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The Council's scheme for the carrying out of the provisions of the Blind Persons Act, 1920,
provides, inter alia, for the examination of persons by the Council's medical officer. In this connection,
most of the examinations made are of children of school age and information in regard thereto is given
on a later page. The other persons examined were few in number. Reports have also been made
as to the suitability of premises suggested for the purpose of workshops in which blind persons might be
taught trades and the question of institutional treatment of blind or partially blind persons has received
consideration.
Blind
Persons
Act, 1920.
The number of midwives with London addresses whose names appear on the Roll of Midwives
exceeds 5,000. Of this number 758 notified their intention to practise within the County during the whole
year or for shorter periods. This is an increase of 24 on the previous year. At any time it is probable
that some 500 midwives, or about 10 per cent, of those on the roll, are in actual practice in London. The
remaining 90 per cent, act for the most part as monthly or general nurses under medical supervision.
All practising midwives, except those working entirely within hospitals under medical supervision, are
subject to inspection by the Council's officers in order to ensure that the proper standard of efficiency
is being maintained. This work of supervision is carried out by four women medical inspectors. Special
visits are also paid to the midwife if any case of a septic nature or a persistent high temperature occurs
in her practice and in all cases of inflammation of the eyes. Advice is given where necessary to midwives
on any point of difficulty which may arise in connection with their work. The medical inspectors paid
1,913 visits during the year to midwives or institutions employing midwives.
Midwives
and lying-in
homes.
In 129 cases there were infringements of the rules of the Central Midwives Board. 54 of these
were slight, and a verbal caution was deemed sufficient. 55 cases were of a more serious nature, and were
dealt with by a written caution. Of the remaining 20 cases 11 midwives were interviewed by the committee,
and personally cautioned, and 9 cases were reported to the Central Midwives Board, and were
investigated with the following results; (a) 3, no further action; (b) 1, charges not proved; (c) 3,
cautioned by Board ; (d) 2, struck off the roll; 4 midwives were suspended from practice in order to
prevent spread of infection, and payment in compensation was authorised in 2 cases.
The fee a midwife receives varies in different localities from 15s. per case upwards, but usually
20s. to 30s. is expected. It is computed that about 45 per cent, of the total births in London were attended
by midwives, excluding the cases attended bv midwives in infirmaries.
Infringemerits
of
rules.
by section 1 (2) ot the Act it has been illegal since March, 1910, for any woman, unless she be
certified under the Act, habitually and for gain to attend women in childbirth except under the direction
of a registered medical practitioner. During the year enquiries were made into all cases in which it was
brought to the knowledge of the Council that possibly a dehvery had been conducted by an uncertified
woman. In 8 of these cases it was decided to take no further action—the remaining 6 were dealt with
by a verbal or written caution.
Uncertified
women,
* The rules of the Central Midwives Board provide that in certain emergencies which are specifically
enumerated, a midwife must advise in writing that medical help be obtained and must also see that such
help is obtained. The form on which this advice is given is sent to the doctor and a copy must also be
forwarded to the local supervising authority. During the year, 7,269 of these notices were received, as
against 7,458 in the previous year. The figures for the previous years were 1917, 3,159 ; 1918, 2,738 ;
1919, 5,347. The general rise in the figure is no doubt due to the fact that midwives realise more fully
the importance of complying with the rule of the Board, and also to the fact that since the 1st January,
1919, the Council has been responsible for the payment of the fees of the medical practitioners called
in. Assuming that 46,000 births were attended during the year by midwives, it is estimated that medical
assistance was required in nearly 16 per cent, of the cases ; in 10 per cent, this was on behalf of the mother
and in 6 per cent, on behalf of the child.
Medical aid.
During the year, 684 still-births were reported by midwives in their practice. The figures for pre- Still-births,
vious years were, 1918, 535; 1919, 686 ; 1920, 896. Of these infants 358 were males, 321 females and in
five cases the sex was not stated. Of the 684 children, 380 were reported macerated, 300 not macerated
and there was no statement with regard to the remaining four.
During the year, 355 cases of puerperal fever were reported in the County of which 111 proved
fatal, a case mortality of 31'3 per cent. In addition to these cases the Registrar General records 37 deaths
from puerperal septic disease, which were, however, not notified as puerperal fever. The distribution
of the notified cases was as follows :—
Puerperal
fever.
Delivery conducted by Cases. Deaths.
(а) Medical practitioners 132 39
(b) Certified midwives 127 42
(c) Medical practitioner and certified midwife 3 1
(d) Hospitals and poor law institutions 78 26
(e) Cases of miscarriage or abortion where no attendant was engaged 12 3
(/) Uncertified woman 1
(?) Unascertained 2
Total 355 111
Great stress has been laid by the Council on the importance of strictly observing the rule that
midwives should advise medical help and see that it is obtained in all cases of inflammation of the eyes
however slight in infants. 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 this assistance and the local medical officer of health 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 and questioned as to the particulars of the case. In connection with the treatment of ophthalmia
neonatorum, the voluntary nursing associations have rendered most valuable assistance. Practically
Ophthalmia
Neonatorum.