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In the case which resulted in blindness in one eye, the midwife failed to recognise any inflammation
until the 8th day of life, although the mother stated that there was something wrong with the
child's eyes at birth. The eyes had been washed at birth with a weak solution of perchloride of mercury.
The case was subsequently recognised to be one of severe gonorrheal ophthalmia. The midwife in this
case was called before the Midwives Act Committee and strongly cautioned.
Lists of Births.—Midwives practising within the County were asked, in October, 1905, to send in
weekly lists of the cases attended by them, forms and stamped envelopes being supplied for this
purpose. A large proportion of the midwives agreed to comply with this request and have since
more or less regularly forwarded these lists to the Council. The information thus obtained was
distributed to the medical officers of health in London. The lists are received each week on Monday
or Tuesday and the information is sent to the medical officers of health of the sanitary authorities
on the following Friday.
Some 185 midwives reported cases more or less regularly, and on the average 110 lists were
received weekly. Lists were also received from 15 institutions employing one or more midwives, and
the authorities of six lying-in hospitals supplied lists of the addresses of London mothers discharged
from the hospital.
The following figures obtained from these lists afford some idea of the extent of the practice of
midwives —
4 midwives reported over 500 cases each in the year.
4 „ „ 400-500 „ „
• • 8 „ „ 300-400 „ „
6 , „ „ 250-300 „ „
7 „ „ 200-250 „ „
15 „ „ 150-200 „ „
26 „ „ 100-150 „ „
41 „ „ 50-100 „ „
33 „ „ 25- 50 „ „
41 „ „ less than 25 „ „
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The midwives of 15 institutions reported attending 4,454 cases in their own homes and the 6
lying-in hospitals sent information as to 2,866 patients discharged. The total number of births
reported was 26,993, of which 862 were those of infants who were either still-born or died before the
list was sent in.
Fees charged by Midwives.—The fees charged by midwives vary in different localities from
5s. per case upwards, but as a general rule, a fee of 7s. 6d. (or 10s. if patient be a primipara) is expected.
Fees of 15s. and even up to £1 1s. have been paid to a midwife on rare occasions. The charities
employing midwives pay 5s. or 6s. per case and provide the necessary drugs, registers of cases, etc.
It is apparent from the number of cases attended by midwives given in the above table that only a
small proportion of midwives can depend solely upon their practice for their livelihood, and many
supplement their incomes by other means. A few keep lying-in homes and others are registered under
the Infant Life Protection Act to take charge of nurse children. Some of those midwives who have
an extensive practice are approved by the Central Midwives Board as qualified to give practical
instruction to pupil midwives, and receive fees from the pupils for this instruction.
The lying-in hospitals in London receive into their wards some 5,000 women annually and provide
for attendance on about 10,000 in their own homes. The latter cases are conducted almost
exclusively by midwives and many of the cases thus attended are included in the figures obtained
from the lists of births. Some of the hospitals pay the midwife a fee for each case, while others pay a
fixed salary. The patients are not as a rule expected to pay for the services rendered by the district
midwives attached to hospitals, and in the case of institutions there is either free attendance or a
nominal fee.
Having regard to the provision made for the free attendance of labour cases in London on the
one hand and the low fees required by medical men in some districts, the scope for a midwife in private
practice is not great, and when it is remembered that a midwife can only attend normal cases and, if
any abnormality occurs, medical help must be summoned and a medical man has to be paid in addition
to the midwife, it is not surprising that many midwives find great difficulty in making a living.
Medical help for poor patients.—The difficulty of securing medical help for poor patients has
been frequently brought to notice and the Boards of Guardians have been asked to make arrangements
for the medical attendance in such cases.
In July, 1907, a circular was issued by the Local Government Board calling the attention of the
Board of Guardians to the powers they possess under Section II. of the Poor Law Amendment Act,
1848, of paying for medical assistance rendered in a case of midwifery, without an order from the
relieving officer, and of subsequently recovering the fee if the patient be found in a position to pay.
As a rule the Boards of Guardians require a midwife in the first instance to call one of the district
medical officers, but in some districts the Guardians will pay a fee to any medical practitioner called in,
reserving the right to recover the fee if the patient's circumstances warrant such a course.*
* The Council has since issued to every midwife in London a statement showing the arrangements for this
purpose in the several poor law districts so far as arrangements have been made.