Report of the Departmental Committee appointed by the Lord President of the Council to consider the working of the Midwives Act, 1902.
- Great Britain. Midwives Act Committee.
- Date:
- [1909]
Licence: In copyright
Credit: Report of the Departmental Committee appointed by the Lord President of the Council to consider the working of the Midwives Act, 1902. Source: Wellcome Collection.
Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.
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![19 May 1909.] Dr. A. RlVEES-WlLLSON. [Continued. 6527. Tou liave formed some view as to what the influence of the Midwives Act has been in regard to the number of lying-in cases attended by medical practitioners ?—^^Tes. 6528. Has it been reduced ?—Yes, it has. The number of midwifery cases has diminished by two-thirds certainly in my practice. The diminution has been very marked in the last two or three years. 6529. Midwives have been substituted for the doctors, you mean ?—-Yes; they have been substituted for the doctors. Of course one gets a large proportion of first midwifery cases, but very few subsequent cases. I used to attend between 80 and 90 cases a year privately, and now I suppose within the last thi-ee years I have not attended many more than 20 in the year. Not- withstanding the fact, that I have taken a younger man as partner, who would be quite willing to attend these cases, still they have not come to us, and many cases that formerly were attended by me are now attended by midwives. 6530. But do you wish us to understand that that has been attended with any detriifient to the patient ? —I am not saying that exactly. Of course it has been a financial loss to the profession. 6531. Bat perhaps it has allowed more time for cases that are more remunerative ?—I do not think that. What I meaa to say is that the younger prac- titioners do not regard the Midwives Act as an unmixed blessing from a financial point of view. 6532. Bat of course the more serious cases in connection with parturition are still reseiwed for the doctor ?—-Yes, undoubtedly. We get calls to the more serious cases. 6533. Does that not compensate yoti to some extent ?—It does not in the absence of any scheme for ensuring the remuneration. One gets the cases, but not the payment. 6534). Do you mean that payment is not forthcoming in a great number of cases ?—In most of the cases that are attended by midwives there is no payment. 6535. What line have the authorities taken in regard to the obligation to pay.P—They have done nothing. In Oxford we have three boards of guardians ; the Headington guardians have districts within the range of the city; then there is the Abingdon board of guardians and the Oxford Incorporation, but none of them have done anything at all. 6536. Oxford is a county borough, and has a council of its own ?—Yes. 6537. The council have done something, I presume ? —Nothing at all. 6538. They could have done something, as they have in Manchester and Liverpool ?—Yes, they could have done something. 6539. Do you mean to say that the boards of guar- dians have made no x-esponse to the Local Government Board's circular on the subject ?—-Nothing at all. 6540. Is that due to any ill-feeling towards the medical profession ?—Not at all, I think. It is simply that they have relied on the doctors gomg to cases out of mere humanity. 6541. Has there been any organised objection on the part of doctors in Oxford to attend cases ?—The matter is now being considered by a committee of the British Medical Association. 6542. But I mean locally ?—It is being considered by a local committee of the branch there. I had hoped that the committee might have met before I came up here, but it has not done so. 6543. But have medical men made any organised attempt to refuse to attend ?—Yes, many of them. 6544. With any bad results to women in labour ?— No doubt suffering has been increased. I am not aware that there has been any actual death, but salfermg has been prolonged in many instances on account of the difficulty of gettmg assistance. 6545. Would a man make a difiiculty about attending in the case of a woman he was in the habit of attending for other matters ?—I take it he would go then. The cases of that kind are generally among the very poor. 6546. Do many of the poor go into institutions for their confinements ?—No, not in Oxford. We have no lying-in institution there. Our Lying-in Charity is an outdoor charity entirely. 6547. Does the charity not help ?—It helps a good deal in Oxford, but it only takes cases from certain 6548. Does it contribute towards the payment of the doctors' fees in cases of difiiculty and emergency ?—• They appoint two surgeons, who divide Oxford into two districts. The people who wish to be attended under the charity obtain a card from a subscriber, so that the doctor is really engaged to attend beforehand, and in no haphazard fashion. 6549. Has that not contributed to compensate medical men to some extent for the loss of that class of practice ?—-This state of things has existed for about 100 years; it is no new thing. We are exceptionally situated in Oxford with regard to medical attendance on lying-in cases, much more favourably situated than many other places. 6550. Through the agency of this charity ?—Yes. 6551. Does that dispense large resources ?—The charity attends about 250 cases a year. 6552. How many women of the poorer class are in labour annually in Oxford ?—I could not tell you exactly. This charity only covers a certain number of parishes within the old boundary of Oxford. The boundary of the city has been enlarged in the last few years, and the charity does not take in the new parts at all. 6553. It is the central portion ?—Yes, the central portion. 6554. Does it take a large proportion of the cases in that area?—Yes, I should think probably 50 per cent. 6555. Then 50 per cent, of the cases are provided with medical assistance through the means of that charity ?—Yes, in the case of Oxford that is so. 6556. Have you formed any opinion as to the best means of providing for the attendance and the remu- neration of doctors called in on the advice of midwives ? —I think that the County Council, or the City Council in the case of Oxford, should be empowered to pay an adequate fee to the doctor who is summoned. 6557. You prefer that to the destitution authority, whatever form it may assume in the future ?—Certainly, I think so. 6558. But is it not of some importance that the authority which is to determine the payment should know a good deal about the circumstances of the patients ?—Yes, and I thmk that might be done. It is done in certain cases through the Charity Organisation Society. 6559. Would that be more popular than the boards of guardians ?—Yes, there is a strong feeling on the part of the poor against anything connected with the poor law. 6560. Do you know exactly why ? — I do not know- exactly why, but it exists. 6561. Is it not part of the business of people to break down these prejudices rather than flatter them ? —I quite agree. 6562. Then have you formed any opinion as to the amount of the fee that should be secured to the medical man ?—Before I suggest anything about that, I should like to say that what we feel about the thing is that, if we go to cases of this kind, having been called in by a midwife, we must be held responsible for the subsequent conduct of the case to the end of the case. For instance, supposing we were called upon to attend a case on the call of a midwife, and instrumental inter- ference were necessary, and we simply contented ourselves with applying the necessary treatment and then left the case to the midwife, and the woman developed puei-peral sepsis, we might be held respon- sible for that subsequent development; so that any fee that is provided should cover that possibility. I mea7i it should cover the whole responsibility. 6563. What fee do you think would meet the case —Under the present rules of the Local Governmen*., Board, boards of guardians, I believe, are empowered to pay a fee of 21. in each case to which the district medical officer is summoned. 6564. But do you tliink a fee as high as that ought to be made general ?—I think so. I do not see](https://iiif.wellcomecollection.org/image/b21361113_0297.jp2/full/800%2C/0/default.jpg)
