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7. Nephritis and uræmic symptoms (three cases).—In two cases which recovered
the cerebro-spinal fluid was found to be normal. In the third case, the increase in
the amount of area to over 0.4 per cent., and of chlorides to 1 per cent., in the cerebrospinal
fluid, pointed to a state of ureæmia, which was associated with sudden fatal
hemiplegia.
Consultation Visits.—The low incidence in London of both encephalitis lethargica
and cerebro-spinal fever during the past year was reflected in the small number of
calls for consultation in suspected cases. Only four such visits were paid to patients
in North Kensington, Hampstead, Islington and Eltham at the request of private
practitioners or medical officers of health:—(1) A boy, aged 5, proved to be a case
of measles complicating cerebral tumour. (2) A woman of 30 (full term pregnancy)
was suffering from probable encephalitis associated with myoclonus; she experienced
a normal confinement, and has so far made a good recovery after an interval of five
months. (3) A man, aged 62, whose febrile state, complicated by extensive rash
and lethargy, rendered diagnosis very uncertain, was transferred to hospital and
very shortly made complete recovery. The final diagnosis was drug-poisoning from
overdose of aspirin and aconite. (4) A girl, aged 18, at Avery Hill College, whose
condition was suggestive of encephalitis lethargica or cerebral tumour, made recovery
and after an interval of five months showed nothing abnormal.
Midwives Acts, 1902 to 1926, Nursing Homes Registration Act, 1927,
and Children Act, 1908.
Midwives.
There are approximately 5,000 certified midwives with London addresses of
whom 854 gave notice of intention to practise within the county during the year
as compared with 870 in 1927, the remainder acting mostly as general or monthly
nurses under medical supervision. Practising midwives, other than those who
work entirely in voluntary or poor law hospitals 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. It may be noted that E.27 of the Rules of
the Central Midwives Board provides that the said Rules, other than 22 (2) shall
not apply to certified midwives exercising their calling in poor law institutions
"under the supervision of a duly appointed medical officer," which is interpreted
by the Central Midwives Board as meaning "a resident medical officer." The
work of inspection is carried out by four women assistant medical officers who
supervise the work of the midwives generally; give advice in regard to any difficulties
that may arise in connection with their work and pay special visits where cases of
a septic nature or persistent high temperature, inflammation of the eyes or blisters
on the child occur. 2,115 visits were paid this year as compared with 2,014 in 1927.
Infringements
of
C.M.B.
rules.
95 infringements of the Rules of the Central Midwives Board were reported
during the year, as compared with 77 during 1927. Of these, 75 were slight and
a verbal caution was deemed to be sufficient, 13 cases of a more serious nature were
dealt with by a written caution, and 5 were interviewed by the Committee and
personally cautioned. One midwife was reported to the Central Midwives Board
and severely censured; in another case the Board directed that special observation
should be kept on the midwife and reports submitted to the Board at the end of
periods of three, six and nine months respectively. This midwife's name was
ultimately removed from the roll.
Suspension
of midwives.
The Midwives Act, 1926, laid it down that in the case of midwives suspended
from practice in order to prevent the spread of infection the local supervising
authorities must compensate such midwife for loss of practice by the payment of
such amount as is reasonable in the circumstances of the case, provided that the
midwife was not herself in default. 15 midwives were suspended from practice
during the year in order to prevent the spread of infection, and in 7 cases compensation
was authorised.