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as to cleanliness, the possession of the requisite apparatus and antiseptics, the keeping of case books
and registers and the giving the required notices to the Local Supervising Authority. Mies V. E. M.
Bennett, M.B., B.S., was appointed as the inspector under the Act, and in addition to her routine
inspections and special enquiries, she gave assistance to midwives by explaining the use of appliances,
by interpreting the rules and by affording advice on difficulties arising in the course of a midwife's
duties.
During the year 1,057 routine visits of inspection were made. In 572 cases the midwives were
found to be satisfactory, in 330 unsatisfactory and in 155 cases the midwife was out or away from
home. Considering that many of the 330 unsatisfactory reports were made after the first visit to
midwives and that these women had hitherto been under no supervision, this number does not appear
to be excessive. There seems to be good ground for hoping that as the number of those who are
unsatisfactory through ignorance and want of training will tend to diminish from year to year, a
better standard of efficiency will be attained.
In 19 cases there were more or less serious breaches of the rules but these were dealt with by
severe caution, and in only one instance was a prima facie case of misconduct established and reported
to the Central Midwives Board. The Board, after considering the case, decided that the evidence was
insufficient to warrant the removal of this woman's name from the Roll of Midwives.
As the result of inspection, it was shown that 11 midwives were illiterate, but notes of their
cases were kept either by themselves or were written for them by relatives or friends. Of the
practising midwives 28 were foreigners and their knowledge of English was more or less imperfect.
These midwives practise chiefly in the East End of London among the Jewish population; two
of them however are Italians and practise in the Italian quarter in Saffron-hill, but follow Italian
patients to other parts of London.
Prior to being brought under supervision many midwives were unable to use the clinical
thermometer, an instrument of which they had no knowledge before the Act came into operation. All
have not yet learnt to do so, but such midwives use a thermometer which has upon it one red line
indicating the normal temperature and another marking a temperature of 100.4 deg. The midwife
knows that when the mercury reaches the higher mark the patient is feverish and that medical aid
should be called in if the temperature is maintained.
The fees charged by midwives vary considerably. In some cases a fee of 5s. is charged and
one instance is known in which a midwife received as much as 25s. The payment made by Charities
which employ midwives is usually 5s. per case, but a fee of 7s. Gd. per case in multiparous and 10s. in
primiparous cases would be about the average. In many instances the fees are paid in advance
and by weekly instalments.
Puerperal fever.—All cases of puerperal fever, where it is said or where there is reason to believe
that a midwife or an unqualified person was in attendance, were investigated, and full details of the
illness were obtained. For this purpose early information concerning notified cases of puerperal fever
is received from the Metropolitan Asylums Board, and weekly lists of all deaths which are or may
be due to this cause, are received by arrangement from the office of the Registrar-General. During
the year 148 such cases were investigated ; in 98 a certified midwife was in attendance and it was
ascertained that 34 of these 98 cases proved fatal. It sometimes happens that symptoms of fever
are not developed until after the midwife has ceased attending on the tenth day after labour, and
that the midwife is continuing her work for some days before she hears that one of her previous cases is
septic; second cases occurring in the practice of the same midwife however are comparatively rare.
Disinfection is carried out by the Local Sanitary Authority.

1 In 2 of these eases the rise of temperature was temporary, but a medical man was called id.
2 In 4 of these cases a temporary rise had been noted on the 3rd, oth, 6th and 8th days respectively, but no
medical man was called.