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37
was merely an administrative problem. One need only recall
the mistaken attitude towards ante-natal work which, prosecuted
by an improvised personnel, has almost assuredly done
more harm than good by leading to unnecessary interference
with normal cases."
When the Royal College of Obstetricians and Gynaecologists
issued their Report in 1945 on a National Maternity Service, the
maternal mortality rate had approximately halved in ten years ;
but the writers of the report considered that the improvement had
been associated much more with advances in general medicine than
with any improvement in obstetric practice. This, if correct,
disproved Holland's prophecy of ten years earlier. The damning
criticism in this Report of ante-natal clinics maintained by local
authorities may be fairly considered to have influenced the pronouncements
in the National Health Service Act, 1946, on this
subject. What the immediate effect on the Service will be after
July 5th, 1948, is not clear—possibly none—but it is at any rate
plain that those Maternity and Child Welfare Officers who, like
myself, have been doing this work the past 20—30 years, will
continue to do ante-natal clinics only on sufferance until we are
replaced by something brighter and better. It would seem, therefore,
a good time to do a little stocktaking.
Leyton is one of the extra metropolitan municipal boroughs
which come within the Greater London area. It is largely an artisan
neighbourhood with surprisingly good mortality rates. Thomas
(1946) in a description of Croydon's obstetric services compared the
maternal mortality, still birth rate and neo-natal death rates for
six years in Croydon with the rates for England and Wales. In
Table 1 I have shown these averages and added the Leyton figures
for the same years :—