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55
Puerperal
pyrexia.
The number of notifications of puerperal pyrexia investigated during 1936 was
681, compared with 694 in 1935. The cases were distributed as follows, the deaths
being shown in brackets : medical practitioners 72 (4); certified midwives 94 (6);
hospitals and certified midwives 3 (0); hospitals 488 (12); medical students 7 (0);
cases of miscarriage or abortion where no attendant was engaged 17 (3)—total
681 (25). Seventeen of the cases, with 2 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 call in a medical practitioner. A notice in the approved form is
sent to the doctor, and to the Council. In the year now under review 4,726 such
notices were received, compared with 4,822 in 1935. The estimated number of
confinements conducted by midwives (other than in hospitals approved by the
Central Midwives Board under rule E2) during the year was 17,500. This appears
to indicate that medical aid was necessary in about 27 per cent. of the cases, compared
with 28.4 per cent. during 1935.
The report on Maternity Services of London contains, on pages 12 and 13, an
analysis of reasons for calling for medical aid by midwives in 1913 and 1934. It
was noticeable from the comparative figures that there was a distinct probability
that forceps were used with greater frequency in 1934 than in 1913. The increase
in medical aid between these two dates was largely due to a great increase in cases
of laceration of the perineum ; this does not mean necessarily that there was more
laceration, but that probably midwives were more alive to the need for calling in a
doctor as required by the rules. Further, the greater attention paid to ante-natal
care has resulted in doctors being called in for illnesses or abnormalities arising during
pregnancy approximately four and a half times as often in 1934 as in 1913.
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 medical attendance on account of a baby's eye affection.
The number of claims for attending cases of eye affection during the year was 477
and the amount paid to medical practitioners in respect of the cases was £516,
compared with £534 in 1935.
Inflammation
of the
eyes—
Notices.
During the year, 782 notices were received from midwives indicating that
medical aid had been summoned for inflammation of theeyesof infants,compared with
799 in 1935; 16 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 the total
798 cases, 158 proved to be ophthalmia neonatorum (.81 per cent. of the 17,500
patients attended by midwives), compared with 166 in 1935; 307 other cases that
did not occur in midwives' practices were also notified, making a total of 465 cases
during the year, the percentage occurring in the practice of midwives being 33.97
per cent. of all cases of ophthalmia neonatorum, compared with 44.03 per cent. in
1935. All the midwives' cases were investigated, and it was found that 156 were
completely cured; in one child the sight was impaired ; one child died from a cause
other than ophthalmia. Thirty-five cases became in-patients at St. Margaret's
hospital compared with 28 during 1935.
Pemphigus
neonatorum.
During the year, 53 cases of pemphigus neonatorum occurred in the practice of
midwives, compared with 61 during the previous year.
Instruction
of midwives.
As in past years, courses of demonstrations and lectures at convenient centres
were provided for the post-certificate 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.