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78
THE SEVENTH ANNUAL REPORT
on the
WILLESDEN MATERNITY HOSPITAL.
Report on the work from 1st January, 1937, to 31st December, 1937.
By ARNOLD WALKER, M.A., M.B., B.Ch., F.R.C.S., F.C.O.G.
Although there has been no increase in the number of beds at the Hospital, more than a hundred
additional cases were dealt with during 1937 than during 1936. The 1,037 cases delivered must be
regarded as representing the maximum number which can safely be undertaken with the present
accommodation. At times during the year, the hospital has been overcrowded but this is inevitable
in maternity work and is offset by slack periods. When the hospital is extended, it is to be hoped
that a reserve ward will be provided which will greatly facilitate periodic cleaning. The remarkable
series of booked deliveries without a maternal death has unfortunately been ended. Two booked
cases and one unbooked case died during the year. The first booked case collapsed after an easy
normal delivery and died from a rare condition known as obstetric shock. The second case is obscure.
The patient was admitted when seven months pregnant, having been ill at home without calling in
a private doctor or notifying the Health Centre. She had attended the Ante-natal Clinic regularly,
but failed to make use of the services available when taken ill a day or two after her last attendance.
When admitted, her condition was very serious, but no diagnosis could be made by the obstetrician
nor by a consulting physician who was called in. A post-mortem examination was carried out by a
pathologist which was also inconclusive and every possible pathological investigation has since been
carried out on material which he removed. The case is still not satisfactorily explained although the
sections are still circulating amongst leading pathologists. From the full information in the records,
nothing has come to light to suggest that the death of this woman could have been prevented.
The unbooked case died from shock following a prolonged labour and difficult delivery. This and
the first booked death are true maternal deaths from complications which are not avoidable by antenatal
care and for the treatment of which every facility was available.
At the moment, almost 5,000 cases have been delivered in the Willesden Maternity Hospital
with five booked deaths. There is no doubt that a maternal mortality rate of one per thousand must
be somewhere near the irreducible minimum although the sequence of about 3,400 in the middle of the
series without a death makes one hope for a repetition.
Statistical Details of the 1,037 Cases dealt with during 1937.
Cases Completed 1,037
A. Booked at the Health Centres 1,021
Discharged well 1,015
Delivered elsewhere 2
Transferred (discharged well) 2
Died 2
B. Admitted as Emergencies 16
Discharged well 15
Died 1
Of the 1,021 booked cases, 554 were primiparae and 467 were multiparae.