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meet all requirements. In Westminster the consultant and pathological
services provided by the City Council are very rarely called for; as soon
as a patient shows evidence of morbidity she is notified by the doctor
attending and removed to the special London County Council hospital.
In 1934, 13 cases of puerperal pyrexia were notified and removed to
hospital; puerperal fever cases numbering five were notified and all
were likewise removed to the London County Council hospitals.
By agreement with the three district nursing associations operating
in Westminster the City Council provides, at the request of doctors,
nursing in their own homes of cases of illness occurring before and after
confinement. Generally speaking, the requests are made for the less
serious illnesses, e.g., breast inflammation, and mainly come through the
welfare centres. As indicated above, morbid cases after confinement are
removed expeditiously to the London County Council special hospitals,
while those occurring during pregnancy are admitted to the voluntary
hospitals and to the London County Council general hospitals.
There are two contributory factors, the exact significance of which
must first be appreciated before conclusions can be drawn as to the ri^k
of childbed in districts such as Westminster.
(1) The abnormally low birth-rate. To make this point clear, an
analogy in infantile mortality in certain wards of Westminster must be
quoted. In 1929, in the Strand ward, with a population of 2,116, there
were only three babies born; one of those died of prematurity. This
gives an infantile mortality rate of 333 per 1,000, a figure which at first
glance and by itself might be held to indicate conditions of ignorance,
squalor and poverty. As a matter of fact, as regards standards of housing,
social conditions and maternity and child welfare services, there are few
better in the country. Again, if one of those three mothers had died in
childbed the maternal mortality figure would again have been 333 per
thousand, a figure easy to misinterpret until studied on the basis of the
abnormally low birth-rate.
(2) The factor of illegitimacy has been commented upon by Sir F.
Menzies, the County Medical Officer of Health, in his annual report, and
likewise the fallacy of including maternal deaths from abortion in making
a calculation based on the number of births. In Westminster there is a
high illegitimacy rate. With illegitimacy are associated attempts at
concealment of birth and abortion with all its dangers. This is a not
inconsiderable factor in maintaining a high maternal mortality rate.
Mo3t women in such circumstances eschew ante-natal clinics, make no
arrangements for their confinements, practise furtive methods too often
ending in conditions which no amount of skilled treatment can overcome.