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48
to debility from overwork at school, cardiac syncope and concussion, hysteria, and
in the fourth case the clinical condition pointed strongly to cerebral tumour, opinions
which subsequently proved correct.
(2) Poliomyelitis was suspected in five patients and confirmed at consultation
and by subsequent events in two, one of whom recovered and the other continues
in statu quo. In the other three, opinion was given against poliomyelitis in favour
of neuritis in two, since recovered, and the third, a child of two, when removed to
hospital was found to be suffering from acute pneumonia.
(3) Meningitis—six consultations. Whereas cerebro-spinal meningitis was
suspected in each case, that diagnosis was not supported at consultation or as the
result of lumbar puncture. It was possible to determine that four patients were
suffering from other forms of meningitis; in two, as a complication of middle
ear disease and mastoid inflammation, the other two respectively, acute pneumococcal
meningitis and tuberculous meningitis. In one patient the normal cerebrospinal
fluid clearly contra-indicated meningitis and the symptoms pointed to
intracranial pressure by cerebellar tumour or cyst; sudden death occurred two days
later, but post mortem examination was refused. The acute condition of the
sixth case of supposed cerebro-spinal meningitis was held at consultation to be due
to influenza, from which the child, aged 4, soon recovered.
Midwive8.
Midwives Acts and Children Acts.
Duly certified midwives with London addresses exceed 5,000 in number, of
whom 868 gave notice of their intention to practise within the County during the
whole or part of the year, a decrease of 33 on last year's figures. About 17-3 per
cent, of the midwives with London addresses are in actual independent practice in
the County, the remainder acting mostly as monthly or general nurses under medical
supervision. Practising midwives, other than those who work entirely in hospitals or
infirmaries under medical supervision, are subject to inspection by the Council's
officers, with a view to ensuring that a proper standard of efficiency is maintained.
This work is carried out by four women medical inspectors, who pay special visits
to midwives having cases of a septic nature or persistent high temperature or inflammation
of the eyes. Advice is also given by the inspectors on any point of difficulty
arising in connection with the work: 2,145 visits were paid by the inspectors
this year, as compared with 2,384 the previous year.
Infringement
of
O.M.B.
rales.
88 infringements of the rules of the Central Midwives Board were reported
during the year, of which 50 were slight, and therefore dealt with by means of a
"verbal caution; 25 cases were of a more serious nature, and were dealt with by a
written caution. Of the remaining 13 cases, 11 midwives were seen by the Committee,
and 8 of them cautioned, the other 3 being reported to the Central Midwives
Board ; the hearing of two cases was adjourned by the Committee. Of the
3 cases reported to the Board, one was cautioned; in the other cases the Board
postponed sentence and asked for periodical reports on the midwife's conduct and
methods of practice. Eleven midwives were suspended from practice with a view
to the prevention of the spread of infection, and in 6 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 this was refused. The Midwives Act, 1902 (section 1 (2)), as amended by
the Midwives and Maternity Homes Act, 1926, makes it an offence for any uncertified
person to attend women in childbirth except under the direction and personal
supervision of a registered medical practitioner, except in sudden or urgent necessity.
During the year 11 inquiries were made by the inspectors into such cases, in 8 of
which it was decided to take no further action; 2 were dealt with by a verbal or
written caution and one woman was prosecuted and bound over in the sum
of £20.