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One midwife had five cases in her practice during the year, but there appeared to be no connection
between these cases and the patients attended in the intervals went on favourably. Two
midwives had each three cases during the year—and in respect of both midwives there was reason for
suspecting that they had conveyed infection from one case to another. Each of nine midwives
had two cases of puerperal fever during the year. Information as to whether the patients had been
previously confined was obtained in 64 cases of puerperal fever and of these 14 were found to be
primiparse.
Notification of Births.—With a view to bringing new-born infants under the supervision of
medical officers of health, certified midwives were asked to furnish weekly lists of the cases attended by
them. About 150 midwives (including most of those with large practices) voluntarily supply this
information, the postage being paid by the Council. The lists are received by the Council and the
names and addresses of the mothers are forwarded to the various medical officers of health concerned.
In this way mothers can be visited on the average within 11 days after the birth of the child, i.e., just at
the time when the midwife ceases her attendance and the mother is left to her own resources. These
lists are also useful in affording information as to the number of cases attended by midwives and prove
of value in enabling more accurate comparison to be made of the incidence of still births or puerperal
fever occurring in the practice of particular midwives. In the 11 weeks of 1905 during which this system
was in operation, 6,506 cases were attended by midwives furnishing lists Thus a yearly
average of 30,000 children or nearly a quarter of the total number of births in London—and these
almost exclusively of the poorest class—are brought under some kind of supervision as to management
and feeding.
Medical aid.—In all cases where a midwife is in attendance and medical aid is called in, she
must give notice of the fact to the Local Supervising Authority stating the reason for such assistance.

Still-births.—405 still births were notified Assuming that the proportion of still-births is the
same among the midwives who send weekly lists as among those who do not, this would give a rate of
approximately 15 still-births per 1,000 cases attended by midwives. The term still-birth is somewhat
loosely used. A definition of the term has been suggested as including children of over seven months
gestation. No such definition is used by midwives who often include as a still-born child a foetus
of less than six months gestation.
The cases of still-born children are investigated to ascertain (a) the age of child; (b) whether
it was macerated. With regard to (a) information in 274 cases was obtained, viz.:—
3 died during birth.
118 wero of full term.
50 were of over 8 months gestation.
41 „ 7
33 ,, 6 ,,
29 were of under 6 months gestation.
In addition to these cases, 52 were stated to be premature but no information as to the age
was given.
In regard to question (b) information was obtained in 279 cases, 161 of which were said to be
macerated.
Inquests.—In June, 1905, the London coroners were asked to notify any inquests to be held
before them in which a patient or child, attended by a midwife, had died, and by the courtesy
of all the London coroners the Council's inspector is allowed to attend the inquest and is often referred
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