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Midwives act
January, 1906]
Midwives Act
248
MIDWIVES ACT. THE County Council of Hertfordshire--with a Ropulation of 270,000 and acreage of 403,000--is about to consider the question of appointing a whole-time Medical Officer of Health ; but meanwhile has commissioned its present Medical Officer to carry out the Midwives' Act, 1902, and report quarterly to the District and Parish Councils' Committee, which is the body responsible in the first instance for all its sanitary duties. The Medical Officer, therefore, has, not unwillingly, undertaken himself to visit all midwives in the county for the present ; as this, in the first place, gives him a personal acquaintance with the midwives and of the actual difficulties he will have to meet under the Act, and in the second, gives him an opportunity of visiting all the parishes throughout the county, for which he has hitherto had to draw up 'his annual report with absolutely no first-hand information, with the few exceptions of those cases in which he has been commissioned to hold special enquiries; for instance, into water supply, sewerage, or hospital accommodation. He is at the same time able thus to visit the District Medical Officers of Health and Coroners. He is paid three guineas a day, out of which he has to pay expenses. The work is usually done on a bicycle, starting by railway out of London, where he lives for convenience sake. All committees of the Herts Coun~ Council are held in London, and six main railway lines pass from London through this county, which is singularly ill-provided with means of west to east communication. As a result of a first visit to the 124 registered midwives in the county, there would aFnear to be no doubt as to the advisability of appointing a lady-inspector to carry on the work of inspection in future. The Hefts County Council, being a conservative body, will certainly not sanction the removal of midwives from the Register except in the most flagrant and undoubted cases of misconduct, until satisfactory provision has been made to replace them. As the training of midwives as a branch of higher education is not regarded with favour by the Board of Education, and as the pious wish of the County Council for a grant from the imperial exchequer for the purpose is not likely to be gratified, it is necessary to face the probable dearth of midwives in the future with private effort, and the consequently charitable relaxation of the letter of the law. Hertfordshire is noted above all other English counties for its number of beautiful country-houses and private parks; and from their owners it enjoys, therefore, a very widespread network of philanthropic assi'stance in its village life. It is common to find a village nursing association employing one or even two thoroughly well-trained nurses for an area of three miles' radius. As a rider to this proposition it is also not uncommon to find villages where there is no squire, or where the squire leads a selfish or absentee life--villages left to the kindly but rough and uncleanly mercies of a simple, untrained village woman. For these villages it must be hoped that publi c spirit Will be kindled to institute nursing-associations to supply by co-operation, both for m i d ~ e r y and general work, the services of a well-trained nurse, which all classes of the nation are learning warmly to appreciate. The Midwives' Act is only a step towards the establishment of the nursing profession throughout the country ; and in showing the medical profession that the drawbacks of this natural develop-
244
Midwives Act
[e~bito ~o~t~
ment are far less and the advantages far greater than have often been supposed. But it wilt be long before every village is thus properly provided ; and meanwhile the genus C-amp, t h e untrained, empirical old woman of the lower orders, who exists by virtue of bona-fide practice before 1905, continues to be recognized by the State as a midwife. Many of thes~ women are seriously perplexed by the frequent circulars and forms sent them by the County Council ; they feel obscurely there is a law over them, of which they have only a vague knowledge, being often barely able to read or write, still less to realize the meaning of official phraseology. It is with difficulty that they are persuaded by medical men to keep on at their work, the doctor being only too anxious, selfishly and unselfishly, that even a poor best-available should undertake the unprofitable and remotely scattered eases in the outlying parts of his district. Mrs. Gamp, on the other hand, attends to onty 12, 6, or 3 eases a year, and in those eases she gets but from 3s. 6d. to 7s. 6d. for ten days' attendance, without any perquisite ; while she is now deeply impressed with the vague terrors of the law in case anything goes wrong. Evidently her memory is not very clear when she remarks, with few exceptions: " I ' v e attended 104" (it may be as many as 400) " pore women, doctor, in ther troubles, and never anything gone wrong. 'Mrs. Gamp,' sez they, ' I ' m perfectly satisfied, and couldn't have 'ad a better.' " In fact things have gone wrong and do still go wrong, and it is for the new system to diminish and in time to prevent the preventable mishaps. For the present, therefore, the Gamp must continue ; and it is with these women, not with the welltrained midwife, that the authority must mainly concern itself. For this purpose it is useless to enforce many of the rules of the Central Midwives' Board. " Bag ? " They haven't a bag. "Rules ? " They have never read them. " T h e r m o m e t e r ? " They can't even see the m e r c u r y . "Vaginal syringe ? " They are infinitely better without i~. Grimy nails, cracked, gTimy hands, or dirty, untidy house, sure sign of a careless mind ; and above all a note of self-assurance ; these are the real defects to be met and remedied. The wonder is that so few women develop puerperal septiesemia, not so many. I t is of no use to cry out against the employment of Mrs. Gamp. If you disestablish her without a substitute, she will still be employed, with the additional dangers of illegality and concealment. And the idea of sending such women away from the household, often largely dependent on them in active life if not in finance, go a distance to be trained, is impracticable. Therefore, for the present, we must have frequent and personal influence on these women, who are only too ready to talk over difficulties and ask advice; and when once the County Medical Officer has seen enough to have a clear view of the situation of affairs throughout the county in his mind's eye, his place will be best taken by a painstaking lady-inspector, acting under his supervision. DEATH OF DR. J. trIouSLEY.--We regret to record the death of Dr. John Housley, until lately Medical Officer of Health for the Borough of Retford. Dr. tiousley, who was seventy years oi age, had held the post of coroner for the Retford and Worksop District for twenty-five years' and was highly respected for his sterling qualities throughout North Nottinghamshire.
