- Email: [email protected]
INFANT FEEDING AND MILK-SUPPLY.
POPULAR SANITATION.-INFANT FEEDING AND MILK-SUPPLY.
present in the upper limb. Summarising his observations Dr. Gordon concludes that, without exception, in all the cases of cerebral paralysis examined the sense of pain was impaired the most in all parts of the body-face, upper limb, trunk, and lower limb. The sense of heat and cold (temperature sense) was affected next in order of intensity, while touch (cutaneous tactile sensibility) was the least affected. " There was no exception to the fact that whether in pain, touch, or temperature, the hypo-sensations [diminution of sensibility] occurred in the largest number of cases, while anassthesias were met with in a comparatively small number and hyperaesthesias in extremely few cases." It was also noticed that in the largest number of cases the impairment of sensibility to touch, pain, and temperature occurred in the upper limb and that the face was the least affected part of the entire individual. Verger of Paris has stated that the impairment of sensation in the limbs in cases of hemiplegia had a tendency to be most marked in the hands and feet and 1iO diminish towards the proximal part (shoulder or hip), an assertion which Dr. Gordon found to be correct in a large number of his cases. The stereognostic sense was disturbed in 29 out of the 35 cases and in 22 of these the loss of this sense was complete. The greater the involvement of the other sensations the more marked was the astereognosis, a fact which tended to favour the conception of the stereognostic sense as depending upon the integrity of the separate tactile, muscular, and other cutaneous sensations. Finally, in the one case with symptoms of hysteria, which was studied as a test case, Dr. Gordon was able to satisfy himself that the sensory impairment present was parallel to that observed in other cases of cerebral paralysis and was in no wise dependent upon the neurosis present.
Nevertheless, it is a fact that the necessity of ventilation by fresh air is probably the one principle essential to health which is least appreciated by many persons even at the present time ; nor is it sufficiently understood that the partial opening of one window in a compartment implies the most trifling inconvenience to its inmates, while an even freer entrance of air is often desirable in their common interest. A little judicious advice from railway companies on this subject would go far to insure the comfort and the well-being of passengers. On the same ground it is to be hoped that something will be done wherever practicable to improve the existing inlets other than windows and toprovide exits in the roof which at present do hot exist.
was
-
POPULAR SANITATION.
1257
THE
I
FATE
OF MISS CAMILLE
HOLLAND.
about to be cast on the mystery surthe rounding disappearance of Miss Camille Holland from Moat House Farm, near Clavering in Essex. On Monday last, April 27th, the persevering efforts of the police, who have for some weeks been digging over the ground in the vicinity of the farm buildings and draining off the water from ditches and ponds, were rewarded by the discovery of a woman’s body buried in circumstances which leave no doubt as to the interment having been surreptitious. Several who well were with Miss Holland are persons acquainted said to have identified the remains as being hers and the police, in conjunction with medico-legal experts acting on behalf of the Home Office, may be relied on to make full use of all the material available for arriving at a conclusion. There is satisfaction in the reflection that amid the atmosphere of suspicion which envelopes Miss Holland’s disappearance the public have refrained from hysterical denunciation of the man who is charged with attempting to obtain money by forging Miss Holland’s name and against whom additional charges will no doubt now be brought. The absolute and incontrovertible identification of a secretly-buried body as that of a person who has not been seen alive for several years may present circumstances of considerable difficulty to the experts whose opinion will be of paramount importance both to the prosecution and to the defence. Strange errors of identification of persons deceased or alleged to be deceased occur from time totime, and have been recorded in THE LANCET, while the long-drawn-out controversy which centred round the Tichborne claimant 30 years ago forms a historic example. These are the cases that lead the law to require overwhelming testimony founded on the most stringent testsbefore identification is accepted. LIGHT
seems now
