View report page

42
Puerperal
pyrexia.
Medical aid.
Ophthalmia
neonatorum.
Inflammation
of the eyes—
Notices.
of nearly 19.9 per cent. compared with 18.7 per cent. in 1928. In addition, the
Registrar General recorded 39 deaths from puerperal sepsis which were not certified
as fever, compared with 33 the previous year. The distribution of notified cases,
with the mode of delivery, was as follows, deaths being shown in brackets:—Medical
practitioners, 75 (16); Certified midwives, 91 (18); Medical practitioner and certified
midwife, 5(1); Hospitals and poor law institutions, 87 (18); Medical students,
12 (2); Cases of miscarriage or abortion where no attendant was engaged, 39 (7);
Not ascertained, 2 (—). Total, 311 (62).
In July, 1926, the Ministry of Health made Regulations requiring the notification
of puerperal pyrexia which is defined by the Regulations to be "any febrile condition
(other than a condition which is required to be notified as puerperal fever under
the Infectious Diseases (Notification) Acts) occurring in a woman within 21 days
after child-birth or miscarriage in which a temperature of 100.4° Fahrenheit (38°
centigrade) or more has been sustained during a period of 24 hours or has recurred
during that period."
The Regulations were amended in 1928 and now require a medical practitioner
to notify any such case on the approved form and transmit the notification to the
medical officer of health of the district in which the patient is actually living at
the time of notification. In addition, any notification of a case in a London hospital
must specify the place from which and the date at which the patient was brought
to the hospital and shall be sent to the medical officer of health of the district in
which the said place is situated: 781 notifications of puerperal pyrexia were received
during 1929, compared with 787 in 1928; 54 of these cases proved fatal and were
distributed as follows, the deaths are shown in brackets:—Medical practitioners,
158(17); Certified midwives, 170(12); Hospitals and Poor Law institutions, 357 (18);
Medical students, 16 (—); cases of miscarriage or abortion where no attendant
was engaged, 74 (7); Uncertified woman, 1 (—); No information, 5 (—). Total,
781 (54).
Thirty-seven of the cases, with 10 deaths, were subsequently notified as puerperal
fever, and are therefore shown in both tables.
The Rules of the Central Midwives Board indicate the emergencies for which
a midwife must advise in writing that medical aid be obtained, and for which such
help must be secured. A notice in the approved form is sent to the doctor, and to
the Council. In the year now under review, 6,833 such notices were received,
compared with 6,984 in 1928. The estimated number of confinements conducted
by midwives in independent practice during the year was 30,000. This appears to
indicate that medical aid was necessary in about 22.8 per cent, of the cases,
compared with 21.8 per cent, during 1928.
In 1926, regulations came into force rendering it no longer necessary for a midwife
to notify a case of this disease to the local sanitary authority, this duty being assigned
to the medical practitioner only. This, however, did not relieve the midwife of
the necessity of sending a copy of her medical aid notice in all such cases to the
Council. The Ministry of Health issued a memorandum in connection with the
regulations, suggesting that the Council should consider whether it should not
refrain from exercising the power of recovery from the patient's representative of
the fee paid to a medical practitioner summoned by a midwife in a case of
ophthalmia neonatorum, and the Council agreed to adopt the suggestion. The
number of such cases during the year was 754, and the amount paid to medical
practitioners in respect of such cases was £612 17s. 6d.
During the year 1,333 notices were received indicating that medical aid had
been summoned for inflammation of the eyes of infants, compared with 1,421
in 1928 ; 42 other cases arose 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 1,375
cases, 415 proved to be ophthalmia neonatorum, compared with 444 in 1928;