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43
The 392 notified cases of ophthalmia neonatorum occurred in the practice of 163 midwives:—
1 midwife had 13 cases during the year 13
1 „ „ 9 „ „9
1 „ „ 8 „ „ 8
5 „ „ 7 „ „ 35
9 „ „ 6 „ „ 54
4 „ „ 5 „ „ 20
12 „ „ 4 „ „ 48
17 „ „ 3 „ „ 51
41 „ „ 2 „ „ 82
72 „ „ 2 case „ „ 72
163 392
Arrangements have been made by the Metropolitan Asylums Board for the admission of infants
suffering from ophthalmia neonatorum into St. Margaret's Hospital in Leighton-road, St. Pancras, and,
where necessary, accommodation is also provided for the mother at the hospital in order that the child
may not be deprived of the advantage of breast-feeding whilst under treatment.
The Council has arranged classes for the further instruction of midwives at various centres in
London. These classes are attended by midwives who have been in practice for many years, and also
to some extent by pupils to supplement the training they are receiving elsewhere. Midwives showing
lack of knowledge of their work are advised by the Council's inspectors to attend these classes.
The Midwives Act, 1918, came into force on January 1st, 1919. The chief duties laid upon local
supervising authorities are contained in sections 6, 7, 11 and 14 of the Act. Section 6 authorises a local
supervising authority to suspend from practice a midwife who has been reported to the Central Midwives
Board until a decision has been arrived at in her case, and in certain circumstances to pay compensation
for such loss of practice. Section 7 requires the local supervising authority to supply midwives gratis
with all books and forms required to be filled up. Section 11 empowers a local supervising authority to
aid the training of midwives and to make grants for this purpose. Section 14 provides for the payment
by local supervising authorities of a fee to a medical practitioner in all cases where he is called in by a
midwife to her assistance in a case of emergency, and the local supervising authority may recover the
fee from the patient's husband or other person liable to maintain the patient, unless they are satisfied
that the patient or husband or such other person is unable by reason of poverty to pay such fee.
A scale of fees was laid down by the Local Government Board in which, generally speaking, the
doctor is entitled to a fee of two guineas in cases of difficult labour, etc., where an operation is involved ;
one guinea where no operation is necessary; and 3s. 6d. for an ordinary day and 7s. 6d. for a night visit.
This scale is at present being revised. During the year 2,034 approved claims were received from 368
medical practitioners, amounting in all to £3,047 2s., i.e., an averaeg of 30s. per case.
The reasons for calling in medical assistance have been already referred to and there is no
doubt that the large increase in the number of instances in which a doctor was called in is in part to be
attributed to the fact that the Council is responsible for payment of the doctor's fees, although, of
course, there has been a general increase in the birth-rate, particularly in the last quarter of the year.
In cases where an apparently abnormal number of medical aid notices have been sent by midwives
to doctors, enquiries have been made, but in no case has evidence been found to suggest collusion between
doctor and midwife.
In accordance with the provisions of the Act the Council appointed an enquiry officer to
investigate the financial circumstances of each patient in respect of whom a fee became payable, and in
due course each case was considered by a Committee of the Council and assessments varying from 2s.
to £2 2s. were made according to the merits of the case. Up to the present £111 2s. 3d. has been thus
recovered, representing 3.6 per cent. of the fees paid.
Certain new rules of the Central Midwives Board came into force on March 25th, 1919. Rule
E 12 (a) provides that a midwife must forthwith notify the local supervising authority of each case in
which it is proposed to substitute artificial feeding for breast-feeding. One hundred and sixteen notices
were received up to the end of the year and transmitted to the sanitary authorities concerned in order
that the cases might be followed up by the health visitors. Rules F3 and F4 enable the Central Midwives
Board and the local supervising authority respectively in special circumstances to suspend a midwife
from practice pending an enquiry into her conduct, and Rule F3 empowers the Board to suspend from
practice, in lieu of removing her name from the roll, any midwife who may have been found guilty of
disobeying the rules, or other misconduct.
Lying-in Homes.
In 1915 the Council obtained powers from Parliament for the registration and inspection of
premises used for the reception of lying-in patients.
In accordance with the provisions of the Act, which came into force on February 1st, 1916,
hospitals, infirmaries and similar institutions are exempted from registration, and in cases where a
lying-in home is carried on by a registered medical practitioner the Act also provides for exemption,
which must, however, be renewed annually. Two premises were thus granted certificates during the
year. Apart from these, up to the present 362 applications for registration have been dealt with under
the Act. At the beginning of the year 272 premises were on the register, 50 were added during the year,
and 4 registrations were cancelled for different reasons, leaving 318 premises on the register at the end
of the year. All lying-in homes on the register are inspected at regular intervals by the Council's medical
55580 F 2
Classes for
midwives.
Midwives
Act, 1918.