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have a blood specimen taken. This specimen is examined for
determination of the Rhesus factor, while a Kahn test is also
performed. These represent additional safeguards which may well
prevent a tragedy.
Every infant death is fully investigated, in the hope that
preventable circumstances, should they have occurred, can be
eliminated. Such investigations are extremely useful, as they
enable us to form a detailed, over-all picture of the causes and background
of infant deaths within the Borough. We have also arranged
to participate in a national survey connected with Maternity and
Child Welfare, designed to assess the factors which influence the
health of mother and infant. It is only by the accumulation of such
knowledge and the application of the knowledge so acquired that
we can hope to reduce still further the infantile mortality rate.
Later in this report I will emphasize the need for more home visiting.
Maternity and Child Welfare is essentially a service which should
be centred in the home. Until we can be absolutely certain that our
Health Visitors have adequate time to devote to home visiting, we
cannot truthfully say that the steps which we are taking to protect
infant life are as good and as comprehensive as we would wish them
to be.
Stillbirths.—Thirty-one stillbirths, (0 illegitimate) were
accredited to the district for 1947. This is equal to a death rate of
24.27 per 1,000 (live and still) births, the corresponding figures for
1946 being 31 stillbirths, with a rate of 24.92. The rate per 1,000 of
the population was 0.417, the rates for England and Wales and
London being 0.50 and 0.49 respectively.
The stillbirth rate is still unsatisfactory. The associated factors
are inextricably bound up with the causes of infantile mortality
and, in my opinion, should be considered as a single entity. Antenatal
supervision (with which is included investigation of the
Rhesus factor) remains the foundation upon which our preventive
work should be laid. The future of this preventive work when the
Regional Hospital Boards assume at least partial responsibility
in July, 1948, is at the moment somewhat nebulous. It is to be
hoped that the closest possible liaison will be maintained with the
local Health Department; there is no reason to believe that this will
not be the case. For the time being we must continue our work along
the lines which have produced so much improvement during past
years.
Maternal Mortality.—The maternal mortality rate, i.e., the
number of mothers dying as the result of childbirth per 1,000 total
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