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1924, 510 in 1925 and 513 in 1926. Of those cases reported this year, 257 were
males, and 227 females, while of two the sex was not stated ; 279 of the still-births
were reported as macerated, 201 not macerated, and in six the condition was not
stated.
Puerperal
fever.
In 1926 reference was made to the fact that the Ministry of Health had in that
year promulgated regulations with regard to puerperal fever and puerperal pyrexia.
Previously puerperal fever was a notifiable disease, but the new regulations required
that the form of certificate contained in Part I. and II. of the first schedule of the
regulations shall be used in future by medical practitioners for notifying cases of
puerperal fever. There were 267 cases of puerperal fever reported during the year,
as against 337 during 1926. Of these, 40 cases proved fatal, as compared with 90
in 1926, a case mortality of nearly 15 per cent., as compared with 26 per cent, the
previous year. In addition, the Registrar-General recorded 23 deaths from puerperal
sepsis, which were not certified as fever, as compared with 30 the previous year.
The distribution of the notified cases with the mode of delivery was as follows,
deaths being shown in brackets:—Medical practitioners, 93 (16); Certified midwives,
70 (9); Medical practitioners and certified midwives, 2 (0); Hospitals and Poor
Law Institutions, 71 (11); Medical students, 7 (0); Cases of miscarriage or abortion
where no attendant was engaged, 23 (4); Uncertified women, 1 (0); total, 267 (40).
Puerperal
pyrexia.
892 notifications of puerperal pyrexia were received during the year, as compared
with 308 in 1926; 37 of the cases proved fatal, distributed as follows, deaths
being shown in brackets:—Medical practitioners, 246 (15); Certified midwives,
186 (8); Medical practitioner and certified midwife, 1 (0); Hospital and midwife,
1 (1); Hospitals and Poor Law Institutions, 392 (9); Medical students, 21 (0);
Cases of miscarriage or abortion where no attendant was engaged, 40 (4); Uncertified
women, 2 (0); no information, 3 (0); total, 892 (37).
Twenty-four of those cases, with eight deaths, were subsequently notified as
puerperal fever, and are, therefore, shown in both tables. Enquiry was made during
the year into the causation of cases of puerperal pyrexia:—186 cases were analysed,
the most frequently attributed causes being as follows:—influenza, 35; respiratory
system, 20; sapraemia, 20; retained membranes, etc., 9; urinary infection, 8;
pelvic infection, excepting sapraemia or septicaemia, 7; breast inflammation, 6;
digestive system, 5; phlebitis, 5; there was no diagnosis in 35 cases.
Medical aid.
The Rules of the Central Midwives Board enumerate certain emergencies for
which a midwife is required to advise in writing that medical aid be summoned, and
must 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
1927, 6,622 notices were received, as compared with 6,910 in 1926. The estimated
number of confinements conducted by midwives in independent practice is about
34,000. It would therefore appear that medical aid was necessary in about 19.5
per cent, of the cases, as compared with 17.5 per cent, during 1926.
Ophthalmia
neonatorum.
New regulations with regard to the treatment and notification of ophthalmia
neonatorum came into force on 1st October, 1926, making it no longer obligatory
for a midwife to notify a case to the local sanitary authority. This duty is
now placed solely upon the medical practitioner. In a memorandum issued by the
Minister, a suggestion appeared 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 summoned by a midwife
to attend a case of ophthalmia neonatorum, and the Council agreed to adopt the
suggestion.
1,300 notices were received during the year with regard to medical aid summoned
for inflammation of the eyes of infants, as compared with 1,282 notices in 1926.
In addition, 65 other cases occurred in which either medical aid was not called in
by the midwife or she failed to notify the Council that she had done so. Of these