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CENTRAL MIDWIVES BOARD.
1564 most effective and quickest method of emptying the bowel is to wash out the contents by means of an enema; this, however, cannot be done with the colotomy tube at present in use. On several occasions I have tried to do this by making a small hole in the large rubber escape tube used to carry off the bowel contents and introducing fluids while the tube is clamped below the hole. This has proved unsatisfactory, as leakage occurs subsequently through the hole and the tube is rendered useless in future. Some months ago Messrs. Weiss and Son made to my pattern a colotomy tube (see illustration) which avoids these drawbacks and allows the bowel to be flashed without inconvenience. The tube differs from the one in general use in the fact that a small short arm is inset into the convexity of
CENTRAL MIDWIVES BOARD. A MEETING of the Central Midwives Board was held at Caxton House, Westminster, on Nov. 23rd, with Sir FRANCIS CHAMPNEYS in the chair. The following letter was considered from the clerk of the Privy Council as to the power of the local supervising authority to make a rule prohibiting a midwife from laying out a dead body :Privy Council Office, 19th October, 1911, To the Secretary, Central Midwives Board. SIR,-Referring to your letter of the 13th instant enclosing a copy of a
letter from the town clerk of St. Helens
as
to the power of the local
supervising authority to make a rule prohibiting a midwife from laying out dead body, I have to point out, for the information of the Central Midwives Board, that it is not suggested that the local supervising authority has any authority under the Midwives Act, 1902, to make such a rule, but that Rule E, 17 (b) of the Board’s rules, as finally drawn, was intended to save any right possessed by the councils of counties or county boroughs under their general statutory powers to make a rule on the subject, it being better that there should be a general
rule in the matter, rather than that it should be left to the discretion of the authority in particular cases. I am, Sir, your obedient servant, ALMERic FiTRov, (Signed) The Clerk of the Council.
The Board directed that a copy of the letter from the clerk of the Council be forwarded to the town clerk of St. Helens. A letter was considered from the superintendent of the Gloucester District Nurses’ Home, inquiring as to whether a midwife should undertake a case when she believes it would be better for the patient to engage a medical man, and as to her duty to notify a stillbirth when engaged as a maternity nurse under a medical man. The Board decided that the reply should be : (a) That the question of whether a midwife should undertake a case or not is outside the rules, and must be decided by the exercise of the ordinary judgment of a prudent midwife. (b) That a midwife acting as a maternity nurse under the direction of a qualified medical practitioner is not bound to notify a stillbirth under Rule E, 21. A letter was considered from Dr. W. E. Fothergill, of Manchester, one of the Board’s examiners, as to lengthening the curve, so that it has the same direction as the limb of the and raising the standard of training, and a letter was contube which is inserted into the bowel. When in use a small sidered from Mr. E. Sergeant, county medical officer for piece of drainage tube about six inches long is fitted on Lancashire, to the same effect. The Board decided that the After the tube is fastened into the letters of Dr. Fothergill and Mr. to the short arm. Sergeant be noted for conbowel the end of the drainage tube will project above the sideration at the next revision of the rules. dressings, and must be secured to prevent the escape of bowel A letter was considered from Dr. J. M. Cowie, medical contents ; this may be done with a pair of clip forceps or a officer of health of Burton-on-Trent, inquiring as to the course safety pin attached to the binder or the tube may be tied in to be adopted with regard to midwives who can neither read a simple knot. After the first gush of fsecal material has nor write, or who are incapable of learning to take or record passed the interior of the bowel can be washed out by means pulse and temperature. The Board directed that it be pointed of a douche can or an enema syringe, the fluid being led out to Dr. Cowie that it lies with the local supervising through the small rubber tube into the interior of the colotomy authority to take action in the first instance against midtube. The large escape tube is flushed out and then clamped, wives who are unable to comply with the rules of the Board, after which the fluid enters the bowel. In this way enemata and that the