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infirmary for five weeks, then baby was transferred to St. Margaret's Hospital. Result—left eye appears
quite destroyed; has dense central opacity (leucoma) with bulging of cornea (staphyloma). Right eye
dense central opacity (leucoma). This eye has been needled, and appears sensitive to light.
No. 867—Mother has had severe leucorrhoea since the birth of this child. Boracic lotion used
for eyes at birth. Onset of symptoms on seventh day, and medical assistance on ninth day. When
three weeks old was taken to Royal Eye Hospital, and from there sent into St. Margaret's Hospital.
Result—slight opacity, covering all but a small portion of the upper external part of left pupil. At
eight months of age this opacity appears to be less dense than before admission to hospital, and it is hoped
the condition may further improve.
No. 968.—History of vaginal discharge of mother. Hg Cl2 1-4,000 used for eyes at birth. Onset
of symptoms and medical assistance on fifth day. Admitted to St. Margaret's Hospital on seventh day;
in hospital for three months. Result—(seven months of age)awaiting operation for ulcer on eye.
The 684 notified cases of ophthalmia neonatorum occurred in the practice of 274 midwives: Two
midwives had 21 cases each during the year, and 28 others had from 5 to 15 cases each; 244 had from
1 to 4 cases each.
Considerable use, especially in the northern areas of the county, has been made of St. Margaret's
—the hospital provided by the Metropolitan Asylums Board, for the reception of cases of ophthalmia neonatorum.
This provides accommodation for 30 infants and 18 mothers which, up to the present, has
proved adequate to meet the calls made upon it. Possibly the provision of a similar institution on the
south side of the Thames might lead to more cases from that part of the county seeking admission. The
erection of such an hospital has been under consideration.
The classes arranged by the Council for the further instruction of midwives have met with much
success. It was found that the short, intensive series of lectures, etc., presented considerable difficulties
in the matter of the attendance of midwives, and consequently it has been arranged that the course
should be spread over a period of nine months, with one lecture weekly at various institutions both
north and south of the Thames. This plan has enabled midwives to attend in increased numbers.
The Midwives Act, 1918, came into force on January 1st, 1919. Section 14 provides for the
payment by local supervising authorities of a fee to a medical practitioner in all cases where he is called
in by a midwife to her assistance in a case of emergency, and the local supervising authority may recover
the fee from the patient's husband or other person liable to maintain the patient, unless they are satisfied
that the patient or husband, or such other person, is unable by reason of poverty to pay such fee.
A scale of fees was laid down by the Ministry of Health in which, generally speaking, the doctor
was entitled to a fee of two guineas in cases of difficult labour, etc., where an operation is involved ; one
guinea where no operation was necessary, and 3s. 6d. for an ordinary day and 7s. 6d. for a night visit.
This scale has since been revised, but the new scale did not come into force until 1st January, 1921.
During the year 3,646 approved claims were received from 466 medical practitioners, amounting in all
to £5,334 2s.—i.e., an average of 29s. per case, and a total increase of fees of 75 per cent, over the previous
year. This increase is to be accounted for chiefly by the higher birthrate, and also by the provisions
of the new Act becoming more widely known amongst medical practitioners and midwives.
In accordance with the provisions of the Act the Council appointed two inquiry officers to investigate
the financial circumstances of each patient in respect of whom a fee became payable, and in due
course each case was considered by a committee of the Council, and assessments varying from 3s. 6d.
to £2 2s. were made according to the merits of the case. Up to the present about £400 has been recovered
representing 7½ per cent, of the fees paid.
Towards the end of the year an experiment was commenced on a small scale whereby the services
of the inquiry officers might be dispensed with and assessments made direct by correspondence. It is
anticipated that in the future this system will be adopted for the entire county.
In 1915 the Council obtained powers from Parliament for the registration and inspection of
premises for the reception of lying-in patients.
In accordance with the provisions of the Act, which came into force on February 1st, 1916
hospitals, infirmaries, and similar institutions are exempted from registration, and in cases where a
lying-in home is carried on by a registered medical practitioner the Act also provides for exemption,
which must, however, be renewed annually. Six premises were the subject cf certificates during 1920.
At the beginning of the year 258 premises were on the register, 75 were added duringthe year, 1 registration
was cancelled, and 74 premises ceased to be used for lying-in purposes, leaving 258 premises on the
register at the end of the year. All lying-in homes on the register are inspected at regular intervals by
the Council's medical inspectors to ensure that a proper standard of cleanliness and general efficiency
is maintained. During the year 567 inspections were thus made.
In the early part of 1920 the Ministry of Health issued a memorandum (15/M. & C.W.) which
indicated the standards of measurement suitable for the accommodation of maternity cases. The space
suggested is 960 cubic feet for mother and child, 800 cubic feet when the baby is removed at night, and
600 cubic feet for waiting patients. The last-named patients, in the great majority of cases, may be
reasonably expected to be up for most of the day, and able, therefore, to move into other rooms.
Taking the above measurements as a guide, a survey was made of the private lying-in homes in
the county, and it was satisfactory to find that the instances in which the space available fell
markedly below the standard were very few in number. Furthermore, it was found possible, by various
methods of re-arrangement, to ameliorate these conditions without the loss, except in one case, of any
of the available beds.
The number of beds available for maternity cases in registered homes may be estimated approximately
at between 700 and 800. A certain number of these, however, belong to high-class premises.
Classes for
midwives.
Midwivea
Act, 1918—
Payment of
fees.
Lying-in
homes