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20
The attendance at our Clinics was excellent; foods especially
essential to mothers and young babies and vitamin containing
products had a larger sale than ever before; foster children were
visited regularly; our midwives attended more confinements, and
more dental treatment was asked for and provided than in previous
years.
It will be seen that our midwives attended at no less than 987
cases during the year. Each midwife attended on an average 82
cases. This figure is much too high and one I hope to be able to
reduce during the year 1943. I would add, however, that this is
but a hope. It is extremely difficult to-day to obtain the wholetime
services of competent midwives.
The Enfield infantile mortality rate at 46.78 per 1,000 live
births is higher than last year though it is nevertheless 2.22 below
the infantile death rate for England and Wales, which at 49 per
1,000 live births, was the lowest ever recorded. Some analysis of
the Enfield figure is helpful.
The number of children under the age of one year who died was :
1939. 61 out of 1756 live births. Infant mortality rate 35.07
1940. 67 „ „ 1607 „ „ „ „ „ 42.53
1941.53 „ ,,1463 „ „ „ „ „ 38.12
1942. a3 „ „ 1774 „ „ „ „ „ 46.78
The point to note is that we were unfortunate in 1942 in
that we lost 14 children with congenital malformations. This can
only be looked upon as bad luck ; there is no known method of preventing
such conditions. This figure compares with 9 in 1939, 7 in
1940 and 6 in 1941. Apart from this, prematurity accounted for
no less than 22 deaths, a figure which compared with 21 for 1939,
16 for 1940 and 12 for 1941.
It will be seen that the increase in our infantile mortality rate
is due to two main factors, foetal abnormality over which we have
no control: the other, prematurity, the cause of which is little known.
I have not found it possible to attribute it with any certainty either
to work during pregnancy, to diet or to standard of living.
Another factor of importance is that of the 83 children who
died before they reached the age of one year, 39 died in the first
week of life and 58 before they were a month old. The death of
36 of these is accounted for, however, by the two factors previously
quoted.
I have often been asked why women are having children in
larger numbers than in previous years. I have already suggested
that confidence in victory is one reason. This, however, is somewhat
negative for possibly the position would be more correctly
stated were I to say that the number of births might have decreased
had there been any doubt as to the outcome of the War. Another
way of seeking the answer must be found, and I think this is the