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89
Report of the Medical Officer of Health.
Midwives Act, 1902.
The number of midwives giving addresses in London whose names appear on the Roll of Mid- Registration
wives for 1910 is 3,526. This number includes midwives who may perhaps have removed from
the County, but, owing to the fact that they are not practising, their present addresses have not been
reported to the Central Midwives Board, and consequently appear as London addresses. Of this
number, 561 notified their intention to practise during the whole year or for shorter periods.

The midwives in classes (a) and (b) are entitled to use the description " certified midwife by
examination." Of those giving notice of their intention to practise, the untrained midwives, class (c)
represent 16 per cent.
On 1st April, 1910, the provisions of Section 1 (2) of the Midwives Act came into operation, and
no woman who was not a certified midwife was allowed to practise habitually and for gain. The Privy
Council, however, sanctioned a rule allowing the Board to enrol up to 30th September, 1910, any woman
who was qualified either under (b) or (c), but who had failed to secure enrolment before 1st April,
1905.
In the County of London it was felt that there was no lack of midwives and that no good purpose
would be served by adding to the list the names of women who had failed to obtain enrolment,
and the Council informed the Board of their opinion. As a result the women who applied under
this rule, with one exception, were not admitted to the roll. The exception was made in favour of a
woman who, owing to illness, had failed to apply at the proper time for enrolment. The 561 midwives
who gave notice of intention to practise cannot be taken as the number of midwives practising
at any given time in the County. In some institutions it is the custom for a midwife to act as an
assistant for three months or less after she is qualified, and her place is then filled by another newly
qualified assistant, who in her turn gives notice of intention to practise. At any given time it may be
estimated that some 420 midwives, or nearly 13 per cent, of those on the roll are in actual practice
in London. The remaining 87 per cent, act'for the most part as monthly or general nurses under medical
supervision. Of the practising midwives 53 were working entirely within poor-law institutions or lyingin
hospitals and were under medical supervision ; 169 others were attending patients on behalf of
charitable, poor-law or other institutions, and were paid either a salary or a fee for each case allotted
to them. The remainder practised independently.
All practising midwives, except those working in hospitals under medical supervision, are subject
to supervision by the Council's officers, to ascertain whether they are complying with the rules of the
Central Midwives Board as to cleanliness, the possession of antiseptics and appliances, the keeping
of registers and case books and the sending of the required notices to the Local Supervising Authority.
The work of inspection was carried out by Miss I: R. Shields, M.B., B.S., and Miss E. Macrory, M.B.,
Ch.B., L.M., D.P.H. In July Miss Shields resigned her appointment and Miss M. A. Pilliet, M.B.,
Ch.B. was appointed.
Inspection
In addition to the ordinary routine inspection, special visits are paid to the midwife when any
case of a septic nature or a persistent high temperature occurs in her practice, and in all cases of
inflammation of the infants' eyes. The inspectors also advise midwives on any points of difficulty which
may arise in the course of their duties, and in some instances instruct the midwives as to methods of
work. On occasion a midwife is accompanied either to a confinement or on a subsequent visit to a patient
to ascertain whether her methods of work are efficient. This is done where there is any reason to believe
that the midwife's work is not up to standard, and also in cases where a midwife has applied to the
Central Midwives Board for approval to supervise the training of pupils for the Board's examination.
The inspectors paid 1,571 visits to midwives or institutions employing midwives. In 958 cases the
report was satisfactory, in 70 unsatisfactory, and in 543 the midwife was not seen. The 70 unsatisfactory
reports relate to 58 midwives, 47 were reported unsatisfactory on one occasion, 10 on two occasions
and one on three occasions.
Most of the unsatisfactory reports related to cases in which some slight breach of the rules had
occurred, and the midwife's attention was called to the matter by the inspector, who was subsequently
able to report favourably. In cases of a more serious nature, or where the midwife had a bad record
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