IT is always gratifying to those who are engaged in the conflict with disease to note the extension of sanitary knowledge and the translation of its principles into the rule and custom of ordinary life. Happily signs of such prudent intelligence are not wanting in our own day. Cleanliness is already for all classes of the people a word of much deeper and wider meaning than it was a quarter of a century ago. Even in its refined or"surgical" " variety it can often be depended on with some degree of confidence in domestic practice. The danger of infection and the responsibilities which it entails are even better understood. Indeed, there is a tendency in many quarters to excessive caution in respect of it. We may reasonably hope, however, that with fuller knowledge and the passing of a transition period of INFANT FEEDING AND MILK-SUPPLY. half-light this morbid over-sensitiveness will give place to In the meancalmer views of personal and public duty. AT the annual meeting of the Metropolitan Hospital time we may be thankful that the national mind is awake Fund, which was held at the Mansion House on Saturday The notices displayed in many streets of on this subject. Dr. T. D. Lister delivered an address upon the 25th, April the metropolis and in public vehicles in condemnation of of infant feeding and milk-supply. The important subject the practice of spitting afford further proof of this wakeful is of the utmost importance not only as regards subject spirit. In the tramcars under its control the London County waste of human life but also in respect to the future of the Council has gone the length of prohibition under a penalty. For the children of to-day are the fathers and The great importance of these precautions in relation to country. mothers of the future and looking at the appalling infant the danger conveyed by tuberculous sputa can hardly which exists, the puny stamina of town dwellers, be exaggerated. We congratulate the local authorities mortality and the denudation of the country districts we are reminded on a method of notification so happily devised and so inof the words : expensive. We should like to see it still further extended " III fares the land, to hastening ills a prey, Where wealth accumulates and men decay." by railway and shipping companies and, above all, by owners of factories, workshops, and business ofhces. These A Budget of nearly 144 millions makes it all the more neceslatter are probably the chief sources of tuberculous con- sary that the population by whom this enormous sum has to tamination. The National Association for the Prevention be found should be healthy. Dr. Lister in his address gave his of Consumption and other Forms of Tuberculosis has hearers no information which is not perfectly known to most drawn attention to the desirability in this connexion of persons who have studied the subject, but he put very clearly the better ventilation of railway carriages. The dread of a and emphatically the loss of infant life by bad feeding, the draught is fortunately not now so great as it used to be. fact that this loss is mainly due to mothers neglecting either
THE MIDWIVES ACT.
1258
Edinburgh University, will be in the chair, and amongst those who have accepted invitations to be present are Sir William S. Church, Sir H. G. Howse, Sir William Huggins, and Sir William Macewen. Members intending to be present are requested to send in their names to one of the honorary secretaries, Dr. James Taylor, 49, Welbeck-street, W., and Dr. G. A. Sutherland, 73, Wimpole-street, W.
from necessity-i.e., poverty-or carelessness, the first duty -of a mammalian mother-namely, the suckling of the young -and that if children unfortunately have to be artificially fed they should be so fed on fresh cow’s milk and not on condensed or preserved milk. He referred also to the success has attended the principle of a muniwhich great distribution of clean fresh milk and to the very pure cipal careless manner in which milk is allowed to be sold and stored in the poorer districts of London, while at the same time he gave every credit to those firms which try to supply, and succeed in supplying, fresh clean milk. Here are Dr. Lister’s conclusions with which we thoroughly agree :In conclusion, the facts seem to show that ignorance of the usage of cow’s milk for infant feeding, and ignorance as to the proper handling of milk-supply at every stage, are two great factors in excessive infant mortality. In the homes we want wider teaching of mothers and potential mothers as to the care and feeding of children. The London School Board has recently made a step in this direction. The printed pamphlet provided by many health officers is of great use, but an organised service of trained women, "health visitors," or "mothers’ friends," such as is in existence in certain towns, is of far greater value among the poorest and most ignorant and helpless people. Good cow’s milk is a vital necessity to those babies unable to obtain the’ natural food, but it cannot exactly replace it. Where the poverty is such that skimmed milk, tinned or fresh, is all that can be bought, then proper milk should be provided by public funds, either free or at the cost of the materials. This limitation to the extremely poor involves no trade dnjustice. It does not matter whether this be done charitably or as a municipal preventive measure against maintaining an increasing proportion of the population damaged by, but surviving, bad feeling in infancy. Many thousands of children are sacrificed annually for want of such provision. If our common conditions compel this reproach, our common interest, no less than our common conscience, should take .steps to remove it.
