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96
Annual Report of the London County Council, 1910.

The following conditions were noted among the cases of puerperal fever attended by midwives :—
Recovery. Fatal.
Laceration of perineum 3 3
Retained or adherent placenta 2 1
Ante partum hæmorrhage 1 —
Post partum hæmorrhage 2
Ragged placenta (thought complete by midwife) 2 1
Prolonged labour 1 1
Syphilis 1 -
Abscess in uterus 1 1
In five cases of puerperal fever, birth took place before the arrival of the midwife and consequently
she was unable to do the usual cleansing of her patient before labour.
One midwife had three cases of puerperal fever (two fatal) in her practice during the year. The
cases occurred at intervals of 12 and 8 weeks. She has a very large practice and after disinfection
attended many cases which were normal throughout.
One midwife had two cases (both fatal) during the year, one occurred in January and the next
one in December.
Two midwives had each two cases (one of which was fatal). A's cases were in March and September,
and in the interval she attended some 80 cases, all of whom did well. B's cases were in June and
November, and she had several cases in the interval that did well.
Three midwives had each two non-fatal cases—
A had two cases in September, confined on the 5th and 6th of the month. The
symptoms of puerperal fever occurred in the first case on 14th September, and on the 20th
September in the second case, after the midwife had ceased attending and had been disinfected.
B's cases occurred at an interval of nine weeks. She was disinfected after the first case
and delivered some 40 cases before the second case occurred.
Accidents of
Childbirth
C's cases occurred at an interval of 14 weeks, she has a very extensive practice and the
first of her cases was subsequently diagnosed in hospital as high temperature due to excitement.
In addition to the list of deaths from puerperal septic diseases, the Registrar-General supplies
me with lists of deaths from accidents of childbirth. Among these are included cases of eclampsia,
pulmonary embolism, puerperal mania and pneumonia occurring after confinement, as well as deaths
resulting from haemorrhage and difficult labours. 148 deaths from accidents of childbirth were recorded
during 1910. In 13 of these cases the deceased was attended in her confinement by a midwife. The
cause of death in the 13 cases was as follows :—
Collapse following ante partum hæmorrhage 1
„ „ post partum „ 3
Rupture of the uterus 2
Syncope and cardiac disease after parturition 2
Pulmonary embolism 1
Cerebral embolism 1
Suffocation from air embolism, due to partial separation of placenta 1
Thrombosis of pulmonary artery 1
Lobar pneumonia 1
13
Ophthalmia
Neonatorum
It is the duty of a midwife to advise that medical help is required when inflammation of the
eyes, however slight, occurs in infants. Great stress has been laid by the Council on the importance
of strictly observing this rule. When a notice is received from a midwife that medical assistance has been
sought on this account, the Council's medical inspector at once visits the infant to ascertain that it is
receiving the medical assistance which the midwife has advised, and the midwife is also visited to learn
particulars as to the case, the antiseptic precautions taken beforehand, and the disinfection adopted
by the midwife after each visit to the case. It was found in some cases that when medical assistance
was obtained, the medical practitioner, after examining the infant's eyes, gave directions to the parents
as to the course of treatment and left instructions for them to again seek medical help if the inflammation
did not yield to treatment, and if there was no improvement in the condition of the child's eyes.
So long as the midwife remained in attendance, the treatment was for the most part carried out, at all
events once a day ; but many of these cases had not recovered by the tenth day, the time the midwife