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53
written caution. Of the remaining 11 cases, 8 midwives were seen by the Committee,
and 6 of them cautioned ; the other 2 were reported to the Central Midwives
Board, as were 3 other midwives who were not so seen. These 5 cases were dealt
with as under : 1 was removed from the roll; 1 was cautioned ; in one case sentence
was postponed pending the submission of further reports by the Council at the end
•of three and six months ; 1 was found guilty of the charges brought, but no further
action was taken, and 1 was considered to have been acting as a maternity nurse
only. Six midwives were suspended from practice with a view to the prevention
of the spread of infection, and in four cases compensation was authorised. One
midwife applied for a certificate in support of her application to the Central Midwives
Board for the restoration of her name to the Midwives Roll, but the committee
decided that this application could not be entertained. The Midwives Act, 1902
(section 1 (2)), makes it an offence for any uncertified woman habitually and for
gain to attend women in childbirth except under the direction of a registered medical
practitioner. During the year, 20 inquiries were made by the inspectors into such
cases, in 11 of which it was decided to take no further action ; 7 were dealt with by
a verbal or written action, while of the remaining two cases, one was referred to the
Solicitor on two occasions for legal proceedings, and the other committed for trial
for an illegal operation.
During the year there were 582 still-births reported by midwives in their practice.
The figures for previous years were : 1919, 686 ; 1920, 896 ; 1921, 684 ; 1922, 720.
Of these infants, 312 were males, and 270 females. Of the 582 still-births, 346 were
reported macerated, and 236 not macerated.
360 cases of puerperal fever were reported during the year, as against 311 the
previous year. 97 cases proved fatal, as compared with 91 the previous year, a case
mortality of nearly 27 per cent. as against 29 per cent. the previous year. In addition
the Registrar-General recorded 31 deaths from puerperal sepsis, which were, however,
not notified as puerperal fever. The distribution of the notified cases was as
follows:—
Delivery conducted by Cases. Deaths.
(а) Medical practitioners 126 37
(b) Certified midwives 11128
(c) Medical practitioner and certificate 3 1
(d) Hospitals and poor-law institution 87 22
(e) Cases of miscarriage or abortion where no attendant was engaged 33 9
Total 360 97
In certain emergencies specifically enumerated in the Rules of the Central
Midwives Board a midwife is required to advise in writing that medical aid be
summoned, and must also see that such help is summoned and obtained. The
notice is sent to the doctor, and a copy must be forwarded to the local supervising
authority. During 1923 as many as 7,040 notices were received, as compared with
6,804 in 1922. Assuming that approximately 42,000 confinements were conducted
during the year by midwives in independent practice, it appears that medical aid
was required in about 17 per cent. of the cases, as compared with 16 per cent. in
the preceding year.
Medical aid.
Great stress is laid by the Council on the due observance by midwives of the
Rules of the Central Midwives Board with regard to inflammation of the eyes. However
slight the inflammation may be, it is the duty of the midwife to summon medical
aid, and as soon as the notice is received at this office the case is followed up by one
of the medical inspectors. Notice is also sent to the borough medical officer, so that
the health visitor may continue to keep observation on the child after the midwife
has left the case. Most valuable assistance is also given by the Voluntary Nursing
Associations in cases where domiciliary treatment is necessary.