THE MIDWIVES ACT. I
tion of a roll which will contain the names of midwives certified under the Act and for the formation and constitution of a body to be called the Central Midwives Board, who as the central authority for carrying the Act into effect will possess jurisdiction in regard to the issue of certificates and the admission to the roll of midwives and will exercise a general control over the practice of such persons. (Sections 3 and 6.) 3. The Central Midwives Board has been constituted and consists of the following members :-W. J. Sinclair, Esq., M.D., Miss J. Wilson, F. H. Champneys, Esq., M.D., J. W. Cousins. Esq., F.R.C.S., E. P. Young, Esq., M.R.C.S., L.S.A., C. J. Cullingworth, Esq., M.D., F.R.C.P., J. H. Johnstone, Esq., M.P., Miss R. Paget, Miss D. Oldham; secretary, G. W. Duncan, Esq. The temporary office of the Board is at the Privy Council Office, Whitehall, S.W. 4. The Central Midwives Board are to frame rules, subject to the approval of the Privy Council, for the purposes above referred to, and they are also required (amongst other things) to publish annually a roll of midwives who have been duly certified under the Act.
-
THE annual dinner of the Glasgow University Club will be held at the Trocadero Restaurant on Friday, May 29th, at ’7 o’clock. The Rt. Hon. George Wyndham, M.P., the Lord Rector of the University, is announced to be in the chair. Applications for tickets should be made to Mr. James M. Dobbs, Dover House, Whitehall, or to Dr. C. O. Hawthorne, 28, Weymouth-street, Portland-place, W.
(Section 3.)
Franz Narden Koetter, or Nordenkotter, was brought up at the Bow.street Police-court before Mr. Marsham on April 29th for extradition on charges of obtaining money by false pretence in Germany. His proceedings as an unqualified medical practitioner in Berlin and his flight from Germany to evade arrest were mentioned by our Berlin Correspondent in THE LANCET of April 4th, p. 998.
I
THE third annual dinner of South African civil surgeons will take place at the Hotel Cecil on Friday, June 5th, the third anniversary of the entry into Pretoria. Sir William Thomson, C.B., will occupy the chair. Tickets, price 10s. 6d., may be had on application to the secretaries, Mr. C. G. Watson, 44, Welbeck-street, or Dr. F. E. Fremantle, ’The College, Guy’s Hospital.
Mr. A. G. R. Foulerton has resigned his post as director of the Cancer Research Laboratories at Middlesex Hospital, so that he may have more time to devote to his duties, lately much increased, as director of the clinical and bacteriological laboratories of the hospital. A director will be appointed to devote the whole of his time to the work of the Cancer Research Laboratories. ____
conference, convened by the Matrons’ Council the Society for the State Registration of Trained Nurses, will be held at 20, Hanover-square, London, W., on Friday next, May 8th, at 3 P. M. The question to be considered is the State Registration of Trained Nurses as it .affects the Community. A and
CONJOINT
by
-
THE May dinner of the Edinburgh University Club of London will take place on May 20th at the Criterion Restaurant. Sir William Turner, K.C.B., principal of
THE following Memorandum has been issued by the Local Government Board with reference to the Midwives Act, 1902 (2 Edw. VII. c. 17) :1. Object of Act.-The object of this Act, which, except as otherwise provided, came into operation on the 1st of April, 1903, is to secure the better training and supervision of midwives by the establishment of a system of certification and enrolment of women who are properly qualified to act in that capacity. 2. ividwites roLL.-The dct accordingly makes provision for theinstitu-
5. Definition of midwife.-The term "midwife" as used in the Act is defined by section 18 as meaning a woman who is certified under the Act, unless the context otherwise requires. 6. Local supervising authorities.-The local supervision of midwives is entrusted to the council of every county or county borough throughout England and Wales who by section 8 are made the local supervising authority over midwives within their respective areas. 7. The same section imposes upon each local supervising authority as thus constituted various specified duties in relation to midwives. Their first duty (section 8 (7) ) will be to give due notice of the effect of the Act, so far as practicable, to persons at present using the title of midwife. It is understood that the Central Midwives Board contemplate the preparation of a form of notice for the use of local authorities, which will be communicated to them, together with the rules under section 3. The council should forthwith ascertain, so far as possible, the names and addresses of all women in the county who are accustomed to hold themselves out as midwives. 