Board would deal with any midwife against can be given at short intervals without disturbing or soiling whom the authority had found a prima-faoze case of malthe dressings. The ordinary enemata can be employed, but practice, negligence, or misconduct. if an irritant such as turpentine is used only half the usual A letter was read from the superintendent of the Cornwall strength should be given on account of the inflamed state County Nursing Association, inquiring whether a midwife of the bowel. may attend maternity cases and nurse cases of enteric fever Another great advantage is that after the bowel is cleared, at the same time. The Board decided that the superintendent which can be done usually in about six hours, fluids of the Cornwall County Nursing Association should be referred such as warm saline can be given in the same manner as is to Rule E, 5, which runs as follows : employed in septic peritonitis. It is rapidly absorbed and Whenever a midwife has been in attendance upon a patient suffering is useful in replacing the amount of fluid lost by the from puerperal fevers, or from any other illness supposed to be she must disinfect herself and all her instruments and other previous vomiting. If the vomiting has been present for infectious, appliances, to the satisfaction of the local supervising authority, and some days another element antagonistic to the patient has must have her clothing thoroughly disinfected before going to another to be reckoned with, namely, actual starvation, as nothing labour. Unless otherwise directed by the local supervising authority, taken by the mouth has been retained in the stomach; for all washable clothing should be boiled, and other clothing should be this reason it is a good plan to add to the saline sufficient sent to be disinfected by the local sanitary authority. A letter was considered from the clerk of the Aberdare glucose to make a 2 per cent solution. This can be urban district council forwarding a copy of a resolution as blood used a food. absorbed directly into the and I have used these tubes on more than a dozen cases and passed by the council expressing the opinion that a period of find them a great advance on the old ones, which serve 24 hours is too short a quarantine for a midwife who been attending on virulent cases of puerperal fever. merely as an outlet for the bowel contents. The tubes are has made in four sizes, ranging in diameter from half an inch to The Board directed that the attention of the clerk of the Aberdare urban district council be called to the terms of an inch and a îIl1arter. Rule F, 2, which prescribes the procedure in cases where it C. L. Ch.M. DUNCAN Edin., FITZWILLIAMS, is found necessary to suspend a midwife for a longer period F.R.C.S. Eng. and Edin. Grosvenor-street, W. than 24 hours. A letter from Dr. Comyns Berkeley, obstetric physician, ASSOCIATION OF CERTIFYING FACTORY SURGEONS. Middlesex Hospital, on behalf of the weekly board of -The annual dinner of this association will be held at the the hospital, with regard to a complaint made by a Trocadero Restaurant, London, on Friday next, Dec. 8th, at certified midwife of the inadequacy of the training given at 7.30 P.M. Communications should be addressed to the the hospital, was considered, and the Board decided that all further action should be left in the hands of the chairman. Secretary, 16, John Dalton-street, Manchester.
CENTRAL MIDWIVES BOARD. A MEETING of the Central Midwives Board was held at Caxton House, Westminster, on Nov. 23rd, with Sir FRANCIS CHAMPNEYS in the chair. The following letter was considered from the clerk of the Privy Council as to the power of the local supervising authority to make a rule prohibiting a midwife from laying out a dead body :Privy Council Office, 19th October, 1911, To the Secretary, Central Midwives Board. SIR,-Referring to your letter of the 13th instant enclosing a copy of a
letter from the town clerk of St. Helens
as
to the power of the local
supervising authority to make a rule prohibiting a midwife from laying out dead body, I have to point out, for the information of the Central Midwives Board, that it is not suggested that the local supervising authority has any authority under the Midwives Act, 1902, to make such a rule, but that Rule E, 17 (b) of the Board’s rules, as finally drawn, was intended to save any right possessed by the councils of counties or county boroughs under their general statutory powers to make a rule on the subject, it being better that there should be a general
rule in the matter, rather than that it should be left to the discretion of the authority in particular cases. I am, Sir, your obedient servant, ALMERic FiTRov, (Signed) The Clerk of the Council.