Midwives Act
248
MIDWIVES ACT. THE County Council of Hertfordshire--with a Ropulation of 270,000 and acreage of 403,000--is about to consider the question of appointing a whole-time Medical Officer of Health ; but meanwhile has commissioned its present Medical Officer to carry out the Midwives' Act, 1902, and report quarterly to the District and Parish Councils' Committee, which is the body responsible in the first instance for all its sanitary duties. The Medical Officer, therefore, has, not unwillingly, undertaken himself to visit all midwives in the county for the present ; as this, in the first place, gives him a personal acquaintance with the midwives and of the actual difficulties he will have to meet under the Act, and in the second, gives him an opportunity of visiting all the parishes throughout the county, for which he has hitherto had to draw up 'his annual report with absolutely no first-hand information, with the few exceptions of those cases in which he has been commissioned to hold special enquiries; for instance, into water supply, sewerage, or hospital accommodation. He is at the same time able thus to visit the District Medical Officers of Health and Coroners. He is paid three guineas a day, out of which he has to pay expenses. The work is usually done on a bicycle, starting by railway out of London, where he lives for convenience sake. All committees of the Herts Coun~ Council are held in London, and six main railway lines pass from London through this county, which is singularly ill-provided with means of west to east communication. As a result of a first visit to the 124 registered midwives in the county, there would aFnear to be no doubt as to the advisability of appointing a lady-inspector to carry on the work of inspection in future. The Hefts County Council, being a conservative body, will certainly not sanction the removal of midwives from the Register except in the most flagrant and undoubted cases of misconduct, until satisfactory provision has been made to replace them. As the training of midwives as a branch of higher education is not regarded with favour by the Board of Education, and as the pious wish of the County Council for a grant from the imperial exchequer for the purpose is not likely to be gratified, it is necessary to face the probable dearth of midwives in the future with private effort, and the consequently charitable relaxation of the letter of the law. Hertfordshire is noted above all other English counties for its number of beautiful country-houses and private parks; and from their owners it enjoys, therefore, a very widespread network of philanthropic assi'stance in its village life. It is common to find a village nursing association employing one or even two thoroughly well-trained nurses for an area of three miles' radius. As a rider to this proposition it is also not uncommon to find villages where there is no squire, or where the squire leads a selfish or absentee life--villages left to the kindly but rough and uncleanly mercies of a simple, untrained village woman. For these villages it must be hoped that publi c spirit Will be kindled to institute nursing-associations to supply by co-operation, both for m i d ~ e r y and general work, the services of a well-trained nurse, which all classes of the nation are learning warmly to appreciate. The Midwives' Act is only a step towards the establishment of the nursing profession throughout the country ; and in showing the medical profession that the drawbacks of this natural develop-
244
Midwives Act
[e~bito ~o~t~
ment are far less and the advantages far greater than have often been supposed. But it wilt be long before every village is thus properly provided ; and meanwhile the genus C-amp, t h e untrained, empirical old woman of the lower orders, who exists by virtue of bona-fide practice before 1905, continues to be recognized by the State as a midwife. Many of thes~ women are seriously perplexed by the frequent circulars and forms sent them by the County Council ; they feel obscurely there is a law over them, of which they have only a vague knowledge, being often barely able to read or write, still less to realize the meaning of official phraseology. It is with difficulty that they are persuaded by medical men to keep on at their work, the doctor being only too anxious, selfishly and unselfishly, that even a poor best-available should undertake the unprofitable and remotely scattered eases in the outlying parts of his district. Mrs. Gamp, on the other hand, attends to onty 12, 6, or 3 eases a year, and in those eases she gets but from 3s. 6d. to 7s. 6d. for ten days' attendance, without any perquisite ; while she is now deeply impressed with the vague terrors of the law in case anything goes wrong. Evidently her memory is not very clear when she remarks, with few exceptions: " I ' v e attended 104" (it may be as many as 400) " pore women, doctor, in ther troubles, and never anything gone wrong. 'Mrs. Gamp,' sez they, ' I ' m perfectly satisfied, and couldn't have 'ad a better.' " In fact things have gone wrong and do still go wrong, and it is for the new system to diminish and in time to prevent the preventable mishaps. For the present, therefore, the Gamp must continue ; and it is with these women, not with the welltrained midwife, that the authority must mainly concern itself. For this purpose it is useless to enforce many of the rules of the Central Midwives' Board. " Bag ? " They haven't a bag. "Rules ? " They have never read them. " T h e r m o m e t e r ? " They can't even see the m e r c u r y . "Vaginal syringe ? " They are infinitely better without i~. Grimy nails, cracked, gTimy hands, or dirty, untidy house, sure sign of a careless mind ; and above all a note of self-assurance ; these are the real defects to be met and remedied. The wonder is that so few women develop puerperal septiesemia, not so many. I t is of no use to cry out against the employment of Mrs. Gamp. If you disestablish her without a substitute, she will still be employed, with the additional dangers of illegality and concealment. And the idea of sending such women away from the household, often largely dependent on them in active life if not in finance, go a distance to be trained, is impracticable. Therefore, for the present, we must have frequent and personal influence on these women, who are only too ready to talk over difficulties and ask advice; and when once the County Medical Officer has seen enough to have a clear view of the situation of affairs throughout the county in his mind's eye, his place will be best taken by a painstaking lady-inspector, acting under his supervision. DEATH OF DR. J. trIouSLEY.--We regret to record the death of Dr. John Housley, until lately Medical Officer of Health for the Borough of Retford. Dr. tiousley, who was seventy years oi age, had held the post of coroner for the Retford and Worksop District for twenty-five years' and was highly respected for his sterling qualities throughout North Nottinghamshire.