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new matter and the deletion of matter which no longer required special mention,
but also to the rearrangement of the order of the rules, and to redrafting them.
In the Board's opinion, this step had become necessary owing to the fact that past
additions to and subtractions from the original framing of the rules had resulted in
loss of symmetry and clarity. The memorandum, which explains the alterations
in the rules, and a copy of the new edition of section E, were sent by the Council in
August, 1934, to each midwife on the list of midwives practising in the County, and
the Council called attention to the responsibility of every midwife to make herself
acquainted with the new rules.
Certified midwives to the number of 904 gave notice of intention to practise
within the county during the year, compared with 854 in 1933. Practising midwives,
other than those who work entirely in hospitals approved by the Central Midwives
Board under medical supervision, are subject to inspection by the Council's inspectors
of midwives with a view to ensuring that a proper standard of efficiency is maintained.
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 ; 2,421 visits were paid this year compared with 2,623 in 1933.
Infringements of the Rules of the Central Midwives Board to the number of 42
were reported during the year, compared with 51 in 1933. Of these 37 were slight,
and a verbal caution was deemed to be sufficient; 4 cases of a more serious nature
were dealt with by a written caution, and one midwife was interviewed and cautioned
bv the Committee.
The Midwives Act, 1926, requires that, in the case of midwives suspended from
practice in order to prevent the spread of infection, the local supervising authority
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; 18 midwives were suspended from practice during the year
in order to prevent the spread of infection, and 12 claimed compensation which was
authorised.
Suspension of
midwives.
The Midwives and Maternity Homes Act, 1926, amended section 1 (2) of the
Midwives Act, 1902, so as to make it an offence for any uncertified person to attend
women in childbirth, except under the direction and personal supervision of a
registered medical practitioner, unless the case was one of sudden or urgent necessity.
During the year 6 enquiries were made into such cases, compared with 7 in 1933.
In 3 cases a caution was administered; in 3 cases no further action was considered
necessary.
Uncertified
persons.
During the year there were 274 still-births reported to the Council by midwives
in their practice, compared with 594 in 1924, 510 in 1925, 513 in 1926, 486 in 1927,
473 in 1928, 413 in 1929, 408 in 1930, 363 in 1931, 324 in 1932 and 316 in 1933. Of
the cases reported this year 145 were male, 128 female and in one case the sex was
not stated ; 158 were reported as macerated, and 116 not macerated.
Still-births.
During the year 257 cases ot puerperal tever were investigated, compared with
259 in 1933. Of these cases 33 proved fatal, compared with 41 in 1933, a case
mortality of 12.8 per cent., compared with 15.8 per cent, in 1933. The distribution
of notified cases, with the mode of delivery, was as follows, deaths being
shown in brackets :—Medical practitioners 62 (7); certified midwives 66 (8);
hospitals and certified midwives 2 (1); hospitals and poor-law institutions 79 (13);
medical students 10 (0) ; cases of miscarriage or abortion where no attendant was
eneased 38 (4)—Total 257 (33).
Puerperal
fever.
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."
Puerperal
Pyrexia.