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of the case as early as possible—but the patient cannot afford this
attention. It seems the solution to this difficulty must, be the
formulation of a scheme by whieh eases of this nature—of persons
of limited financial means—referred from the clinics to their own
attendants for supervision, should be financially assisted by the
Local Authority paying the doctors' fees.
An extension of such a seheme is possible by which the patient's
own medical attendant undertakes adequate ante-natal supervision
even of normal cases, instead of their attending the clinics. The
objections to the proposal would mainly arise through the medical
practitioners' difficulty in finding the time necessary to undertake
the routine ante-natal supervision of a large number of cases.
(2) Supply of Midwives. There arc 18 midwives resident in
the area whose practice is almost entirely confined to this district,
In addition there arc three midwives resident, on the boundaries
whose work is largely carried on here.
The number of births notified in the year by these midwives
was 1,521.
There is no shortage of midwives in this district. In the near
future a Training Home for pupil midwives will be opened in connection
with the working of the Dagenham branch of the Essex
County Nursing Association.
The midwives being well distributed through the area and each
carrying on a fair practice, there is no need to subsidise any of the
present midwives nor is there any justification for the provision of
a municipal midwife. Pregnant women who find difficulty in
finding the midwives' fees are provided for by the District Nursing
Association. The Committee of this Association, after consideration
of the financial circumstances waive the fee in necessitiois
cases. The objection to this instead of making a financial grant
to individual midwives for any necessitous cases they attend is
that the patient has not an absolute choice in se lecting her
attendant.
The displacement of handywomen in a doctor's ease by a
midwife is a matter of difficulty. Many patients cannot afford the
fee of both Doctor and Midwife. Even though sonic from of
grant were made towards payment of a midwife's fee on condition
that one were engaged in addition to the doctor, the fact that the
persons were in a position to book a doctor would usually mean
their income would put them outside the scale in which assistance
is granted for other schemes under the Act.