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the Registrar-General recorded 41 deaths from puerperal sepsis which were not certified
as fever, compared with 29 the previous year. The distribution of notified cases,
with the mode of delivery, was as follows, deaths being shown in brackets :—
Medical practitioners 71 (17); certified midwives 59 (9); medical practitioners
and certified midwives 3 (1); hospitals and poor-law institutions 103 (23); medical
students 19 (2); cases of miscarriage or abortion where no attendant was engaged
27 (7); not ascertained 1 (0).—Total, 283 (59).
Puerperal
pyrexia.
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 must be sent to the medical officer of health of the district in which
the said place is situated ; 871 notifications of puerperal pyrexia were investigated
during 1931, compared with 760 in 1930. The cases were distributed
as follows, the deaths being shown in brackets:—Medical practitioners
139 (10) ; certified midwives 159 (11) ; medical practitioners and certified midwives
8 (1); hospitals and poor-law institutions 485 (24); medical students 33 (0); cases
of miscarriage or abortion where no attendant was engaged 45 (2) ; uncertified
women 2 (1)—Total 871 (49). Nineteen of the cases, with 4 deaths, were subsequently
notified as puerperal fever, and are therefore shown in both tables.
Medical aid.
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 6,326 such notices were received, compared
with 6,516 in 1930. The estimated number of confinements conducted by midwives
in independent practice during the year was 28,228. This appears to indicate that
medical aid was necessary in about 22.4 per cent, of the cases, compared with 22.5
per cent, during 1930.
Ophthalmia
neonatorum.
In 1926, regulations came into force rendering it no longer necessary for a midwife
to notify a case of ophthalmia neonatorum 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 decided that parents should not be asked to reimburse
the Council for fees paid for such medical attendance on account of a baby's eye
affection. The number of cases of eye affection during the year was 761 and the
amount paid to medical practitioners in respect of the cases was £699 Is., compared
with £716 in 1930.
Inflammation
of the
eves—
Notices.
During the year 1,288 notices were received from midwives indicating that
medical aid had been summoned for inflammation of theeyesof infants, compared with
1,346 in 1930 ; 36 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 1,324
cases, 326 proved to be ophthalmia neonatorum, compared with 321 in 1930 ; 298
other cases that did not occur in midwives' practices were also notified, making a
grand total of 624 cases during the year, the percentage occurring in the practice of
midwives being 52.2 per cent., compared with 52.3 per cent, in 1930. All the