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13 of these cases, with 3 deaths, were subsequently notified as puerperal fever,
and are, there fore, included in both tables.
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 1926, 6,910 notices were received, as compared with
7,034 in 1925. Assuming that approximately 40,000 confinements were conducted
during the year by midwives in independent practice, it appears that medical aid
was required in 17.5 per cent. of the cases, nearly the same percentage as in the
preceding year.
Ophthalmia
neonatorum.
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 by the medical inspector 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.
During the year the Minister of Health decided to issue new Regulations with
regard to the treatment and notification of Ophthalmia Neonatorum. The new
Regulations which came into force on the 1st October, 1926, make it no longer
obligatory for a midwife to notify a case. This duty is made the sole responsibility
of the medical practitioner in charge of the patient. The midwife must, however,
forward a notice of sending for medical aid to the local supervising authority. The
reason for this alteration is that the system of dual notification by midwives and
medical practitioners had in some instances resulted in complete failure
to notify. An obligation is also laid upon the Medical Officer of Health
of a Local Sanitary Authority to forward a copy of every notification that
he receives to the County Medical Officer of Health within 24 hours after the receipt
of the notification. In London the Borough Medical Officers are also required to
send a copy of the notification to the Metropolitan Asylums Board within 12 hours.
A memorandum on the new Regulations was issued by the Minister of Health in
which he indicated the necessity for close co-operation between the Local Supervising
Authority under the Midwives Acts and the Local Sanitary Authority where the
former authority is not also the Maternity and Child Welfare Authority and the
Local Sanitary Authority, and he indicated the method he considered would best
bring about the desired result. Steps have been taken in the direction indicated.
The Minister further suggested that the Council should consider whether they should
not refrain from exercising their power of recovery from the patient's representative
of the fee paid to a medical practitioner called in under Section 14 of the Midwives
Act, 1918. The Council decided to adopt the suggestion of the Minister.
1,282 notices were received from midwives during the year with regard to
medical aid summoned for inflammation of the eyes of infants, as compared with
1,284 in 1925. In addition, 60 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 1,342 cases, 413 proved to be ophthalmia neonatorum, as compared
with 422 in 1925; 278 other cases that did not occur in the practice of midwives
were also notified, making a total for the year of 691 notified cases of this disease.
The percentage occurring in the practice of midwives was 59+, as against 60+ in
1925. All the cases that occurred in the practice of midwives were investigated by
the inspectors, and it was found that 404 were reported as completely cured, while
4 died. Impairment of the vision in one eye occurred in 2 cases, whilst in 3