8. The other duties enjoined upon the local supervising authority by section 8 are as follows :-(1) To exercise general supervision over all midwives practising within their area in accordance with the rules to be laid down under the Act. (2) To investigate charges of malpractice, negligence, or misconduct on the part of any midwife practising within their area, and should a primd facie case be established to report the same to the Central Midwives Board. (3) To suspend any midwife from practice, in accordance with the rules under the Act, if such suspension appears necessary in order to prevent the spread of infection. (4) To report at once to the Central Midwives Board the name of any midwife practising in their area convicted of an offence. (5) During the month of January of each year to supply the secretary of the Central Midwives Board with the names and addresses of all midwives who, during the preceding year, have notified their intention to practise within their area, and to keep a current copy of the roll of midwives accessible at all reasonable times for public inspection. (6) To report at once to the Central Midwives Board the death of any midwife or any change in the name or address of any midwife in their area, so that the necessary alteration may be made in the roll. 9. Delegation of powers by local supervising authorities.-The local supervising authority may delegate, with or without any restrictions or conditions as they may think fit, any powers or duties conferred or imposed upon them by or in pursuance of the Act, to a committee appointed by them and consisting either wholly or partly of members of the council. The provisions of sub-sections (1) and (2) of section 82 of the Local Government Act, 1888, are applied to every committee appointed under this section and to every council appointing the same, and women are made eligible to serve on any such committee. "
(Section 8.)
10. In addition to the general right thus conferred upon the local supervising authorities of delegating their powers and duties under the Act to committees, the councils of counties are empowered by section 9 of the Act to delegate, with or without any restrictions or conditions as they may think fit, any powers or duties conferred or imposed upon them by or in pursuance of the Act to any district council within the area of the county. It is provided that the powers and duties so delegated may be exercised by a committee appointed by such district council and consisting either wholly or partly of members of the district council, and that women shall be eligible to serve on any such committee. Any expenses incurred by a district council in the execution of any powers or duties so delegated are, to an amount not exceeding such sum as may be prescribed by the county council, to be repaid to the district council as a debt by the
present in the upper limb. Summarising his observations Dr. Gordon concludes that, without exception, in all the cases of cerebral paralysis examined the sense of pain was impaired the most in all parts of the body-face, upper limb, trunk, and lower limb. The sense of heat and cold (temperature sense) was affected next in order of intensity, while touch (cutaneous tactile sensibility) was the least affected. " There was no exception to the fact that whether in pain, touch, or temperature, the hypo-sensations [diminution of sensibility] occurred in the largest number of cases, while anassthesias were met with in a comparatively small number and hyperaesthesias in extremely few cases." It was also noticed that in the largest number of cases the impairment of sensibility to touch, pain, and temperature occurred in the upper limb and that the face was the least affected part of the entire individual. Verger of Paris has stated that the impairment of sensation in the limbs in cases of hemiplegia had a tendency to be most marked in the hands and feet and 1iO diminish towards the proximal part (shoulder or hip), an assertion which Dr. Gordon found to be correct in a large number of his cases. The stereognostic sense was disturbed in 29 out of the 35 cases and in 22 of these the loss of this sense was complete. The greater the involvement of the other sensations the more marked was the astereognosis, a fact which tended to favour the conception of the stereognostic sense as depending upon the integrity of the separate tactile, muscular, and other cutaneous sensations. Finally, in the one case with symptoms of hysteria, which was studied as a test case, Dr. Gordon was able to satisfy himself that the sensory impairment present was parallel to that observed in other cases of cerebral paralysis and was in no wise dependent upon the neurosis present.
Nevertheless, it is a fact that the necessity of ventilation by fresh air is probably the one principle essential to health which is least appreciated by many persons even at the present time ; nor is it sufficiently understood that the partial opening of one window in a compartment implies the most trifling inconvenience to its inmates, while an even freer entrance of air is often desirable in their common interest. A little judicious advice from railway companies on this subject would go far to insure the comfort and the well-being of passengers. On the same ground it is to be hoped that something will be done wherever practicable to improve the existing inlets other than windows and toprovide exits in the roof which at present do hot exist.
was
-
POPULAR SANITATION.
