View report page

8
of the birth passages, and the complications that arise therefrom. What
exactly is being notified, and who is doing the notification ? It must be
borne in mind that the cause of the fever is not required to be stated under
the regulations, even if it is not in any way relevant to the intentions of the
principles of notification of infectious disease. For some time, however, we
have written to the doctor notifying the pyrexia and asking him for the
cause. The results have been illuminating.
Of the 65 notified since 1st August, 1951, we have had replies with
respect to the causation of the fever in 62. Of these 62, in 50 cases (81 per cent.)
the fever was quite unconnected with any infection of the birth passages.
Of these 50, in 34 (55 per cent, of the total) the fever was due to some
disturbance of lactation, often not proceeding as far as mastitis.
Who are notifying the cases? In Ilford 63 per cent, of births occur in
hospital, but 89 per cent, of notifications came from hospitals. Although
complicated cases tend to be admitted to institutions, the causes of this fever
are so trivial that they might well occur in domiciliary practice. The
conclusion we have to come to is that the busy family doctor, appreciating
the triviality of this notification, neglects to fill in yet another form, whereas
the hospital doctor, more bound by rules, and with the help of the temperature
chart, does so.
We may thus assume that, at any rate in Ilford, notification of Puerperal
Pyrexia has little relationship to infections of the birth passages, as intended,
but tends to be merely an indication of minor breast troubles in maternity
wards. This is a form to be filled in that can accordingly be easily dispensed
with.
Prematurity.
It will be noted that for the first time for some years the infant mortality
rate has risen, and is approximately at the level it was at in 1948. It is
now 21.04 deaths per 1,000 live births, as compared with 18-7 in 1950 (but
still well below the rates for England and Wales, Great Towns, Smaller Towns
of England and the Administrative County of London). This rise is a
disturbing factor in our vital statistics and merits further investigation. In
1950 forty-five children under one year of age died, and in 1951 there were
fifty. Study of the death certificates brings forth the fact that on 9 certificates
in 1950 prematurity was mentioned as a factor, and on 23 certificates in 1951,
a considerable jump. Although the stillbirth rate, the causes of which have
much in common with prematurity, rose (from 19-56 to 24-63 per 1,000 total
births), there has been no rise in the proportion of premature children born
to Ilford mothers (53.6 per 1,000 in 1950 and 52-6 in 1951).
What is possible in the way of prevention ? This resolves itself into
(a) the prevention of the deaths of premature infants, and (b) the prevention
of prematurity itself.
With respect to any possible activity of the local authority to prevent
these deaths, it is of interest to note that of the 23 who died, 20 were born
and died in hospital, and 3 were born at home and died in hospital (two of
these were in a hospital within an hour). It is apparent therefore that it is
mainly for the hospitals, and not the local authority, to prevent deaths of
premature infants. The prevention of prematurity itself is a local authority
duty and requires a knowledge of its causes. Important among these are a
poor social environment, and certain obstetric conditions such as toxaemia,
multiple pregnancy and haemorrhage. Ante-natal care can help, and last
year ante-natal clinics to be run by midwives were introduced for the first
time in Ilford for domiciliary cases, to supplement the work of the private
doctor. Ante-natal clinics for cases to be confined in hospital have of course
been conducted for many years. Domestic help in the home in the last few
weeks of pregnancy may also help, and this service is of course in being, and
consideration should be given to its expansion.