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associated with a general hospital. It is because the treatment of the
acute infectious diseases is so important that control of the institutions
to which the patients are admitted should be under a clinician specialising
in them, otherwise they as diseases will run the risk of their not being
studied.
6. It was the general experience throughout the country before
the war that an increasing proportion of women wished to have their
confinements in an institution. At one time much was heard of the
risk of institutional confinement as contrasted with those in the patients'
homes. With the truer appreciation of the factors leading to puerperal
infection, the risks have been substantially eliminated. If then there
are no medical contra-indications of the confinements taking place in
an institution, authorities can do little but to provide the accommodation
for those wanting it. It is probable that war experience will only
have stimulated this growing demand, and that it will be found necessary
for authorities to provide beds to meet the needs of proportions even
greater than those before the war. The White Paper sees the maternity
services as part of the general health services, the institutional accommodation
being provided by those bodies responsible for the general
hospital accommodation. There is then to be no comprehensive maternity
service with each sphere linked to the other. Under to-day's arrangements,
and the future holds hope of nothing brighter, we have (a) the
domiciliary midwife as an independent unit who establishes touch with
the doctor at the ante-natal clinic, but who summons other doctors
to her help by the issue of medical aid notices ; (b) the doctor at the
ante-natal clinic who sees any midwife who brings her case to the clinic,
but sees no patients in hospital and who never attends a confinement ;
(c) the Redhill Hospital or the Bushey Annexe, run as a detached service,
though the ante-natal supervision of many normal cases is undertaken
at the Council's clinics ; (d) a consultant service provided either by the
doctor who attends the consultant ante-natal clinic or by one from Redhill
Hospital. Apart from the personal contact of the midwife and the
doctor at the ante-natal clinic, all other communications are by writing
or possibly by telephone. Another body of persons, the health visitors,
also is brought into the picture. Full co-operation and unification of
the services could be brought about if a local authority were enabled
to provide its maternity home, the medical officers to attend the district
ante-natal clinics and also answer midwives' medical aid notices, and
the district midwives to be periodically interchanged with those at the
home.
It is hoped that the midwife of the future will be anxious to and
will be enabled to be the mother's adviser as to the care of the young
infant for a period longer than that for which she continues to attend
the mother. The mother passes through a very trying transitional stage
about the time she first gets up, so frequently her milk fails then. It
is most important that the midwife on whom she has recently been
relying so very much should be there to advise and encourage her. It
is felt that the midwives can probably, without its making too great a
demand on their time,. fit in regular visits to their mothers at least until
the infant is one month old. This practice has been adopted here, the