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53
placing of maternity nursing on a more satisfactory basis; (10) The training in
midwifery of medical students. It was agreed that evidence should be submitted
on these matters to the Departmental Committee in due course.
During the year 125 cases of pemphigus neonatorum occurred, as compared
with 251 during the previous year. In my last report attention was drawn to the
fact that the cause of infection in such cases is obscure, and that an arrangement
had been made for a special enquiry to be carried out. Dr. Christabel Eyre, who
made the enquiry, came to the conclusion that the cases occurring were true pemphigus
neonatorum and that the measures at present enforced by the Council for
the prevention of the spread of infection appeared to be adequate so far as our
present knowledge permits. Midwives now appear to realise the great importance
of early diagnosis and careful personal disinfection once the diagnosis is established.
Pemphigus
neonatorum.
In the last annual report attention was drawn to the fact that there had been
scarcely any decrease in the maternal mortality rate for some years past, and it was
hoped that the higher standards of work in midwifery would lead to improvement
in this respect. On 23rd April, 1928, the Ministry of Health issued a circular on the
subject. This circular referred to a prior one, dated 30th June, 1924, suggesting
that an investigation be made in every area by a competent and experienced medical
officer with regard to all maternal deaths and all cases of puerperal fever. The
inquiry was to be conducted with a view to ascertaining more exactly the actual
causes which lead to maternal mortality, and in order, if possible, to provide further
means of prevention. Further it was suggested that the responsibility for the
investigation should be undertaken by a medical officer of experience, and that in
those cases in which the Maternity and Child Welfare authority is not also the local
supervising authority under the Midwives Acts the two authorities should confer
with a view to deciding to what officer these investigations should be entrusted.
Arrangements to give effect to the suggestion of the Ministry have been made, and
reports on forms issued by the Ministry will be made by the officers of this Council
concerned and exchanged with the borough medical officers, it being clearly understood
that such reports are strictly confidential. A discussion of the statistics of
maternal mortality appears earlier in this report, see p. 12.
Maternal
mortality.
The Midwives Act, 1918, gave to the Council the duty of paying the medical
practitioners' fees when called in by midwives in cases of emergency. Later the
Ministry of Health laid down a scale to which local authorities must adhere. The
Midwives Act, 1926, fixed a limit of time, namely, two months from the date of the
first visit, within which a medical practitioner must submit his claim. In pursuance
of this provision 95 claims amounting to £97 18s. 0d. were refused during 1928.
In addition 69 claims submitted by one medical practitioner in 1926 amounting to
£85 6s. 0d. were refused. The claims were spread over a number of years, some
visits being paid prior to 1926 and the refusal was based on the opinion of the solicitor.
3,736 claims were submitted during the year 1928, as compared with 3,535 in 1927,
the total amount involved being £4,131 15s. 0d. as compared with £3,012 11s. 0d.
in 1927.About 25 per cent. of this amount will, it is believed, in due course be
recoverable from patients.
Payment of
medical fees.
On 1st January, 1928, there were in all lying-in homes registered under
the provisions of Part IV of the London County Council (General Powers) Act,
1921. Twenty-five applications for registration were received during the period
1st January to 30th June, 1928. Fourteen of these applications were granted and
one refused. During the same period 56 registrations were cancelled at the request
of the registered keepers or upon the receipt of reports that the premises were no
longer used as lying-in homes. On 30th June, 1928, there were 203 homes on the
register.
Lying-in
homes.
The Nursing Homes Registration Act, 1927, came into force on 1st July, 1928.
This Act repeals Part II of the Midwives and Maternity Homes Act, 1926, and also
Nursing
homes.