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17
London-a very special district-1.66 and the working class Borough
of Stepney (2.42). Both Hampstead and Lewisham with the lowest
rates of infant mortality of the metropolis had higher maternal
mortality rates than Shoreditch (with the highest rate of infant
mortality).
Maternal mortality does not seem to bear much relation to
the percentage of married women engaged in extra-domestic duties.
In the Metropolitan Boroughs, the lowest mortalities are in those
districts which have the highest percentage of married women
engaged in some extra-domestic occupation. In last year's
report, figures were given showing the position of Acton in this respect.
The relationship between these two factors has been discussed,
but no definite conclusion can be drawn. Certain kinds of
employment may be harmful. The nature of the work may be
such as to exert a harmful effect upon pregnancy and child-bearing,
as, for example, certain processes necessitating the use of lead; or
the work may involve heavy lifting or abdominal strain or pressure,
as in some operations in the tinplate industry or in weaving.
In Acton there is no work which can be considered directly
harmful. In spite of changes, the industry which employs most
of the married women is the laundry industry, and in no part of the
process are there conditions which can be regarded as directly or
indirectly harmful.
The effect of general sanitation and housing upon maternal
mortality is not quite obvious. A sanitary wholesome dwelling
is of obvious importance at the time of confinement, quite apart
from its effect upon the general health of its inmates. One would
expect the incidence of puerperal infection to be high under conditions
of overcrowding, defective lighting, ventilation and drainage.
In point of fact, insanitary conditions appear to have a less
injurious effect upon maternal mortality than might be supposed.
Domestic uncleanliness and lack of facilities and conveniences add
enormously to the difficulty of applying effectual antisepsis and to the
risks of operative procedure. Hence, in abnormal labours, every
endeavour should be made to remove the patient to an institution
before attempting instrumental delivery.
It is desirable to refer to the clinical cause to which the
majority of deaths are attributable, but it is important to lay
emphasis upon the fact that the actual deaths form only a part, and
perhaps a comparatively small part, of the whole problem of maternal
mortality and morbidity. For every mother who dies, there
are many more who are injured more or less seriously, more or less
permanently. These preventable sequelae of child-bearing cannot
fail seriously to reduce the health and capacity for work, to say
nothing of the comfort and happiness of many working class women,
and the elimination of such causes of sickness and disability is
of little less importance than the reduction of the mortality.