1257
THE
I
FATE
OF MISS CAMILLE
HOLLAND.
about to be cast on the mystery surthe rounding disappearance of Miss Camille Holland from Moat House Farm, near Clavering in Essex. On Monday last, April 27th, the persevering efforts of the police, who have for some weeks been digging over the ground in the vicinity of the farm buildings and draining off the water from ditches and ponds, were rewarded by the discovery of a woman’s body buried in circumstances which leave no doubt as to the interment having been surreptitious. Several who well were with Miss Holland are persons acquainted said to have identified the remains as being hers and the police, in conjunction with medico-legal experts acting on behalf of the Home Office, may be relied on to make full use of all the material available for arriving at a conclusion. There is satisfaction in the reflection that amid the atmosphere of suspicion which envelopes Miss Holland’s disappearance the public have refrained from hysterical denunciation of the man who is charged with attempting to obtain money by forging Miss Holland’s name and against whom additional charges will no doubt now be brought. The absolute and incontrovertible identification of a secretly-buried body as that of a person who has not been seen alive for several years may present circumstances of considerable difficulty to the experts whose opinion will be of paramount importance both to the prosecution and to the defence. Strange errors of identification of persons deceased or alleged to be deceased occur from time totime, and have been recorded in THE LANCET, while the long-drawn-out controversy which centred round the Tichborne claimant 30 years ago forms a historic example. These are the cases that lead the law to require overwhelming testimony founded on the most stringent testsbefore identification is accepted. LIGHT
seems now
IT is always gratifying to those who are engaged in the conflict with disease to note the extension of sanitary knowledge and the translation of its principles into the rule and custom of ordinary life. Happily signs of such prudent intelligence are not wanting in our own day. Cleanliness is already for all classes of the people a word of much deeper and wider meaning than it was a quarter of a century ago. Even in its refined or"surgical" " variety it can often be depended on with some degree of confidence in domestic practice. The danger of infection and the responsibilities which it entails are even better understood. Indeed, there is a tendency in many quarters to excessive caution in respect of it. We may reasonably hope, however, that with fuller knowledge and the passing of a transition period of INFANT FEEDING AND MILK-SUPPLY. half-light this morbid over-sensitiveness will give place to In the meancalmer views of personal and public duty. AT the annual meeting of the Metropolitan Hospital time we may be thankful that the national mind is awake Fund, which was held at the Mansion House on Saturday The notices displayed in many streets of on this subject. Dr. T. D. Lister delivered an address upon the 25th, April the metropolis and in public vehicles in condemnation of of infant feeding and milk-supply. The important subject the practice of spitting afford further proof of this wakeful is of the utmost importance not only as regards subject spirit. In the tramcars under its control the London County waste of human life but also in respect to the future of the Council has gone the length of prohibition under a penalty. For the children of to-day are the fathers and The great importance of these precautions in relation to country. mothers of the future and looking at the appalling infant the danger conveyed by tuberculous sputa can hardly which exists, the puny stamina of town dwellers, be exaggerated. We congratulate the local authorities mortality and the denudation of the country districts we are reminded on a method of notification so happily devised and so inof the words : expensive. We should like to see it still further extended " III fares the land, to hastening ills a prey, Where wealth accumulates and men decay." by railway and shipping companies and, above all, by owners of factories, workshops, and business ofhces. These A Budget of nearly 144 millions makes it all the more neceslatter are probably the chief sources of tuberculous con- sary that the population by whom this enormous sum has to tamination. The National Association for the Prevention be found should be healthy. Dr. Lister in his address gave his of Consumption and other Forms of Tuberculosis has hearers no information which is not perfectly known to most drawn attention to the desirability in this connexion of persons who have studied the subject, but he put very clearly the better ventilation of railway carriages. The dread of a and emphatically the loss of infant life by bad feeding, the draught is fortunately not now so great as it used to be. fact that this loss is mainly due to mothers neglecting either
THE MIDWIVES ACT.
