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In two of the above deaths, however, an avoidable factor must be presumed. One new-born
infant which was found at Victoria Station had been asphyxiated by its umbilical cord, whilst a
five-month old infant perished from asphyxia in a fire.
From the causes of death it is apparent that the greatest remaining problems are the incidence of
prematurity, especially in unmarried mothers, and severe congential abnormalities.
(See Analysis of causes of infant deaths, Table 2, page 67.)
MATERNAL MORTALITY
It is regrettable to have to record that there were two maternal deaths in Westminster during 1969;
there were no such deaths in the City in 1968. Comparative statistical rates are set out in the General
section of this report, page 67.
Both these maternal deaths were associated with abortion.
In one case, a married woman of 37 years, therapeutic termination of pregnancy (associated with
sterilisation) was carried out in a teaching hospital. Unfortunately, an infection developed leading to
death from suppurative bronchopneumonia.
The second death related to a young single woman of 20 years who had undergone a criminal
abortion which lead to the development of septicaemia. This patient was admitted to hospital but
unfortunately died notwithstanding intensive treatment.
THE ROLE OF THE DEPARTMENTAL MEDICAL OFFICER
Nine full-time medical officers undertake child health work in clinics, day nurseries and schools
and they are assisted by twelve part-time medical officers.
As far as possible, the medical officers work in defined areas, thereby becoming acquainted with
the local mothers, the health visitors, the voluntary workers and the general practitioners.
In the child health clinics, the medical officers' main duties are to undertake developmental
screening of all children at regular intervals and to immunise the children. Subject to parental
consent and provided there is no contra-indication in the child's health, the course of immunisation
recommended by the Department of Health and Social Security is completed.
The health visitor is responsible for the social and educational work of the clinic and for advice
on infant feeding and general management. But many problems of management, behaviour and other
maternal anxieties are brought to the doctor's attention for more detailed investigation and advice.
Early psychiatric problems may be detected and sympathetic listening and support can be of immense
benefit. Both developmental examinations and counselling interviews are time-consuming and
require experience, skill and enormous patience.
Medical officers, as far as possible, see their patients by appointment and by limiting the numbers
seen at each session, ensure that adequate time is available for each.
The purpose of developmental screening is to identify deviations from the normal at an early stage.
Identification must be followed by action. Children with suspected defects of hearing or vision are
referred to the appropriate specialist department of hospitals for diagnosis and treatment. Those with
orthopaedic defects, herniae, cardiac murmurs and enlarged tonsils are referred to the family doctor
for any action he considers appropriate. However, the commonest condition either suspected or
found is developmental retardation. Delay in locomotor development with or without clumsiness
may make one suspect cerebral damage. Mental retardation or delay in speech may be due to
emotional factors or to an unstimulating deprived environment (which is not uncommon in cases
where the child is cared for by a succession of people other than his mother) or it may be an indication
of mental subnormality.
The Council's medical staff, both full-time and part-time, bring very great clinical skill and
judgment to this aspect of their work. It is a field in which they excel and one in which many hospitalorientated
doctors are not yet fully conversant.