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]
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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. RiVERS-WlLLSON. \_Continiied. 6606. They would refuse solely on account of the probability of their not being paid ?—Yes. 6607. If the local authority provided the fee, that would remove all the feeling against midwives, would it ?—Yes, I think so. It would go a good way towards removing it. 6608. Do you imagine it would remove it entirely ? 1 think the younger men will feel the loss of their midwifery practice, but I think that is a matter that will wear off. 6609. Can you tell me the proportion of births attended by midwives as against those attended by medical men ?—No. I tried to get it, but I could not get the information, because a good many of them work privately. 6610. {Mr. Davy.) What is the population of Oxford, can you tell me ?—It is estimated at 52,000. 6611. That would be the city ?—Yes. 6612. In that area there are three \mions, I under- stand ?—Yes. 6613. The Abingdon union comes up to the river ? —Yes, on the Berkshire side. 6614. Where does the Headington imion come up to ?—It takes in the whole of St. Giles' and it takes the whole of St. Clement's on the other side of the river. 6615. Then practically this question would only concern the Oxford board of guardians really, would it not ?—But there is St. Clement's, which contains a very large working-class population, and that is under the Headington board. 6616. If a midwife sends for the medical practi- tioner she would naturally send to the relieving officer in such cases ?—Yes. 6617. Would she communicate first with the poor law medical officer?—Yes, she would. The doctor would hardly, I think, feel justified in refusing to go. ^ 6618. He would not wait for the relieving officer's order ?—No, it is not usual. 6619. Are you a district medical officer yourself ? —No. 6620. What would be the fee usually charged to a person in circumstances such as you have described who required a medical practitioner ?—Taking them all round as they come, that is to say, the ordinary cases or the normal ones taken with the difficult ones, it would range from one to two and a half guineas. 6621. Do you think it would satisfy the medical profession if the guardians or some other authority paid a round sum of IZ. for each case ?—For each case that a midwife is engaged to attend, do you mean ? That would, I think, cover the difficulty, and it would be a vei-y satisfactory solution. 6622-3. Do you think there would be any objection on the part of the medical profession to make a claim on the authority for that sum, stating in the claim that they had made every reasonable effort to secure their fee ?—There might be soma difficulty about that, I think. It would involve a good deal of trouble. It would necessitate the medical man proving that he had done all reasonable things to get his fee. 6621<. But he could make a statement to that effect ?—If it is canfined to a statement to that effect I think it might be managed perhaps. 6825. You think that might give us the lines of a satisfactory solution ?—Yes, I think so. 6626. {Dr. Champneys.) I want to be quite sure that it is your opinion that, if the question of fees were satisfactorily arranged, there would be no further difficulty with medical men.—I do not think there woiild. 6627. Are there any institutions in Oxford, such as provident clubs, or anything of that sort, for maternity cases ?—Yes. 6628. By which the patients pay beforehand ?— Yes, by which they pay by instalments some time beforehand. 6629. Can you tell me at all the scope of that sort of thing ; how many patients are attended ?—I do not think very many are attended under that scheme at the present time, but the facilities exist. 6630. Do you- hear much about patients being attended in those circumstances ?—No, not very much. 6631. In your opinion, is that not a very desli-able thing to develope ?—Undoubtedly. 6632. And it could be developed ?—Yes. 6633. Could you tell the Committee at all under whose supervision, or under the supervision oi what body, the scheme is worked? Is it a private affair altogether ?—No. That again was one of the city medical charities which, by permission of the Charity Commissioners, was converted into a provident scheme. It was called the Cutler-Boulter Dispensary; the late Sir Heniy Acland, who was Regiiis Professor of Medi- cine, was instrumental in evolving the present scheme, and I think certainly that it is a thing to be encoiu-aged. I may say that, not only under that scheme, but gene- rally the majority of general practitioners are quite willing to accept fees by instalments in advance, in a similar manner. 6634. Then the reason why several medical practi- tioners in Oxford have declined to meet midwives in consultation is that they have been exploited?— Precisely. 6635. Their services have been used and no attempt at payment has been made ?—There has been no fee. 6636. I think you have stated that you were not aware of any cases in which a patient, for instance, has lost her life from hsemon-hage?—No such case has come under my notice, nor so far as I can find has any such case happened in Oxford. 6637. Do you think that, however much a medical man might give out that he would decline to attend, he would decline in such circumstances to save life ?— Certainly not. I mean that, although I give notice that I do not respond to midwives' calls, yet if somebody sent to me and said that Mrs. So-and-so was bleeding after her confinement, I should go to her; but I mean also that I should not be held to be compelled to go, though as a matter fact I should go. 6638. As a human being ?—-Yes. 6639. Are you aware of the use of abortifacients at all in Oxford ?—-No, I do not think there is anything general of that kind. I have never come across any evidence of such a thing there. 6640. (Dr. Downes.) Would you think that your notice that you are not prepared to attend has had anything to do with reducing the number of midwifery cases in your practice ?—No, because I have only given this notice within the last year. 6641. I see in your precis jow have a note as to lists of all medical practitioners willing to respond to midwives' calls ?—Yes, I have. I think if such a list were prepared by the local authority it would obviate unnecessary delay. It seems to me that a midwife might—I do not say she would—deliver a message under the Rules of the Central Midwives Board to the Regius Professor of Medicine, sending it to his house and leaving it there, and not go any further. 6642. The intention woiild be to circulate this list among midwives ?—Yes. 6643. How often should it be revised?—Once a would be no difficulty at all about 6644. The proporti coming to medical mer system, you think ?—^Y to difficult cases. 6645. With 3n of difficult and serious cases tends to be high under the new 3S, becavise one is only summoned to the fee of 2L, I believe the wording of the poor law Order is that it is to be given only in cases of special difficulty, or long-continued after attendance?—These cases are really cases of special difficulty that are laid down in the Rules. 6646. Some of the cases referred to in the Rules of the Central Midwives Board, under which the medical practitioner is called in, are comparatively trivial. I think if you look through the list of them you will find that that is so, so that you would not propose 21. for everything, perhaps ?—The cases coming under heading (a) in Riile E. 19 (2), such as that of deformed pelvis, are cases of pregnant women, and the cases I have referred to are those in actual labour. 6647. You do not necessarily include^e pregnancy period in the scale, do you ?—No, Ijecaiise I think that.