London's Pulse: Medical Officer of Health reports 1848-1972
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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
London County Council 1907
[Report of the Medical Officer of Health for London County Council]
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midwife was in attendance, and one of the Council's inspectors is permitted to be present. The
inspector is often referred to on points arising under the Midwives Act, and the Rules. Much useful
information as to the practice of midwives is often elicited in the course of such inquests, and many
uncertified women, whose practice has hitherto been unknown to the inspectors, have been brought
to notice as the result of inquiries into the deaths of mothers or infants.
During the year, 129 inquests were attended by the Council's inspectors, 14 where the mother
and 115 where the infant died. Of these cases 14 were attended by uncertified women. The following
table shows the opinion of the coroner's jury in these cases as regards want of skill displayed, or
neglect to call in medical aid sufficiently early. In one case a midwife and in another an uncertified
person were censured! by the jury for neglect of a patient.
The midwife who was censured by the jury was subsequently represented by the Council to the Central Midwives Board for neglect and her name was removed from the Roll.
| Attended by— | Total Inquests. | Children. | Mothers. | ||||||
|---|---|---|---|---|---|---|---|---|---|
| No blame attached. | Want of skill. | Failure to call medical help sufficiently early. | Censured by jury. | No blame attached. | Want of skill. | Failure to call medical aid | Censured by jury. | ||
| (a) Certified midwives | 115 | 88 | 5 | 10 | - | 9 | 1 | 1 | 1 |
| (b) Uncertified persons | 14 | 6 | 2 | 3 | 1 | 2 | — | - | — |
| Total | 129 | 94 | 7 | 13 | 1 | 11 | 1 | 1 | 1 |
The cause of death was given as follows:—
| Mothers. | Children. | ||
|---|---|---|---|
| Puerperal fever | 1 | Overlaying | 12 |
| Puerperal peritonitis | 3 | Suffocation in bed (alone) | 4 |
| Puerperal septicaemia | 2 | Asphyxia and atelectasis | 27 |
| Acute nephritis | 1 | Accident at birth | 4 |
| Hæmorrhage | 3 | Convulsions | 8 |
| Fatty degeneration of the heart | 2 | Weakness due to prematurity | 22 |
| Heart failure | 1 | Syncope and heart disease | 4 |
| Epilepsy | 1 | Jaundice | 1 |
| Cerebral hæmorrhage | 3 | ||
| Bronchitis | 5 | ||
| Tubercular pleurisy | 1 | ||
| Tetanus | 1 | ||
| Erysipelas | 2 | ||
| Want of attention at birth (born before midwife's arrival) | 10 | ||
| Congenital malformation | 3 | ||
| Haemorrhage from cord | 3 | ||
| Still-birth | 5 | ||
| 14 | 115 | ||
Full reports on all these cases were made by the Council's officers, and in the cases where
blame was attributed to the midwife a letter of caution was subsequently sent to her.
Puerperal Fever.—All cases of puerperal fever where there was reason to believe that a midwife
had been in attendance on the patient were investigated, and full details of illness obtained. For this
purpose early intimation of notified cases of puerperal fever is received from the Metropolitan Asylums
Board, and weekly lists of all deaths from puerperal septic diseases are obtained from the General Register
Office.
During the year 1907, 254 cases of puerperal fever were notified, and 152 deaths were classed by
the Registrar-General as occurring from puerperal septic diseases. The term "puerperal septic disease"
as used by the Registrar-General includes, puerperal septicaemia, sapræmia, pyæmia, peritonitis
and metritis, occurring in connection with parturition, but a more limited interpretation of the term
puerperal fever appears to be sometimes adopted for the purposes of notification by medical men
generally, and no less than 64 of the deaths registered from puerperal septic diseases related to cases
which were not notified as puerperal fever. Thus of the 254 notified cases, 88 or 34.6 proved fatal.
Adding the 64 unnotified cases reported by the Registrar-General to the 254 notified cases, a total
of 318 known cases of the disease is obtained. As the result of enquiry, it was ascertained whether the
patients in all these cases were delivered by a midwife or not, and during the latter part of the year
this enquiry was extended and the cases not attended by a midwife were classed according as they
were attended by medical men, confined in hospitals, etc.
18560 M 2