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

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London County Council 1946

[Report of the Medical Officer of Health for London County Council]

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Maternal deaths—

Deaths due to pregnancy or confinement31
Deaths associated with pregnancy, etc.10
Total maternal deaths41
Maternal mortality per 1,000 total births1.88
Other deaths—
Confined before admission4
From abortion12
„ ectopic gestation3

Emergency
obstetric
service
Considerable use has been made during the year of the emergency obstetric
service which is now operated from the majority of the Council's hospitals with
maternity units. The object of the service is to provide in a patient's home in an
acute obstetrical emergency not covered by the service of consultants maintained
by the Borough Councils, nor by the medical aid which a midwife is required by the
Central Midwives Board to summon in emergency, a hospital unit equipped to
provide all necessary treatment and staffed by doctors and nurses experienced in
obstetrics. The unit is summoned by a district midwife or a doctor in charge of
the confinement telephoning to the London Ambulance Service headquarters, the
unit being brought to the patient's home by ambulance. The service was originally
started in 1938, but considerably increased in use during the latter years of the war.
During 1946, a total of 61 calls was made, covering 17 metropolitan boroughs,
and being answered from 10 of the Council's hospitals. Eleven calls came from the
borough of Wandsworth, and 10 from Lewisham. Eighteen of the total calls were
answered by St. James's Hospital, and 11 by Lewisham Hospital, Hammersmith,
Hospital, with 9, being the next highest. Parts of the county north of the River
Thames, comprising the City and the boroughs of Finsbury, Shoreditch, Holborn,
St. Pancras and Islington, are not included in the Council's scheme, their emergency
needs being covered by University College Hospital and St. Bartholomew's Hospital.
Of the 61 calls, 46 were made by the Council's own midwives, by midwives
employed by district nursing associations and similar bodies, or by independent
midwives; eight calls were made by doctors, and four were from nursing homes.
In the remaining three it is not clear from the information available who made the
call. In 45 the patient was subsequently admitted to hospital.
The majority of the calls were to patients where post-partum haemorrhage
had occurred (43 cases), the next most frequent cause being retained placenta.
In 39 cases a blood transfusion was given to the patient. Out of the 46 calls made
by midwives, medical aid had been summoned prior to the calling of the emergency
service in 31 instances.
It will thus be seen that in a majority of the cases a blood transfusion was
required for a patient who had had a severe haemorrhage, but the service has also
dealt with other serious obstetrical emergencies, and it is, doubtless, true to say that
a considerable number of patients owe their lives to the skill and promptness with
which the emergency service was provided.
During the year 1946, it became apparent that, especially in those parts of
London remote from the centre, and where it was formerly not easy to obtain the
best obstetrical aid in a sudden emergency, the knowledge that the emergency
service was available was being widely spread among general practitioners, with
a resulting considerable increase in the service which the emergency units were
able to render.
Chronic
sick
hospitals
The number of patients in the chronic sick hospitals at the beginning of the year
was 2,243. This rose to 2,455 on 27th November, 1946, and the number remaining
at the end of the year was 2,448.