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arresting or comprehensive remedy. Much of this improved supervision will come about gradually
as the education and training of the medical student and the midwife equip them to appreciate
the importance of painstaking attention to detail as well as to understand and apply the scientific
methods of sound treatment.
" The influence on the better informed public opinion and the effect of education on the
mother herself, whether through direct instruction or the indirect effect of a readily available and
adequate Maternity Service, should also prove beneficial in securing a higher standard of practical
midwifery. It is indeed essential to preserve a due sense of proportion in dealing with this question.
It is useful and necessary to pursue our search for the causes of infection and danger along many
paths, but although valuable and helpful information will certainly emerge from bacteriological
or pathological inquiry, these results can never be wholly fruitful unless the individual care of
the patient as a whole and in every way makes steady advance. It is certain that an excessive
maternal mortality can be prevented, for in some lying-in institutions and in large groups of women
in confinement at home it is already being prevented by these very means. What is being done for
some women can and should be done for all."
Methods adopted in Willesden.
The Willesden Council had all the foregoing considerations before them in reports and circulars
from the Ministry of Health when they established their Maternity Hospital in 1931. Prior to this
date they had been active for many years in all that appertained to Maternity and Child Welfare.
A great impetus was given to their work when the Maternity and Child Welfare Act, 1918, came into
operation and in that year they opened a Pavilion for confinement cases at their Municipal Hospital.
But troublous times were ahead and this Pavilion was put out of use for this purpose and confinement
cases were sent to the Poor Law Hospital. More settled conditions, however, gradually became
established and in December, 1929, the Council resolved to convert their Smallpox Hospital at Kingsbury
into a Maternity Hospital, and this conversion was completed in February, 1931. Since then
progress has been uninterrupted and in February, 1935, the Hospital was extended to be able to cope
with 1,000 cases per annum, and now consists of:—
(1) A Labour Block with five labour and three delivery beds each in separate wards.
(2) An Ante-natal Ward of nine beds.
(3) Three Lying-in Blocks of 43 beds.
(4) An Observation Block of four cubicles.
With the opening of the Maternity Hospital by the Willesden Council in 1931 the arrangements
made for mothers entering the Hospital may be stated briefly as follows :—
(1) Ante-natal Care at the Health Centres under the supervision of the Council's Consultant
Obstetrician.
It should be noted that Health Visiting in connection with ante-natal care is essential and is
fully carried out in Willesden. The results of failure or negligence on the part of the patient, referred
to in the Interim Report, are reduced to a minimum by such visits which are designed to ascertain the
causes of the failure or negligence with a view to the necessary assistance.
(2) Hospital Confinements within the limits of the Hospital accommodation under the supervision
of the Council's Consultant Obstetrician.
In such confinements the best medical advice and the best facilities for effective medical
care are at the disposal of the patient.
(3) Post-natal Care at the Health Centres under the supervision of the Council's Consultant
Obstetrician.
It will be observed then that women booking for their confinements at the Willesden Maternity
Hospital are dealt with under the best possible circumstances and I am unaware of any condition
outlined as desirable in the foregoing Departmental Reports which is not embodied in the Willesden
scheme.
The First Three Thousand Cases.
A Report of the first 3,000 cases admitted to the Hospital is submitted by the Council's Consultant
Obstetrician, Mr. Arnold Walker, M.A., M.B., B.Ch., F.R.C.S., M.C.O.G. This report is of great
clinical interest but its main feature is the fact that out of the 3,000 cases admitted 2,939 were booked
and had the full benefit of the Council's arrangements for their welfare. Of this number three died,
giving a puerperal mortality rate of 1.02 per 1,000. Sixty-one cases, on the other hand, were admitted
as emergency cases with four deaths, giving a puerperal mortality rate amongst these cases of 65-6
per 1,000. I am satisfied as the result of this experience and particularly having regard to the fact
that at present the booked cases tend to be weighted with those requiring hospital confinement for
medical reasons that the Council's scheme is established on sound principles.
Note.—It may be suggested that the four deaths which occurred among the 61 emergency
cases should not be considered only in relation to these emergency cases but should be included
with the deaths amongst all remaining mothers in Willesden who did not book for confinement
in the WTillesden Maternity Hospital during the period under review. During this period approximately
11,274 such women were confined with 48 deaths. The 11,274 include the 61 emergency
cases and the 48 deaths include the four deaths above referred to. The 48 deaths occurring in
the 11,274 cases gives a puerperal mortality rate of 4.26 per 1,000 as compared with the Hospital
puerperal mortality rate for booked cases of 1.02 per 1,000 recorded above.