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hæmorrhage of the mother. Two were stated to be born with a caul completely over the head, two
were hydrocephalic, and three imperfectly developed. In one case of triplets all were still.born. Of
30 cases of twins, one child was alive in 18 instances, and both children were still.born in 12 instances.
The form of questions has now been included by the Central Midwives Board in the new series of
rules and fuller information on these points is likely to be obtained.
Inquests.— Arrangements have been made with the coroners in London to notify any inquest
that is to be held where a midwife has been in attendance on the deceased, and by the courtesy of the
various coroners the Council's inspectors are permitted to be present at the inquest, and are referred to in
many instances where question is raised as to compliance with the rules of the Central Midwives Board.
In this manner many cases of uncertified women practising midwifery have been brought to notice,
and additional information has been obtained as to the methods adopted by midwives in the course of
their practice.

Full reports on all these cases were made and the censure of the coroner for not calling in medical
aid was followed by a letter of caution from the Council. One case has already been referred to where an
uncertified woman was committed for trial on a charge of murder.
Puerperal fever.—All cases of puerperal fever, where there was reason to believe that a midwife
was in attendance on the patient, were investigated, and full details of the illness obtained.
For this purpose early intimation of all notified cases of puerperal fever is received by telephone from the
Metropolitan Asylums Board, and weekly lists of deaths from puerperal septic diseases are obtained from
the Registrar General. The term puerperal septic disease is held by the Registrar General to include
puerperal septicæmia, sapræmia, pyaemia, peritonitis and metritis, occurring in connection with parturition.
This definition of puerperal fever is in accord with that of the Royal College of Physicians, but a more
limited interpretation of the term appears to be often adopted for the purposes of notification. During
1906, 298 cases of puerperal fever were notified, and 187 deaths were registered in London. Of these
deaths, 68 referred to cases not notified as puerperal fever, and it would appear therefore to be probable
that many cases of puerperal fever in its wider sense which do not prove fatal are never officially
notified.
The cases classed as puerperal fever in the following table comprise all notified cases, together with
the fatal unnotified cases mentioned in the Registrar General's weekly return:—