View report page

57
Medical aid.
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 1924 as many as 6,961 notices were received, as compared with
7,040 in 1923. Assuming that approximately 42,000 confinements were conducted
during the year by midwives in independent practice, it appears that medical aid
was required in under 17 per cent. of the cases, about the same percentage as in the
preceding year.
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.
1,266 notices were received from midwives during the year with regard to
medical aid summoned for inflammation of the eyes of infants, as compared with
1,339 in 1923. In addition, 57 other cases occurred in which either medical help
was not called in by the midwife or she failed to notify the Council that she had done
so. Of these 1,323 cases, 431 proved to be ophthalmia neonatorum, as compared
with 449 in 1923; 275 other cases that did not occur in the practice of midwives
were also notified, making a total for the year of 706 notified cases of this disease.
The percentage occurring in the practice of midwives was 61.0, as against 59.6 in
1923. All the cases that occurred in the practice of midwives were investigated by
the inspectors, and it was found that 403 were reported as completely cured, while
7 died. Impairment of the vision in both eyes occurred in 4 cases and of one eye
also in 4 cases, whilst in 13 instances the result could not be ascertained owing to the
removal of the patients. In addition, one unnotified case in the practice of midwives
was investigated in which there was damage to the eyes, resulting in impairment
of vision in one eye. 54 cases received in-patient hospital treatment at St.
Margaret's Hospital.
In past years classes have been arranged for the instruction of midwives, and
were well attended. As it was found that there had been a falling off in the attendance,
it was decided to dispense with such classes during 1923, but they were resumed
this year.
Pemphigus
neonatorum.
The occurrence during the year of 35 cases of pemphigus neonatorum in the
practice of midwives calls for some special comment. As regards the nature of
this complaint, it would appear that no definite description of it was made until
the year 1588, when Schenck wrote an account of an epidemic in Germany amongst
newly born children, which appears to have been pemphigus neonatorum. Since
then the subject has been frequently referred to by various writers, but there are
still unsolved various points in connection with the ailment. For example, agreement
has not been reached as to the actual place this complaint should occupy
amongst skin diseases. Again, the causative organism, if any, has not been identified
with any degree of certainty, and there is still doubt as to the length of the incubation
period. There is, however, one question on which there can be no disagreement,
and that is the extremely infectious nature of pemphigus neonatorum. Under the
Central Midwives Board rules a midwife has to notify to her supervising authority
any case of skin disease in an infant when accompanied by the presence of blisters,
and on receipt of such notice the child is at once visited by one of the Council's
inspectors, and it is often found that sufficient attention has not been paid to the
infectivity of the condition. It has sometimes proved difficult to limit the spread
of the disease, and the question has even been raised as to the necessity of having to