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42
Puerperal
pyrexia.
the Registrar-General recorded 26 deaths from puerperal sepsis,which were not certified
as fever, compared with 41 the previous year. The distribution of notified cases,
with the mode of delivery, was as follows, deaths being shown in brackets:—
Medical practitioners 55(6); certified midwives 43(9); medical practitioners
and certified midwives 17(3); hospitals and poor-law institutions 69(13); medical
students 9(0); cases of miscarriage or abortion where no attendant was engaged
24 (4); medical students and certified midwives 2 (0).—Total, 219 (35).
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 on 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. The number of notifications of puerperal pyrexia investigated
during 1932 was 783, compared with 871 in 1931. The cases were distributed
as follows, the deaths being shown in brackets:—Medical practitioners
94(3); certified midwives 128(8); medical practitioners and certified midwives
7(0); hospitals and poor-law institutions 479(17); medical students 25(1); cases
of miscarriage or abortion where no attendant was engaged 50(2)—Total 783(31).
Three of the cases, with one death, 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 5,990 such notices were received, compared
with 6,326 in 1931. The estimated number of confinements conducted by midwives
in independent practice during the year was 26,105. This appears to indicate that
medical aid was necessary in about 22.9 per cent, of the cases, compared with 22.4
per cent, during 1931.
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 718 and the
amount paid to medical practitioners in respect of the cases was £733, compared
with £699 in 1931
Inflammation
of the
eyes—
Notices.
During the year 1,155 notices were received from midwives indicating that
medical aid had been summoned for inflammation of the eyes of infants, compared with
1,288 in 1931; 37 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 1,192
cases, 333 proved to be ophthalmia neonatorum, compared with 326 in 1931; 349
other cases that did not occur in midwives' practices were also notified, making a
grand total of 682 cases during the year, the percentage occurring in the practice of
midwives being 48.8 per cent., compared with 52.2 per cent, in 1931. All the