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104
One midwife had three cases in her practice. The first case occurred in June, and the midwife
was disinfected and resumed her work, delivering several women who had no symptoms of puerperal
fever; the second patient was confined on 15th October, and was up on the 24th October, when the
midwife ceased attending. This patient was subsequently taken ill, and died on 31st October; in
the meantime, i.e., on 30th October, the midwife had delivered the third case before the second was
notified.
Eleven midwives had two cases each in their practice during the year. The interval between
the cases in seven of these groups of two was 3 months, or more, and the midwife had been disinfected
after the occurrence of the first case, and had attended several other cases in the meantime,
all of which did well. In three of the groups the second case was delivered before any symptoms
of puerperal fever had appeared in the first case, and hence there had been no opportunity of
disinfection between the occurrence of puerperal fever in the first case and the confinement of the
second. In the remaining group a brief interval separated the occurrence of the first and second
cases of puerperal fever, but during this time the midwife had been disinfected. The first case proved
fatal, but the second case was described as "mild sapraemia," and recovered.
Two uncertified women each had two cases in their practice, the intervals between the cases
being four and ten months respectively.
Of cases attended by midwives in which death occurred, the patient was delivered in four
cases by medical practitioners by the aid of forceps. In one case of transverse presentation, turning
was effected by a medical practitioner; in three cases the foetus was dead, being described as
still-born, macerated, or a miscarriage; in five there was laceration of the vagina or perineum;
in three there was adherence of or retention of membrane or placenta; in one post partum
haemorrhage; in one ante partum haemorrhage, drugs having been taken to produce abortion; in
one " blood poisoning " four months before confinement; in one phlebitis after being delivered of
triplets; one was a case of puerperal mania removed to an asylum; in one instance death occurred
under chloroform. In two or three cases the exceptionally dirtv condition of the patient and the home
are commented upon by the inspectors, and in one case the patient's clothes had to be taken out
of pawn the day after the confinement.
Ophthalmia.—It is the duty of midwives to advise that medical assistance should be sought
in all cases of inflammation of the eyes, however slight, occurring in new-born infants. Notice of
advising medical help is sent to the local supervising authority. In this way cases of inflammation
of the eyes occurring in the practice of midwives are brought to notice. The attention of midwives
has been specially directed to the importance of strictly observing this rule.
During the year 162 notices were received from midwives stating that medical help had been
advised on account of inflammation of the child's eyes. Three cases were reported by the borough
health visitors, where it was found that the midwife had failed to realise the seriousness of the case,
and no medical assistance had been obtained. In several cases there was delay in advising medical
help, and the midwives were duly cautioned. In five instances where medical help was advised, it
was not obtained. These were all slight cases, and all of them recovered.
All the cases were investigated by the Council's inspectors, the midwife was interviewed
to learn what antiseptic precautions had been taken, and the infant was visited to see that it was
receiving medical treatment. The progress of the disease was followed and the final result ascertained
where possible. In one case an infant died. 136 infants were eventually reported to be
completely cured, but in 12 cases some impairment of vision resulted. In 16 cases the parents
removed, and it was not possible to trace them and ascertain the result of the illness.
The duration of the disease in the 136 cases in which there was a complete cure was as follows:—
Disease lasting less than 10 days 47 cases.
Disease lasting between 10 and 30 days 46 cases.
Disease lasting over 30 days 43 cases.
Many of these cases were, however, extremely slight.
Assuming 30,000 confinements to be attended annually by midwives not working in hospitals
or poor law institutions under medical supervision, the above figures show that inflammation of the
eyes occurred in 5.3 per 1,000 births.
The day inflammation of the eyes was first noticed was as follows:—Day of confinement,
9; 2nd day, 26; 3rd day, 17; 4th day, 23; 5th day, 23; 6th day, 20; 7th day, 15; 8th day, 13;
9th day, 14; 10th day, 3; after 10th day, 2; total, 165. A history of a discharge in the mother
was obtained in 64 cases, i.e., in nearly 40 per cent.
Midwives acting for some of the lying-in hospitals were taught in 1909 to use a solution of
perchloride of mercury (1 in 4,000) for the eyes of infants whose births they attended, the eyes being
washed with boracic acid lotion or sterile water immediately after the use of the perchloride; a few
midwives used a much weaker solution of perchloride of mercury and those of a particular institution
used a one per cent. solution of nitrate of silver followed by washing with boracic acid lotion.
Other midwives used boracic acid lotion only, and a few, sterile water.
In one case there was no opacity of the cornea and apparently no more serious result than a
slight squint. The following details were obtained of 11 cases in which there was serious impairment
of vision:—
(1) No history of discharge in mother. Stickiness noticed on 4th day and pus on 10th
day, when medical help was obtained. Result—Opacity covering lower half of each cornea.