London's Pulse: Medical Officer of Health reports 1848-1972
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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
London County Council 1950
[Report of the Medical Officer of Health for London County Council]
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50
major causes of prematurity is not surprising. In spite of the tendency for all twins
to.be delivered in hospital, there were 38 in this total series—some were undiagnosed,
and in some cases the mothers refused hospital confinement. Age and parity do not
appear to have any effect on the gestation period. Only one mother was over 45, and
one under 16 : 21 had had 5 or more nrevious confinements and one had had 15.
Details as to concurrent conditions are given below :—
| Primiparae | Multiparae | Total | |
|---|---|---|---|
| Twins | 4 | 34 | 38 |
| Toxaemia | 8 | 14 | 22 |
| Ante-partum haemorrhage | 1 | 9 | 10 |
| Influenza or other general ill | — | 9 | 9 |
| ness. | |||
| Wassermann reaction positive | 1 | 1 | 2 |
| Moving house | — | 2 | 2 |
| Hopping | 1 | 1 | 2 |
| Fall | — | 1 | 1 |
| Fibroids | 1 | — | 1 |
| Double uterus | — | 1 | 1 |
| Pyelitis | — | 1 | 1 |
| External version | — | 3 | 3 |
| No special possible causal | 60 | 233 | 293 |
| feature observed. |
Ante-natal
care
A few of the cases were unbooked emergencies, some had booked so late in
pregnancy that only one or two attendances at the clinic were possible and others had
failed to attend for ante-natal examination. 10 primiparae and 38 multiparae had
inadequate or no ante-natal care.
Gestation
period
Dates as given by the mothers are never regarded as being very reliable. According to these :—
| Primiparae | Multiparae | Total |
|---|---|---|
| Under 3£ lb 6 | 23 | 29 |
| 3½-4½lb | 52 | 64 |
| 4½-5 lb 13 | 86 | 99 |
| 5-5½ lb 48 | 176 | 224 |
| 416 |
Weights
Domiciliary
care
The management of each individual case was left to the discretion of the doctor
or midwife. Generally premature babies were not bathed at birth or for some days
afterwards. They were not fed for the first 24 hours, after that time feeds of glucose
water or expressed breast milk were given. Most of the larger babies were able to
suck and could be put on to 3 hourly breast feeding. The midwife continued to attend
each case for 28 days, or until the infant was well established.
Breast
feeding
It is satisfactory to find that it appears to be as easy to establish breast feeding
in the premature as in the normal baby. In 1950 94 per cent. of all domiciliary
midwives' cases were discharged entirely breast fed. Out of 300 premature babies
who survived 269 (90 per cent.) were entirely breast fed. In the cases which were
transferred to hospital, out of 75 infants who survived 56 (75 per cent.) were entirely
breast fed. These babies included the smaller, feebler and most immature. There
was also the added difficulty that the mothers were often not admitted and had to
exnress their milk and take or send it to hospital dailv.
Neo-natal
mortality
The following table shows the maturity and weights of the 192 infants under
5 lb. As might be expected the chance of survival of a small baby is related to the