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15
Midwives Act, 1902.
Tlie number of certified midwives with London addresses exceeds 5,000, of whom 535 notified
their intention to practise in the county during the year, a decrease of 19 on the previous year. During
the year the four medical inspectors in the Public Health department made 2,406 inspections of the work
of the certified midwives.
The number of births notified under the Notification of Births Act, 1907, by certified midwives
during the period under review was 34,976, and 2,738 notifications were received by the Council that
medical aid had been advised by certified midwives in the following circumstances—Pregnancy, 170;
lying-in, 480; labour, 1,089; child, 999. Notifications were also received as to the occurrence of 30
deaths in the practice of certified midwives, four cases of liability to be a source of infection and 16 cases
of laying out a dead body. The occurrence of 535 stillbirths was reported, the foetus in 243 cases being
macerated, and in 252 cases not macerated, while in 40 cases no definite particulars were given. During
the year inquests were held on the bodies of 13 women and 48 infants arising out of cases in which
certified midwives had been in attendance.
613 cases of ophthalmia neonatorum were notified by medical practitioners, under section 55 of
the Public Health (London) Act, 1891, 332 being in respect of cases in the practice of certified midwives.
Of this number 314 were cured, impairment of vision resulted in four cases, seven infants died, and in
seven instances information could not be obtained owing to the removal of the parents.
158 cases of puerperal fever were notified in the County and the Registrar-General records 95 deaths
from puerperal septic disease. 61 of these occurred in the practice of certified midwives. The RegistrarGeneral
also records 121 deaths from other'accidents of child birth, of which 6 were in the practice of
midwives.
A new Midwives Act was passed duirng the year, but did not come into force until 1st January
1919. It provides, inter alia, for the payment by the local supervising authority of the fees of medical
practitioners in cases where midwives summon medical assistance in accordance with the rules of the
Central Midwives Board, and empowers the local authority to recover the fee from the patient or other
person liable unless evidence is forthcoming that such person is too poor to pay. The Act also empowers
local supervising authorities to supply midwives gratis with all books and forms which they are required
to fill up or use, and stamped envelopes where necessary. Section 12 of the Act repeals the provisions
of section 8 of the Act of 1902 which enabled County Councils to delegate their powers and duties to
district councils.
The establishment of prima facie cases of negligence and misconduct on the part of five midwives
were reported to the Central Midwives Board, the name of one being subsequently removed from the
roll of midwives. The remaining four were cautioned, subsequent reports as to the conduct and
methods of practice of three of them being required by the Board at the expiration of three months,
and again at the expiration of six months from the date of the hearing of the charges.
At the end of the year 272 lying-in homes remained on the register, 67 having been added
during the year and registration in respect of 17 having either been cancelled or the use of the premises
for confinements having been discontinued.
Children Act, 1908—Part I.
The work arising under this part of the Act was transferred to the Public Health Department
in March, 1917. Part I. of the Act provides that if a person undertakes for hire or reward the nursing
and maintenance of an infant under the age of seven years, apart from its parents, due notice of such
reception must be given to the local authority—in London the Council—within 48 hours. A similar
requirement is imposed in the case of the change of address of a foster parent, or the removal or death
of the infant. There is also an obligation to notify the local coroner in the case of the death of an
infant, but such notification must be given within 24 hours.
At the beginning of 1918 the number of notified houses on the register was 2,995, and the number
ot nurse infants was 3,900. At the end of the year the figures had dropped to 2,654 houses, and 3,461
infants. Since the war began there has been a gradual reduction in the number of houses and infants,
due mainly to the fact that it has been possible for foster parents to obtain lucrative employment, and
they feel indisposed to be burdened with the care of nurse infants. In this connection it may be noted
that the charges have gradually risen, and although before the war it was possible to find a home for
an infant at 5s. a week, the amount now asked is, on an average, 12s. 6d. and upwards; but there are,
of course, a few cases where for special reasons foster parents can be induced to take an infant at a lower
sum. It is hoped that the powers in the Maternity and Child Welfare Act, 1918, given t6 borough councils
to assist foster mothers financially, may result in an increase in the number of suitable homes and foster
mothers available. At present it is an exceedingly difficult matter to find a suitable home for a young
infant so greatly has the number of applications for such homes increased. The applicants are either
unmarried and must work to live, or are married and find it more profitable to go to work and place
infants out to nurse. The homes for infants are also finding it necessary to refuse applications.
The staff charged with the duty of carrying out this part of the Act comprises 15 female visitors,
and two male inspectors. The female visitors are required to visit the foster mothers, to see that the
infants are receiving proper care and attention and to advise foster mothers as to the best method of
feeding, etc., the particular infants in their care. The two male inspectors watch advertisements in the
Press, trace unregistered foster mothers, verify removals of infants from foster parents outside London
to parents or relatives in London in cases where the outside authority advises the Council of such removals,
assist the visitors in tracing infants or foster mothers who have removed without notice being given, and
render assistance to visitors in difficult cases.