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whom information is available. During the year, 491 midwives (or less than 18 per cent. of the number
enrolled) gave notice of intention to practise, 28 gave notice of working temporarily in London and
17 notices were received that midwives residing in adjoining counties had acted on specific occasions in
the County of London.
Of these 491 notices, 388 were received from midwives who had previously practised in London,
and 103 were notices sent by midwives for the first time. During the year, 4 deaths of midwives
were reported, 41 midwives removed from the county, 34 to other parts of England and 7 abroad, 7
gave up practice on account of ill-health, 10 gave up practice for other reasons, and 11 were found on
being visited to be acting only in the capacity of monthly nurse.
Inspection.—All practising midwives are subject to inspection to ascertain whether they are
observing the rules of the Central Midwives Board, as to cleanliness, the possession of the requisite
apparatus and antiseptics, the keeping of case books and registers, and the sending in of the prescribed
notices to the local supervising authority. Two inspectors possessing medical qualifications carried
out these duties, Miss Lila S. Greig, M.B., L.M., D.P.H., and Miss Ida R. Shields, M.B., B.S. In
addition to the routine inspections, special investigations are made into all cases of a septic character
occurring in the practice of midwives, and much useful information has been collected. It has also
been the practice of the inspectors to explain to midwives any difficulties that may arise in the course
of their work, and to suggest methods for the better performance of their duties. The inspectors have
also on many occasions accompanied midwives to deliveries and in their subsequent visits in order
to obtain fuller information concerning their mode of practice.
During the year, 1,443 visits of inspection were paid, including visits in special cases as well as
routine inspections. In 737 instances the reports were satisfactory, in 175 unsatisfactory, in 434
the midwife was either out, away or ill, and in 97 it was found that the midwife had ceased to practise
or had removed to some other address. The large proportion of cases (some 30 per cent.) in which
the midwife was out may be explained by the fact that the practice of making appointments with midwives
has been abandoned, except in a very few instances where an interview with the midwife is
urgently needed. In the two previous years it was found expedient to make appointments, partly as
a sort of introduction and partly in deference to the susceptibilities of women, who for many years
had worked entirely without supervision and who by the passing of the Midwives Act were suddenly
brought under inspection and had to conform to many rules and regulations. However necessary these
appointments may have been at the beginning of a new regime, it is obvious that they gava
opportunity for preparation on the part of midwives for the inspector s visit and the object of the
inspection was thus often lost.
The 175 unsatisfactory reports referred to 118 midwives. Of these midwives 74 were found
unsatisfactory on one occasion only, 32 on two occasions, 11 on three occasions and 1 on four occasions.
220 midwives had no unsatisfactory reports during the year, while the rest were either found not
to be practising or were out when called upon. There is a decided improvement in the work of midwives
and the proportion of unsatisfactory reports has fallen from about 20 per cent. in 1906 to just
over 12 per cent. in 1907. Midwives are classed according to their general work, and an endeavour
is made to visit the most unsatisfactory six times a year, the fairly satisfactory class four times in the
year, while some two visits a year are paid to the satisfactory ones. In most of the cases where the
report was unfavourable the inspector drew the attention of the midwife to the particular rule that
had been broken and at a further inspection was able to report favourably. In cases of serious
breaches of the rules or persistent neglect after caution by the inspector the matter was brought to the
notice of the Midwives Act Committee, and a letter of caution was sent to the midwife. The latter
course was adopted in 39 cases. The following were the reasons for the cautionary letter :—
Omitting to send in required notices 6
Not advising the calling in of a doctor early enough to a weakly infant 14
Not advising the summoning of medical aid to a mother when required
by rules to do so 4
Neglect to observe rules as to cleanliness 5
Neglect to observe rule as to antiseptics 4
Not possessing the required apparatus 4
Not keeping register as required 1
Leaving a pupil in charge of a patient 1
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For more serious offences the midwives were summoned to appear before the Committee.
In four instances the midwives were verbally cautioned, one for employing an uncertified
substitute, two for neglect in cases of puerperal fever, and one for persistent neglect to send required
notices.
Two women were suspended from practice for not possessing the required apparatus or antiseptics
and thus rendering themselves liable to be a source of the spread of infection. The suspension
was withdrawn when the required articles had been obtained.
In one instance a midwife was reported to the Central Midwives Board under Section 8 of the Act
as having been convicted under the Infant Life Protection Act of neglect of infants under her care. A
sentence of 9 months imprisonment was imposed by the magistrate and the Board removed the name
of this woman from the Roll.