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practice a much higher standard must be aimed at. By far the greater
proportion of maternal deaths is due to sepsis and this, so far as
extraneous sources are concerned, is preventible. It was recommended
that a greater supply of highly trained midwives should be available
and that the midwifery training of future medical practitioners should
be considerably improved. The study of midwifery and its practice
should be regarded in the schools as certainly no less important than the
courses in medicine and surgery. It is becoming clear that none
but the simplest operative procedures in obstetrics should be done
in poor homes. For anything requiring considerable manipulation or
surgical methods, patients should be placed in suitable institutions
where strict antiseptic principles can be enforced. Even then no great
advantage will be gained unless difficulties are diagnosed early and the
patient admitted to hospital at once. The cases which go wrong in
hospital are usually those which have received considerable interference
before admission. In these days midwifery is a science to be practised
by experts. To allow a handy woman to interfere with a lying-in woman
is as much a crime as to permit her to attempt a surgical operation.
It is extremely important that there should be in every district an
adequate number of maternity beds in an institution where skilled help
is available. In the City, towards the end of the year, it was reported that
there was a difficulty in obtaining sufficient accommodation for women
who desired to have their confinements in hospital. The question as to
the provision of maternity beds is a matter which will engage attention
during the next year.
The Maternity and Child Welfare services of the Council remain as
described in the report for last year. During the year visits were paid
to the Council's centres and to that of the Westminster Health Society
by a medical inspector from the Ministry of Health. The Ministry in
referring to the inspector's report expressed appreciation of the maternity
and child welfare services of the Council and commended the work of
the Council's officers and those of the Society.
The question of rheumatism in all its forms has evoked particular
study during the year. In some districts special clinics have been set
up with the objects of discovering rheumatism in childhood in its earliest
stages. It is during childhood and early adolescence that the seeds of
the most disabling effects of rheumatism are sown. The large and
increasing number of deaths in later life from valvular disease of the
heart is due almost entirely to acute rheumatism contracted in childhood.
In very young children the disease may be very insidious in
onset, appearing in the form of recurring tonsillitis or "growing pains"
or slight forms of St. Vitus dance. If such cases could be detected at the