1258
Edinburgh University, will be in the chair, and amongst those who have accepted invitations to be present are Sir William S. Church, Sir H. G. Howse, Sir William Huggins, and Sir William Macewen. Members intending to be present are requested to send in their names to one of the honorary secretaries, Dr. James Taylor, 49, Welbeck-street, W., and Dr. G. A. Sutherland, 73, Wimpole-street, W.
from necessity-i.e., poverty-or carelessness, the first duty -of a mammalian mother-namely, the suckling of the young -and that if children unfortunately have to be artificially fed they should be so fed on fresh cow’s milk and not on condensed or preserved milk. He referred also to the success has attended the principle of a muniwhich great distribution of clean fresh milk and to the very pure cipal careless manner in which milk is allowed to be sold and stored in the poorer districts of London, while at the same time he gave every credit to those firms which try to supply, and succeed in supplying, fresh clean milk. Here are Dr. Lister’s conclusions with which we thoroughly agree :In conclusion, the facts seem to show that ignorance of the usage of cow’s milk for infant feeding, and ignorance as to the proper handling of milk-supply at every stage, are two great factors in excessive infant mortality. In the homes we want wider teaching of mothers and potential mothers as to the care and feeding of children. The London School Board has recently made a step in this direction. The printed pamphlet provided by many health officers is of great use, but an organised service of trained women, "health visitors," or "mothers’ friends," such as is in existence in certain towns, is of far greater value among the poorest and most ignorant and helpless people. Good cow’s milk is a vital necessity to those babies unable to obtain the’ natural food, but it cannot exactly replace it. Where the poverty is such that skimmed milk, tinned or fresh, is all that can be bought, then proper milk should be provided by public funds, either free or at the cost of the materials. This limitation to the extremely poor involves no trade dnjustice. It does not matter whether this be done charitably or as a municipal preventive measure against maintaining an increasing proportion of the population damaged by, but surviving, bad feeling in infancy. Many thousands of children are sacrificed annually for want of such provision. If our common conditions compel this reproach, our common interest, no less than our common conscience, should take .steps to remove it.
THE MIDWIVES ACT. I
tion of a roll which will contain the names of midwives certified under the Act and for the formation and constitution of a body to be called the Central Midwives Board, who as the central authority for carrying the Act into effect will possess jurisdiction in regard to the issue of certificates and the admission to the roll of midwives and will exercise a general control over the practice of such persons. (Sections 3 and 6.) 3. The Central Midwives Board has been constituted and consists of the following members :-W. J. Sinclair, Esq., M.D., Miss J. Wilson, F. H. Champneys, Esq., M.D., J. W. Cousins. Esq., F.R.C.S., E. P. Young, Esq., M.R.C.S., L.S.A., C. J. Cullingworth, Esq., M.D., F.R.C.P., J. H. Johnstone, Esq., M.P., Miss R. Paget, Miss D. Oldham; secretary, G. W. Duncan, Esq. The temporary office of the Board is at the Privy Council Office, Whitehall, S.W. 4. The Central Midwives Board are to frame rules, subject to the approval of the Privy Council, for the purposes above referred to, and they are also required (amongst other things) to publish annually a roll of midwives who have been duly certified under the Act.
-
THE annual dinner of the Glasgow University Club will be held at the Trocadero Restaurant on Friday, May 29th, at ’7 o’clock. The Rt. Hon. George Wyndham, M.P., the Lord Rector of the University, is announced to be in the chair. Applications for tickets should be made to Mr. James M. Dobbs, Dover House, Whitehall, or to Dr. C. O. Hawthorne, 28, Weymouth-street, Portland-place, W.
(Section 3.)
Franz Narden Koetter, or Nordenkotter, was brought up at the Bow.street Police-court before Mr. Marsham on April 29th for extradition on charges of obtaining money by false pretence in Germany. His proceedings as an unqualified medical practitioner in Berlin and his flight from Germany to evade arrest were mentioned by our Berlin Correspondent in THE LANCET of April 4th, p. 998.
