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The rules of the Central Midwives Board require the midwife to notify to the local supervising
authority all cases in which the mother or child dies before the attendance of a registered medical
practitioner. In 34 cases midwives notified the deaths of infants, and in 9 cases notices of deaths of
mothers were received.
By the courtesy of the London coroners notices are sent of inquests in which midwives are concerned
and one of the Council's inspectors attends the court to hear the evidence and learn whether the
midwife has complied with the rides of the Board. Eighty-three inouests were thus reported upon.
Death of
mother or
child.
In the following table particulars are given with respect to these cases:—
Confinement conducted by
Total number
of inquests.
Deaths of
mothers.
Deaths of
infants.
Midwives
83
10
73
During the year, 310 cases of puerperal fever were notified in the County and the RegistrarGeneral
records 150 deaths from puerperal septic disease in the same period. The term puerperal septic
disease used by the Registrar General includes puerperal septicaemia, pyaemia and sapræmia, as well as
peritonitis and metritis occurring in connection with parturition. A list of deaths is received weekly
from the Registrar-General and the deaths are compared with the notified cases so that it is possible to
ascertain whether the latter terminate fatally. Of the 310 notified cases, 126 proved fatal, a case
mortality of 40.6 per cent. The 24 other deaths referred to in the next paragraph related to cases which
were not notified.
Early information of notified cases of puerperal fever is received from the Metropolitan Asylums
Board or from the borough medical officers, and I am indebted to the latter for information as to the
person by whom the patient was delivered. The following table gives the results of these inquiries
which relate to the 310 notified cases and include the 24 deaths of cases which were not notified :—
Puerperal
fever.
Delivery conducted by
Cases.
Deaths.
(а) Medical practitioners (including cases attended by medical students and also eases in which a medical pracctitionen was in charge of the case but
the birth took place before his arrival) 141 68
(b) Certified miawives (including cases in which birth took place before the 112 35
arrival of the midwife)
(c) Medical practitioner and certified midwife, i.e., cases in which a midwife 8 4
was unable to deliver and called in a medical practitioner
(d) Hospitals and poor law institutions 52 31
(e) Cases of miscarriage or abortion where no attendant was engaged 16 9
(f) Uncertified woman 1 -
(g) Unascertained 4 3
Total 334 150
The cause of death as stated in the death certificates in the 150 fatal cases occurring in London
is shown in the following table:—
Cause of death.
Notified cases.
Unnotified eases.
Total.
Puerperal septicæmia, toxæmia, and septic absorption
1ll
18
129
Puerperal peritonitis
6
3
9
Pyæmia
—
1
1
Sapræmia
4
-
4
Metritis, perimetritis, parametritis and endometritis
2
1
3
Pelvic cellulitis
2
-
2
Salpingitis
—
1
1
Septic pneumonia
1
-
1
126
24
150
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 medical officer of health of the borough in
which the patient resides is immediately informed of the condition of the case and whether the infant is
being removed to a hospital for treatment. 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
55580 F
Ophthalmia
Neonatorum