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Death of mother or child.—The rules of the Central Midwives Board provide that when the death of
the mother or child occurs before the arrival of a medical practitioner the midwife in attendance must give
notice to the Local Supervising Authority ; 45 such notices were received, in two instances the mother
and in 43 the infant died before medical assistance was obtained. The mother died from pulmonary
embolism in one case and syncope from haemorrhage due to rupture of the uterus in the other case.
Inquests.—Inquests are held in such cases as the above and also frequently in cases where a medical
practitioner, though in attendance before death is unable to certify as to the cause of death. By the
courtesy of the London coroners, notice is given to the Council's medical officer of inquests in cases
where a midwife was in attendance on the deceased prior to death, and one of the Council's inspectors
is thus enabled to be present to take notes of the evidence given. The inspector is frequently referred
to on points arising as to the duties of the midwives under the rules. In this way, much useful
information has been obtained as to the practice of midwives, which would not he elicited in the
ordinary course of inspection. As the result of attendance at inquests on the deaths of mother or
children, knowledge of uncertified women practising midwifery has been gained.

In all cases where there was delay in sending for medical assistance, a letter of caution was
addressed to the midwife concerned.
Puerperal Fever.—During the year, 228 cases of puerperal fever were notified in London and
the Registrar-General records 137 deaths from puerperal septic diseases. The term " puerperal septic
disease " used by the Registrar-General includes puerperal septicaemia, sapræmia and pyœmia, as well as
peritonitis and metritis occurring in connection with parturition. A more limited interpretation of
puerperal fever appears to be adopted by some medical practitioners for the purposes of notification
and of the 137 registered deaths from puerperal septic diseases, no less than 50 were not regarded by
medical practitioners as puerperal fever, or at all events were not notified. In the table headed " causes
of death " there is a column relating to the 50 deaths of unnotified cases.
Of the 228 notified cases, 87 proved fatal, this gives a case mortality of 38.2 per cent.
All cases of puerperal fever in which a midwife was in attendance on the patient, were investigated
by the Council's inspectors, and full details of the illness obtained. For this purpose, early intimation
of cases of puerperal fever is received from the Metropolitan Asylums Board, and by the courtesy
of the several medical officers of health, I am able to ascertain by whom the delivery is conducted. A
list of deaths from puerperal septic diseases is obtained each week from the General Register office.
It has
thus been possible to ascertain in each case whether a medical practitioner was in charge of the case,
whether a midwife or uncertified woman conducted the delivery or whether the patient was confined in
poor law institution or hospital; the results of the enquiries are as follows:—