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National Society for the Prevention of Cruelty to Children are utilised, whilst for the elderly the City
of Westminster Old People's Welfare Association and Task Force are the main agencies. There are
many others to whom the City Council owes it gratitude—Paddington Charitable Estates, Marylebone
Health Society and Westminster Amalgamated Charities make financial grants to suitable cases
recommended by field staff. One of the duties of the Health Department's Principal Social Worker
(Miss J. McFarlane) is to arrange case conferences to coordinate the field work of statutory and
voluntary agencies, to prevent overlapping and to ensure that the most appropriate help is provided
for every family in need.
The City Council has a duty to provide facilities for students of all kinds to obtain some insight
into community services. Owing to the number of teaching hospitals and educational establishments
in the area there is a great demand for training and for visits of observation. Post graduate doctors,
medical students, student nurses, social work students and student teachers either in groups or as
individuals apply for instruction and field experience. It is extremely difficult to meet all their requirements
with the limited staff available. With the increasing attention being paid to community medicine
and social care a stage of saturation has been reached and the Department is having to refuse or
limit the attendances of some groups.
There are also local or national surveys in which the Council is asked to participate—the pilot
scheme, survey and follow up of the British Births survey 1970, the rubella survey, the Inner London
Education Authority's spina bifida research project, are examples. Although the organisation and
statistical analysis is the responsibility of the bodies concerned, most of the collection of data is
undertaken by Health Department field staff. Participation in research is considered to be of the
utmost importance and is willingly undertaken; but the demands upon individual members of the
staff are very heavy.
It can be claimed that the services for mothers and young children (with the possible exception of
nursery school services) are second to none and that they are well used by the majority of the
population.
There is, however, a proportion of residents in need, for medical or social reasons, who do not
know of or do not wish to avail themselves of the existing services and in future every endeavour will
be made to redress this.
INFANT AND CHILDHOOD DEATHS
With a decline in the number of births a decrease in the number of infant deaths was to be expected,
and this is confirmed by the figures (Table 2, page 64). Fifty eight children under one year of age
died during 1970, compared with 65 in 1969. This still produces an infant mortality rate of 21, which
is higher than the national average (18) but compares favourably with the 22.42 infant mortality
rate in Westminster in 1969.
It is also satisfactory to note that the infant mortality rate for illegitimate infants is 27 for 1970,
as against 39 in 1969.
98.5 per cent, of births took place in hospitals or nursing homes and only 1.5 per cent (43) were
born at home. The total number of stillbirths was 25, giving the very low stillbirth rate of 9, compared
with the figure of 13 for England and Wales. However, the neonatal mortality rate of 16, which is
higher than the national average, must be associated with the low stillbirth rate.
Forty four children died during the first month of life and 40 of these occurred during the first week.
Thirty-two of these infants were premature and died despite expert care in special units. Four of
the early deaths were due to congenital abnormalities incompatible with life. Twin infants who had
died of inhalation asphyxia were found at Marylebone Station. Most of these neonatal deaths can be
regarded as inevitable and can only be prevented when the causes of prematurity and congenital
abnormalities are fully understood. Our attention should therefore be focussed on the post neonatal
deaths, those occurring between the second and twelfth month of life.
Fourteen children died in this period of life, six of them from severe congenital abnormalities,
although all received expert care and treatment. One baby of eight months died from overwhelming
infection associated with hypogammaglobulinaemia. Another of four months died from septicaemia
and meningitis. Both parents of this child were drug addicts, but the care of the infant, undertaken
by the grandmother, was excellent. A tragic death from gastroenteritis occurred in a baby of eight
months, living under adverse social conditions. The father was in prison and the mother and baby
were living part of the time with the grandmother. They were not in touch with the family practitioner
and help for the baby was obtained too late to save life.