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78
Annual Report of the London County Council, 1913.
Midwives Act, 1902.
The number of midwives giving addresses in London whose names appear on the Roll of Midwives
for 1913 is 4,821. This number includes midwives who may 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, 574 notified their intention to practise during the whole year or for shorter periods.

Inspection.
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 13.2 per cent. The 574 midwives who gave notice of intention to practise cannot be taken as
the number actually practising 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 400 to 450 midwives, or about 10 per cent. of those on the roll are in actual practice
in London. The remaining 90 per cent. act for the most part as monthly or general nurses under medical
supervision. Of the practising midwives 47 were working entirely within poor-law institutions or lyingin
hospitals and were under medical supervision; 160 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 inspection 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 E. Macrory, M.B., Ch.B., L.M., D.P.H., and Miss
M. A. Pilliet, M.B., Ch.B.
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 an infant's 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 by the inspector 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 her supervising the training of pupils for
the Board's examination. The inspectors paid 1,755 visits to midwives or institutions employing
midwives. In 1,214 cases the report was satisfactory, in 56 unsatisfactory, and in 485 the midwife
was not seen. 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
previously, the matter was reported to the Midwives Act Committee of the Council, and a letter of
caution was sent to the midwife. This occurred in seven instances for the following reasons:—
Omitting to advise the seeking of medical assistance for the mother 1
Delay in advising medical aid for inflammation of eyes 1
Failure to notify case of infectious disease 3
Employment of uncertified person as substitute 1
Insufficient attention to patients 1
Charges of malpractice, negligence or misconduct against four midwives were investigated
during the year, and in two instances prima facie cases of negligence and misconduct were established
against the midwives concerned. The name of one of these midwives was in due course removed from
the roll and the Council was requested by the Board to furnish further reports with regard to the other
midwife.