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to where questions as to the rules to be observed by midwives are raised. From June to
December, 1905, 33 inquests were attended, 22 on the bodies of children and 11 where the mothers
had died in childbirth. In 23 of these inquests no blame was attributed to the midwife, but in 10
instances it was considered that medical help should have been summoned earlier. The causes of
death in these cases were as follows:—
Mothers.
Puerperal fever and puerperal peritonitis 8
Syncope 1
Septic pneumonia 1
Heart failure from hæmorrage 1
11
Children.
Atelectasis and weakness from prematurity 9
Suffocation 3
Injury at birth 2
Pneumonia 2
Congestion of lungs 1
Catarrh of stomach 1
Septic umbilicus 1
Exhaustion from diarrhoea 1
Congenital syphilis 1
Still born 1
22
Full reports on all these inquests were made, and where the midwife was at fault, she was
cautioned by letter or was summoned to appear before the Midwives Act Committee.
Unregistered women.—39 uncertified persons were reported to be practising as midwives and
investigations were made. In many of these cases there was found to be no infringement of the
Act and in others the infringement was due to ignorance of the law and the persons were cautioned.
Legal proceedings were instituted in four cases and a nominal penalty imposed by the magistrate
in two instances.
Payment of fees to medical practitioners.—The Act requires that a midwife on recognising
certain conditions specified in the Rules must decline to attend alone and advise that a registered
medical practitioner be sent for. In many cases difficulty is experienced in obtaining this help and
the doctor when so called cannot recover his fee as the patient is not in a position to pay it. The
Poor Law medical officer is frequently appealed to, but under the Poor Law Acts although this officer
may attend without an order in cases of emergency, he is not obliged to do so, and in actual
practice an order is first obtained from the Relieving Officer, who has to ascertain that the case is
a fit and proper one for relief. The delay that this system entails often leads to a patient being
left without medical aid for several hours and may have fatal results.
The question of payment of the fees of medical men called in emergency was under the consideration
of the County Council, the Midwives Act Committee recommended the Council to
adopt a scheme for the payment of these fees and a clause was included in the draft General Powers
Bill, 1906 before its introduction, but at a later stage the clause was not proceeded with.
Training of midwives.—The Midwives Act Committee of the Council, after consultation with
the Education Committee, drew up a scheme for offering scholarships to students in midwifery. At
the outset it was thought advisable to make the scholarships tenable only at institutions where internal
cases were attended. From a list of these institutions in which the annual number of cases
exceeded 500, four hospitals were selected, and the Council was recommended to grant scholarships
tenable at these. The value of the scholarships was fixed at £25, and the condition was imposed
that a six months' course of training should be undertaken, except in the case of nurses who had
previously been trained in hospitals.
Classes for midwives.—In order that midwives who were trained many years ago, or whose
training had been deficient, might be brought to a higher standard of efficiency, evening midwifery
classes were arranged in some of the Council's schools and midwives invited to attend.
The Society for Promoting the Training and Supply of Midwives has rendered service to the
Council in this connection by informing midwives of the existence of these classes.
Shirley F. Murphy,
Medical Officer of Health.
December, 1906.
To the London County Council.