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and health visitors would become trained to a point where they would no longer need
to work with the support of a child psychiatrist, may need to be modified and a continuous
service through permanent case conferences may take its place.
(r) Early diagnosis of congenital deajness—Medical officers working in child welfare
clinics see 88 per cent, of infants born in the County (page 142 above), and thus have a
unique opportunity to screen babies for congenital handicaps. This is perhaps peculiarly
true of congenital deafness. In 1957 Mr. J. C. Ballantyne, f.r.c.S., consultant otologist
to the Council, and Dr. Mary Sheridan, m.d., d.c.h., medical officer, Ministry of
Health, were invited to train medical officers in screening tests of the hearing of young
children. Some 30 medical officers have attended these courses and by the end of
1959 it is expected that all medical officers in the Council's service will have had the
opportunity of studying these techniques. The importance of the standardisation of tests
has not been overlooked. Every maternity and child welfare centre has been equipped
with the 'Stycar' testing set designed by Dr. Sheridan. Medical officers have been asked
to train health visitors not only to refer babies known to be at risk but also to help to
carry out screening tests at the centre. All cases of suspected deafness are being referred
to the divisional otologist or to Mr. Ballantyne. The youngest child for whom a hearing
aid and auditory training have so far been prescribed was four months of age.
In the 10 years under review the infant mortality rate in the County has fallen from
31 per 1,000 in 1948 to 23 per 1,000 in 1958. This figure compares favourably with the
national figure of 26 per 1,000. Much work however remains to be done. The application
of the newly discovered tests for errors of metabolism may help us to tackle the problem
of hereditary and familial diseases. Screening tests for the early diagnosis of congenital
handicaps are being developed to meet the needs of the handicapped child under two
years of age. In the field of preventive mental health only the first steps have been taken.
Peri-natal mortality remains a challenge.
Domiciliary midwifery
The domiciliary midwifery service underwent no fundamental change as a result of
the coming into force of the National Health Service Act, 1946, except that it became a
free service. The Council had employed salaried midwives since 1938 and had entered
into agreements with hospitals and district nursing associations to continue district
practice. This structure of the service has been maintained through the last ten years
and remains centrally administered.
In 1949 there were 16,090 home confinements—5,573 more than in 1958. The
number reached its lowest level in 1955. The decline in the general birth rate up to and
including 1955 relieved the pressure on hospital beds and the proportion of domiciliary
confinements fell, staff being reduced accordingly: from 1956 onwards the birth
rate has risen but although there has been an absolute increase in domiciliary confinements
these still represent a smaller proportion of total births. In 1949 the Council's
140 directly employed midwives carried a case-load of 58. In 1957, in spite of new
responsibihties in ante-natal care 87 midwives carried a case-load of 71. The lower caseload
in 1949 is perhaps explained by the fact that the Council's policy then was to offer
an alternative choice of midwife to each mother so that Council midwives practised in
the same areas as midwives employed in district nursing associations and hospital districts.
Shortage of woman power now makes this pohcy impracticable
Ante-natal
services
The main changes brought about by the Act nave been the closer integration ot the
domiciliary midwifery services with the maternity and child welfare, home help and
other health services; with the general practitioner service through the maternity medical
services and with the hospital maternity and paediatric units. All midwives, including
most of those employed in District Nursing Associations, now do their ante-natal work
in the centres. There are the obvious advantages of the better facilities than could be
provided formerly in the home of the midwife and the fact that the midwife is brought
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