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95
Report of the Medical Officer of Health.
In cases where a midwife was concerned the Council's inspector visited the midwife, learnt particulars
of the case from her, made enquiries as to any other patients recently attended, and took steps to
ensure that the rules as to disinfection were fully carried out before the midwife resumed her work.
Tn addition to this the inspector ascertained the views of the medical practitioner who was railed in to the case

The rule which requires that medical help shall be advised when the patient's temperature rises
to 100.4 deg. and remains above that figure for 24 hours has proved useful in affording information
concerning cases in which there is danger of the development of puerperal fever; 194 notices were
received stating that medical assistance had been advised for this reason. The inspector learnt from
the midwife whether the high temperature was persistent and in 141 cases it was found that the temperature
had fallen, and no further symptoms of puerperal fever occurred. In some cases where the temperature
remained high, although the case had not then been notified, the midwife was directed to undergo the
usual disinfection before going to another case. In 53 instances the rise of temperature proved to be
the first indication of septic trouble and the inspector was thus able in some cases, before the notification
as puerperal fever was known to her, to prevent the midwife from attending other patients until disinfection
had been thoroughly carried out. In cases of puerperal fever the services of the nurses of the
Queen Victoria Jubilee Institute, the Ranyard and the Holloway Institutes are usually available so
that when the midwife ceases to visit, the patient is left in the hands of a skilled nurse to carry out the
directions of the medical practitioner called in. In cases where a midwife has pupils or assistants one
of them is sometimes set apart to nurse the septic case, attending no other patients meanwhile. A
midwife is thus usually able to carry out disinfection and resume her work with as little delay as is
necessary to ensure that she is no longer likelv to be a source of infection to other patients.

Of the 11 deaths occurring after the 10th day of lying in, five occurred before the 20th day, four
before the 30th day, and two after the 30th day. In 11 cases (4 of them fatal) no rise of temperature
above 100.4 deg. was noted by the midwife during her attendance, and medical help was either called
by her for some other reason or else it was called by the patient's friends after the midwife had ceased
to attend.