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In cases a, b and d there was a history of vaginal discharge from the mother during pregnancy
The treatment adopted by the midwife at birth in these cases was (a) eyes treated with boracic acid
solution at birth ; (b) eyes wiped with dry rag at birth and washed with 1 in 4,000 solution of corrosive
sublimate half-hour later ; (c) child born before arrival of midwife—eyes washed with boracic solution
half-hour later ; (d) eyes treated with 1 in 4,000 solution of corrosive sublimate at birth.
In 13 cases medical assistance was not obtained by the midwife at the onset of the disease. In
four of these a satisfactory explanation was given by the midwife, in four others the midwife was cautioned
by the inspector, in one case she was cautioned verbally by the Midwives Act Committee and in the
remaining four cases a letter of caution was addressed to the midwife.
The antiseptics used by the midwives for treating the eyes at birth were perchloride of mercury
(1 in 2,000 or weaker) in 51 cases, boracic acid (saturated solution) 34 ; lysolsolution, 1 ; cyllin solution, 1.
In 21 cases the child was born before the arrival of the midwife, and consequently there was an interval
between the birth and the treatment of the eyes ranging from 10 minutes to 1½ hours.
A possible source of infection was ascertained in 34 cases. Soreness of the eyes of the mother or
other member of the family existed in six cases. In 28 cases there was a history of [a vaginal discharge
in the mother during pregnancy, and in three of these cases the discharge was admittedly gonorrhœal.
In December the Midwives Act Committee invited Mr. E. Treacher Collins, F.R.C.S., of the
Royal London Ophthalmic Hospital, Moorfields, and Mr. Malcolm M. McHardy, F.R.C.S. of the Royal
Eye Hospital, Southwark, to assist the Committee with their advice as to the most efficient routine treatment
to be adopted by midwives in order to prevent as far as possible the occurrence of ophthalmia in
newly-born infants. As a result of the advice of Messrs. Treacher Collins and McHardy a leaflet was
drawn up for distribution to practising midwives in London. Since then, however, the Central
Midwives Board have had this subject under consideration and pending the amendment of the rules
by the Board the issue of the leaflet has been postponed.
Medical help for poor patients.—The difficulty of securing medical assistance when the patients are
too poor to pay a fee has often been brought to notice, and midwives have asked for advice as to the
course they should adopt in such cases. The arrangements made by the various Boards of Guardians
in London were ascertained and a pamphlet giving this information was sent to every midwife giving
notice of her intention to practise in London. This pamphlet shows that 14 Boards of Guardians
are willing to consider a payment of a fee to any medical practitioner if the case be urgent, but four of
these stipulate that in the first instance application must be made to the poor law medical officer.
Twelve Boards of Guardians are willing to consider the payment of a fee to their own district medical
officers called in by midwives in cases of emergency ; five Boards of Guardians had made no arrangements
for dealing with these cases. It is obvious that unless the Boards of Guardians are willing to
guarantee a reasonable fee to the medical practitioner called in and themselves recover the fee if it is
subsequently found that the patient is in a position to pay, the requirements of the case will not
be met.
Scholarships.—In 1905 a scheme was started for awarding scholarships to students in midwifery.
Up to the end of 1908, 26 students were elected as scholars. Of those elected 12 had completed their
course of training and passed the examination of the Central Midwives Board, and of these 2 were acting
as district midwives in connection with the extern department of a lying-in hospital, 2 were engaged in
infirmaries, 2 filled temporary appointments, but were not subsequently able to obtain a practice,
1 was in private practice and 5 were not practising as midwives. There was very little demand for
these scholarships and the difficulty of the scholars when qualified in obtaining work in London to comply
with the conditions of the award led to the conclusion that the Council was not justified in continuing
to make these awards.
Classes for midwives.—The Education Committee of the Council arranged courses of classes for
the further instruction of midwives. The original intention was to afford an opportunity to midwives
who had been in practice for a good many years to obtain further teaching in the theory of midwifery.
These classes were instituted in 1905 and in subsequent years the numbers attending the classes increased
and classes were arranged at additional centres. The classes were arranged for midwives and maternity
nurses and there is reason to believe that practising midwives formed only a small proportion of those
attending. A new scheme has now been arranged which provides separate courses for midwives and
maternity nurses and reduces to four the number of centres where classes for midwives are held.
Notification of Births Act, 1907.
This Act provides for the notification within 36 hours to the medical officer of health of the
occurrence of the birth of a child. It also provides, in the case of the County of London, that a list
of the births notified each week to a medical officer shall be forwarded to the London County Council. A
local authority may, with the consent of the Local Government Board, adopt the Act.
In London 15 metropolitan boroughs and the City of London adopted the Act during 1908. The
medical officers of health of these districts indicated on the lists sent to the Council the cases which were
notified by midwives. For the purpose of comparison with the number of births given in the RegistrarGeneral's
quarterly returns only the complete quarters during which the Act was in operation in each
borough are taken into consideration.
The following table shows (a) total births registered, (b) total
births notified under the Act, (c) births notified by midwives under the Act.
21322
N