The Board directed that a copy of the letter from the clerk of the Council be forwarded to the town clerk of St. Helens. A letter was considered from the superintendent of the Gloucester District Nurses’ Home, inquiring as to whether a midwife should undertake a case when she believes it would be better for the patient to engage a medical man, and as to her duty to notify a stillbirth when engaged as a maternity nurse under a medical man. The Board decided that the reply should be : (a) That the question of whether a midwife should undertake a case or not is outside the rules, and must be decided by the exercise of the ordinary judgment of a prudent midwife. (b) That a midwife acting as a maternity nurse under the direction of a qualified medical practitioner is not bound to notify a stillbirth under Rule E, 21. A letter was considered from Dr. W. E. Fothergill, of Manchester, one of the Board’s examiners, as to lengthening the curve, so that it has the same direction as the limb of the and raising the standard of training, and a letter was contube which is inserted into the bowel. When in use a small sidered from Mr. E. Sergeant, county medical officer for piece of drainage tube about six inches long is fitted on Lancashire, to the same effect. The Board decided that the After the tube is fastened into the letters of Dr. Fothergill and Mr. to the short arm. Sergeant be noted for conbowel the end of the drainage tube will project above the sideration at the next revision of the rules. dressings, and must be secured to prevent the escape of bowel A letter was considered from Dr. J. M. Cowie, medical contents ; this may be done with a pair of clip forceps or a officer of health of Burton-on-Trent, inquiring as to the course safety pin attached to the binder or the tube may be tied in to be adopted with regard to midwives who can neither read a simple knot. After the first gush of fsecal material has nor write, or who are incapable of learning to take or record passed the interior of the bowel can be washed out by means pulse and temperature. The Board directed that it be pointed of a douche can or an enema syringe, the fluid being led out to Dr. Cowie that it lies with the local supervising through the small rubber tube into the interior of the colotomy authority to take action in the first instance against midtube. The large escape tube is flushed out and then clamped, wives who are unable to comply with the rules of the Board, after which the fluid enters the bowel. In this way enemata and that the Board would deal with any midwife against can be given at short intervals without disturbing or soiling whom the authority had found a prima-faoze case of malthe dressings. The ordinary enemata can be employed, but practice, negligence, or misconduct. if an irritant such as turpentine is used only half the usual A letter was read from the superintendent of the Cornwall strength should be given on account of the inflamed state County Nursing Association, inquiring whether a midwife of the bowel. may attend maternity cases and nurse cases of enteric fever Another great advantage is that after the bowel is cleared, at the same time. The Board decided that the superintendent which can be done usually in about six hours, fluids of the Cornwall County Nursing Association should be referred such as warm saline can be given in the same manner as is to Rule E, 5, which runs as follows : employed in septic peritonitis. It is rapidly absorbed and Whenever a midwife has been in attendance upon a patient suffering is useful in replacing the amount of fluid lost by the from puerperal fevers, or from any other illness supposed to be she must disinfect herself and all her instruments and other previous vomiting. If the vomiting has been present for infectious, appliances, to the satisfaction of the local supervising authority, and some days another element antagonistic to the patient has must have her clothing thoroughly disinfected before going to another to be reckoned with, namely, actual starvation, as nothing labour. Unless otherwise directed by the local supervising authority, taken by the mouth has been retained in the stomach; for all washable clothing should be boiled, and other clothing should be this reason it is a good plan to add to the saline sufficient sent to be disinfected by the local sanitary authority. A letter was considered from the clerk of the Aberdare glucose to make a 2 per cent solution. This can be urban district council forwarding a copy of a resolution as blood used a food. absorbed directly into the and I have used these tubes on more than a dozen cases and passed by the council expressing the opinion that a period of find them a great advance on the old ones, which serve 24 hours is too short a quarantine for a midwife who been attending on virulent cases of puerperal fever. merely as an outlet for the bowel contents. The tubes are has made in four sizes, ranging in diameter from half an inch to The Board directed that the attention of the clerk of the Aberdare urban district council be called to the terms of an inch and a îIl1arter. Rule F, 2, which prescribes the procedure in cases where it C. L. Ch.M. DUNCAN Edin., FITZWILLIAMS, is found necessary to suspend a midwife for a longer period F.R.C.S. Eng. and Edin. Grosvenor-street, W. than 24 hours. A letter from Dr. Comyns Berkeley, obstetric physician, ASSOCIATION OF CERTIFYING FACTORY SURGEONS. Middlesex Hospital, on behalf of the weekly board of -The annual dinner of this association will be held at the the hospital, with regard to a complaint made by a Trocadero Restaurant, London, on Friday next, Dec. 8th, at certified midwife of the inadequacy of the training given at 7.30 P.M. Communications should be addressed to the the hospital, was considered, and the Board decided that all further action should be left in the hands of the chairman. Secretary, 16, John Dalton-street, Manchester.