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Public Health. 147
The order to carry out its duties of general supervision under the Midwives Act, 1902, the Council
has appointed two women inspectors, who are duly qualified medical practitioners, to pay visits of
inspection to midwives practising within the County, as well as to make special investigation into any
case of puerperal fever occurring in the practice of a midwife, and to attend if possible any inquest held
upon the body of a woman or infant in those cases in which a midwife had been in attendance. During
the year 1914 there were 121 cases of puerperal fever in the practice of midwives, 126 inquests were
held in which midwives were concerned, 18 being on the bodies of women, and 108 on the the bodies
of children. 537 cases of inflammation of the eyes were investigated, and 225 cases of ophthalmia
neonatorum occurring in the practice of midwives were notified. The Public Health (Ophthalmia
Neonatorum) Regulations, 1914, issued by the Local Government Board which came into operation
on 1st April, 1914, require midwives to notify cases of ophthalmia neonatorum occurring in their practice.
In compliance with the regulations, 127 notifications of the disease were received by the metropolitan
borough councils from midwives up to the end of the year.
During the year ended 31st December, 1914, 556 midwives notified the Council of their intention
of practising within the County during the year; in addition to these, 6 notices were received from
persons who had acted as midwives on specific occasions-, and 18 notices were received from midwives
who 3tated that they intended to practise within the County for specific periods shorter than a year.
Five charges of malpractice, negligence or misconduct on the part of four midwives were investigated
during the year, with the result that the Central Midwives Board was informed that three prima
facie cases, two of negligence and misconduct, and one of misconduct, had been established. The
charges in the two remaining cases were not sufficiently sustained to establish a prima facie case for
reference to the Board and the midwives concerned were censured. The Board announced its decision
with regard to the charges established in one of the three prima facie cases, to take no action in the
matter, having found the charges not proved. Several cases of infringements of the rules of the Central
Midwives Board were also reported during the year and the midwives concerned were censured or
cautioned with regard to their conduct.
It became necessary during the year 1914 to institute legal proceedings against four women
for attending cases of childbirth without being certified under the Act. Convictions resulted in each
case, fines amounting to a total of £3 5s., with £3 11s. 6d. costs, being inflicted.
The accounts of the Central Midwives Board showed an adverse balance for the year 1913, and
the Council was called upon in 1914 to pay, under section 5 of the Act, a sum of £109 2s. 8d. as its proportion
of this deficit.
Midwives.
During the year the Council introduced into its General Powers Bill clauses to give effect to its
views with regard to the licensing of lying-in homes, reference to which was made in last year's report.*
These clauses had been passed by a Select Committee of the House of Commons, but the outbreak of
war and other circumstances prevented any facilities for a debate in the House of Commons being
obtained, and the clauses in common with the rest of the Bill were suspended until the next session of
Parliament.
Lying-in
homes.
CHAPTER XXVI.
MAIN DRAINAGE.
The area drained by the metropolitan main drainage system is approximately 149 square miles,
including 32 square miles outside the county boundary, and the population of the whole area in 1911
was about 5,334,731.

From the above figures it will be seen that at the Northern outfall one ton of sludge was extracted
from an average of 35,889 gallons of sewage treated; or 3 59 per cent, more than in the previous year.
At the Southern outfall the average quantity of sewage treated to produce one ton of sludge was 42,012
gallons, which is 131 per cent. less than in the preceding year. The total quantity of sewage treated
is shown as about 0.73 per cent. less than in the preceding year. The quantity of sludge sent to sea
was, however, 2.74 per cent. more than in 1913. The six sludge vessels made 2,701 trips to the deposit
area, the distance travelled being 286,896 miles.
* Annual Report of the London County Council, 1913. Vol. III, p. 230.
27715 u 2