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Other Work.
In the foregoing observations I have not included the actual carrying out of the repairs to the
property of the Local Authority nor the question of collection of rents.
Repairs.—The Council would probably require that the actual repairs to their property should
be carried out by their Works Department. If not, it would be the duty of the sanitary inspector
estate manager to secure tenders for the carrying out of the work under his supervision. At the present
time all repairs to houses required by notice served from the Health Department must be carried out to
the satisfaction of the Sanitary Inspector.
Collection of Rents.—With regard to the collection of rents, the local authority would probably
require this to be carried out through the Finance Department of the Council as at present.
Estate Management Generally.
I have not included in the foregoing statement some matters which, in my opinion, should
also be the concern of the estate manager. I refer particularly to the general amenities of housing
estates, such as, the erection of sheds and the keeping of animals. An estate manager should also
have a knowledge of the various agencies which exist to assist people who may fall on bad times,
including public assistance and pensions. But while these matters are important, a knowledge of
them can be acquired in a comparatively short time by any person of normal intelligence, but the
care of house property, which after all is the fundamental matter, requires considerable knowledge
and experience and I know of no one better able to provide that knowledge and experience than an
officer trained as a sanitary inspector.
APPENDIX I.
Submitted to the Hospital Sub-Committee on the 3rd January, 1935.
REMOVAL OF MATERNITY CASES.
MEMORANDUM BY THE MEDICAL OFFICER OF HEALTH.
This enquiry was instituted at Manchester on account of the death of a maternity patient
who was transferred to an ambulance for removal from one hospital in Manchester to another, within
an hour of her delivery in the first hospital. Death occurred in the second hospital about nine hours
after admission thereto.
In their report the Inspectors of the Ministry of Health state that in their opinion death was
due to the condition known medically as delayed obstetric shock, and that the fatal issue was neither
caused nor materially affected by her transfer from the one hospital to the other. Nevertheless they
make certain recommendations with regard to the administrative arrangements which I would advise
the Council to accept generally for purposes of the administration of their Maternity Hospital.
(1) Every effort should be made to reduce the number of transfers to other hospitals.
(2) At least one hour after delivery should elapse before transfer to an ambulance unless the
doctor in charge otherwise decides.
Note by Dr. Buchan.—In the case under consideration this refers to transfer from
one hospital to another. In a few cases to which the Council's ambulance is called the
patient is delivered before the arrival of the ambulance.
I am of opinion that the same rule as to time should also apply to this latter
type of case, and that the midwife with the ambulance should not in any circumstances
have the case removed, if she has any doubt whatsoever that the condition of the patient
is not quite normal.
(3) Before transfer to any hospital of a patient who has recently been delivered of a child,
nourishment should be supplied to her unless a medical direction to the contrary is
given.
Note by Dr. Buchan.—This should also apply to the patient whose child was born
before the arrival of the ambulance, and who is subsequently removed into the Maternity
Hospital.
(4) A midwife of experience should accompany the patient in the ambulance.
(5) Where a patient is transferred to another hospital, immediate information of the transfer
should be transmitted by the hospital from which she is transferred by telephone to the
police on duty in the locality, by whom the message should be delivered to the relatives.
(6) Notes as to the condition of the patient on transfer should be completed on the case sheet,
and a copy of this form, with any further relevant notes, should accompany any maternity
patient on transfer to another hospital.
(7) When thorough cleaning is in progress the number of beds available is, of necessity,
restricted, and the pressure of this limitation is increased in proportion to the number
of emergencies with which the Hospital may be called upon to deal. Overcrowding in
maternity wards and over-pressure of staff cannot be countenanced because of the everpresent
danger of septic infection.