normally seek attention at welfare centres, and four belonged
to the well-to-do class.
Of the three deaths of women belonging to the class for which provision is made by the council's
services, one followed a septic abortion in a widow; the fear of social stigma in this case had caused
the patient to conceal her condition and subsequently had prevented her from consenting to
admission to hospital until she was dangerously ill. The second case was a woman who had received
very careful ante-natal supervision on account of poor health which had occasioned much anxiety
to the council's officers ; the mother herself had expressed the conviction that she would not survive
the confinement. As a result of the care received during pregnancy the woman's physical health
and mental attitude greatly improved, and the labour was normal, the patient saying that she had
made a better recovery than she had from her previous confinements. It was arranged that she
should receive advice on contraception, and the apparently safe issue of this case was a subject for
congratulation when the patient developed an inflamed varicose vein and died suddenly and unexpectedly
from an embolism, a month after labour. The third death was from toxaemia of
pregnancy and occurred in Yorkshire. This woman had lived in Kensington after she married and
had subsequently lived with her mother in the north ; although the death was referred to Kensington
the responsibility for her confinement did not rest on the council's services.
Both the maternal deaths which occurred in 1936 were above-standard patients and the number
of maternal deaths among the well-to-do during 1937 is remarkable when one considers the relatively
smaller number of births belonging to this class. The number of deaths among the mothers for
whom provision is made by the council was three in about 1,700 births, giving a maternal death
rate of 1.8 per 1,000, which is probably near the irreducible minimum, but among the well-to-do
class there were 4 deaths in about 400 births, giving a rate of 10 per 1,000. Three of the four deaths
were due to toxaemia of pregnancy.
An unusually high proportion of pre-eclamptic toxaemia was seen in the council's ante-natal
clinics during 1937, and in several cases prompt treatment was necessary in order to save the woman's
life. The cause of the condition is still obscure but there seems little to uphold the view that it is a
deficiency disease, and the evidence appears to support the old-established theory that it is the
mothers on more liberal incomes and diets who are principally affected.
Of recent years there has been so little pregnancy toxaemia in the borough that the following
figures for 1937, as seen in the ante-natal case records, may be of interest. Forty cases of preeclamptic
toxaemia were encountered; fourteen additional cases showed a rise of blood pressure
during their pregnancy but although kept under careful supervision did not develop the symptoms
or signs of toxaemia and so have not been included in this series. Of the forty cases twenty-four were
successfully treated by dietetic measures at home; sixteen were more severe cases and were admitted
to hospital for treatment. Of these sixteen cases seven needed an operation for the induction of
premature labour on account of the kidney condition; three of the seven infants were stillborn but
every mother recovered. One woman, in whose case labour was not artificially induced, had an
eclamptic convulsion during labour, but both mother and child eventually did well. The onset of
the toxaemic condition was almost invariably heralded by a preliminary rise in the patient's blood
pressure before other signs appeared. The necessity for frequent estimations of the blood pressure
during the last two months of the pregnancy is urgent since toxaemia is one of the main causes of
maternal mortality, and it is of the utmost importance that when midwives are unable to carrv
out this test themselves they should refer their patients to an ante-natal clinic. It is satisfactory
to report that the midwives employed by the London county council are likely to work in close
connection with the clinics and will encourage their patients to make use of the safeguards for their
life and health provided by the council's services.
Apart from the incidence of toxaemia the routine organisation of the ante-natal clinics has
worked smoothly and uneventfully throughout the year. Ante-natal work has become an exact
science and the confidence which experience has given to the medical staff when all tests are found
normal is imparted to the expectant mother. The importance of this feeling of confidence on her
part is difficult to over-estimate. Many of the difficult confinements are not physical but psychological
in origin, and it is surprising to note how many labours are rapid and easy when the woman's
mind is at rest regarding the normality of her case.
Routine Wassermann and Kahn tests carried out in the clinics show a percentage of 1.8 positive
cases during 1937 (17 out of 934 tests performed) compared with 2.2 per cent. in 1936. Treatment
was arranged for every expectant mother who gave a positive test, and the kind co-operation and
assistance of the staff of the special department of the West London hospital has ensured that this
treatment is given with the least possible inconvenience and the greatest consideration of the feelings
of the mother. One may hope that when this line of treatment becomes general throughout the
country it may result in the disappearance of congenital syphilis.
A confidential enquiry into the incidence and causation of abortion in the borough was made
during the early part of the year, and the report upon this subject (the information in which is
being treated as strictly confidential) has been sent for the consideration of the Inter-departmental
Committee on Abortion, who invited the medical officer of health and the senior medical officer in
the maternity and child welfare department to give evidence before them.