View report page

53
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 1934 was 746, compared with 851 in 1933. The cases were distributed
as follows, the deaths being shown in brackets:—Medical practitioners
81 (7); certified midwives 94 (5); hospitals and certified midwives 3 (1); hospitals
and poor-law institutions 516 (15); medical students 13 (0); cases of miscarriage
or abortion where no attendant was engaged 39 (2)—Total 746 (30). Fifty-eight
of the cases, with 7 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 5,362 such notices were received, compared
with 5,405 in 1933. The estimated number of confinements conducted by midwives
in independent practice during the year was 20,180. This appears to indicate that
medical aid was necessary in about 26.6 per cent, of the cases, compared with 25-8
per cent, during 1933.
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 claims for attending cases of eye affection during the
year was 583 and the amount paid to medical practitioners in respect of the cases
was £525 compared with £624 in 1933.
Inflammation
of the
eyes—
Notices.
During the year 955 notices were received from midwives indicating that
medical aid had been summoned for inflammation of the eyes of infants, compared with
1,052 in 1933 ; 23 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 978
cases, 230 proved to be ophthalmia neonatorum, compared with 270 in 1933 ; 242
other cases that did not occur in midwives' practices were also notified, making a
grand total of 472 cases during the year, the percentage occurring in the practice of
midwives being 48.7 per cent., compared with 50.9 per cent, in 1933. All the
midwives' cases were investigated, and it was found that 228 were completely cured ;
2 cases could not be traced owing to the removal of the parents. Forty-six cases
became in-natients at St. Margaret's hospital, compared with 36 during 1933.
Pemphigus
neonatorum
During the year 24 cases of pemphigus neonatorum occurred in the practice of
midwives, compared with 37 during the previous year.
Instruction
of midwives.
As in past years, courses of demonstrations and lectures at convenient centres
were provided for the post graduate instruction of midwives practising in London,
Middlesex, Ealing, Edmonton, Tottenham and Willesden, the cost being shared by
the local supervising authorities in proportion to the numbers of their midwives
attending.
In April, 1930, the Central Midwives Board suggested that lectures to pupil
midwives on the Rules of the Central Midwives Board and the relationship of the
midwife to the various health authorities should be given by the medical officer of
health of the local supervising authority.