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In six cases the child was said to have been born before the midwife arrived, one of these cases
proved fatal.
The distribution of the cases of puerperal fever in the practices of the several midwives who
had more than one case was as follows:—
Two midwives, A and B, had 3 cases each during the year. A's cases were in March, June
and November, and no connection could be established between them. Several other patients
delivered by the same midwife in the intervals did not develop fever. B's cases were 1 in July, and
2 in August. The interval between the 1st and 2nd of these cases was more than 6 weeks, and
several other patients delivered in the interval by the same midwife did not develop symptoms of
puerperal fever. The 3rd case was subsequently diagnosed as "white leg."
Nine midwives had two cases each as follows :—D, cases in January and April. E, cases in
January and August. F, 2 cases in February. The 2nd case was delivered before the 1st case was
recognised and notified—6 patients delivered in the interval between the 2 cases did not develop
symptoms of puerperal fever. G, cases in February and April. H, 2 cases in August. The midwife
was disinfected after the first case and delivered two other women in the evening of the day she was
disinfected, neither of whom developed symptoms of puerperal fever. On the following day a patient
was delivered who developed puerperal fever in a mild form. I, 2 cases in August, the 2nd being
delivered before the 1st case was recognised and notified. J, cases in September and November, at
an interval of 9 weeks. There were no symptoms of puerperal fever in several cases attended in the
interval. K, cases in July and December. L, cases in October and November (4 weeks interval).
The midwife was disinfected after the 1st case ; the 2nd case was considered to be due to decomposition
of a piece of retained membrane.
Ophthalmia.—In October, 1907, special attention was directed to the occurrence of ophthalmia
in newly born infants, and subsequent to that date more comprehensive enquiries were made concerning
cases coming to the knowledge of the inspectors of inflammation of the eyes of newly born children.
The importance of seeking medical advice in such cases was pointed out to midwives by the inspectors,
and as a result there was a marked increase in the last two months of the year, of notices that a
doctor had been called for this reason.

* From this time onwards, these inquiries have been continued and in January, 1908, a circular letter was
addressed to all midwives pointing out the necessity of advising that medical aid should be obtained "in any case of
inflammation of the eyes, however slight."