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33
No case of puerperal fever was notified during the year.
In this connection some reference may here be made to the
local administration of the Midwives' Act.
The supervising authority, the Surrey County Council, has
delegated its executive powers to the Sanitary Committee of that
body.
The County Medical Officer of Health is the responsible
officer, and the local Medical Officers of Health act under his
direction and supervision, and report annually to him.
I have during the year repeatedly visited the homes of the
registered midwives practising in the district (three in number),
and have recently reported at length.
The Act works very well here, the midwives attend between
them about half the births, and no difficulties have arisen.
In my opinion it is in every way desirable that women of the
poorer classes should be primarily attended by registered midwives,
and that the function of medical men, in respect of this class of
practice, should be consultative only.
Severe cases of puerperal fever amongst the poorer class of
parturients arise far more frequently when attendance is by a
doctor and untrained nurse than when the attendant is a registered
midwife.
A study of Table I. shows that the total number of deaths
registered in the district during 1908 was only 213, the smallest
number since 1901, when the ascertained population was 17,821.
As this number—213—includes ten or twelve "deaths registered
in the district" really not belonging to the district—cases of
persons whose bodies were recovered from the river, or found on
the railway lines—it is obvious that our death-rate has fallen
greatly.