I
THE third annual dinner of South African civil surgeons will take place at the Hotel Cecil on Friday, June 5th, the third anniversary of the entry into Pretoria. Sir William Thomson, C.B., will occupy the chair. Tickets, price 10s. 6d., may be had on application to the secretaries, Mr. C. G. Watson, 44, Welbeck-street, or Dr. F. E. Fremantle, ’The College, Guy’s Hospital.
Mr. A. G. R. Foulerton has resigned his post as director of the Cancer Research Laboratories at Middlesex Hospital, so that he may have more time to devote to his duties, lately much increased, as director of the clinical and bacteriological laboratories of the hospital. A director will be appointed to devote the whole of his time to the work of the Cancer Research Laboratories. ____
conference, convened by the Matrons’ Council the Society for the State Registration of Trained Nurses, will be held at 20, Hanover-square, London, W., on Friday next, May 8th, at 3 P. M. The question to be considered is the State Registration of Trained Nurses as it .affects the Community. A and
CONJOINT
by
-
THE May dinner of the Edinburgh University Club of London will take place on May 20th at the Criterion Restaurant. Sir William Turner, K.C.B., principal of
THE following Memorandum has been issued by the Local Government Board with reference to the Midwives Act, 1902 (2 Edw. VII. c. 17) :1. Object of Act.-The object of this Act, which, except as otherwise provided, came into operation on the 1st of April, 1903, is to secure the better training and supervision of midwives by the establishment of a system of certification and enrolment of women who are properly qualified to act in that capacity. 2. ividwites roLL.-The dct accordingly makes provision for theinstitu-
5. Definition of midwife.-The term "midwife" as used in the Act is defined by section 18 as meaning a woman who is certified under the Act, unless the context otherwise requires. 6. Local supervising authorities.-The local supervision of midwives is entrusted to the council of every county or county borough throughout England and Wales who by section 8 are made the local supervising authority over midwives within their respective areas. 7. The same section imposes upon each local supervising authority as thus constituted various specified duties in relation to midwives. Their first duty (section 8 (7) ) will be to give due notice of the effect of the Act, so far as practicable, to persons at present using the title of midwife. It is understood that the Central Midwives Board contemplate the preparation of a form of notice for the use of local authorities, which will be communicated to them, together with the rules under section 3. The council should forthwith ascertain, so far as possible, the names and addresses of all women in the county who are accustomed to hold themselves out as midwives. 8. The other duties enjoined upon the local supervising authority by section 8 are as follows :-(1) To exercise general supervision over all midwives practising within their area in accordance with the rules to be laid down under the Act. (2) To investigate charges of malpractice, negligence, or misconduct on the part of any midwife practising within their area, and should a primd facie case be established to report the same to the Central Midwives Board. (3) To suspend any midwife from practice, in accordance with the rules under the Act, if such suspension appears necessary in order to prevent the spread of infection. (4) To report at once to the Central Midwives Board the name of any midwife practising in their area convicted of an offence. (5) During the month of January of each year to supply the secretary of the Central Midwives Board with the names and addresses of all midwives who, during the preceding year, have notified their intention to practise within their area, and to keep a current copy of the roll of midwives accessible at all reasonable times for public inspection. (6) To report at once to the Central Midwives Board the death of any midwife or any change in the name or address of any midwife in their area, so that the necessary alteration may be made in the roll. 9. Delegation of powers by local supervising authorities.-The local supervising authority may delegate, with or without any restrictions or conditions as they may think fit, any powers or duties conferred or imposed upon them by or in pursuance of the Act, to a committee appointed by them and consisting either wholly or partly of members of the council. The provisions of sub-sections (1) and (2) of section 82 of the Local Government Act, 1888, are applied to every committee appointed under this section and to every council appointing the same, and women are made eligible to serve on any such committee. "
(Section 8.)
10. In addition to the general right thus conferred upon the local supervising authorities of delegating their powers and duties under the Act to committees, the councils of counties are empowered by section 9 of the Act to delegate, with or without any restrictions or conditions as they may think fit, any powers or duties conferred or imposed upon them by or in pursuance of the Act to any district council within the area of the county. It is provided that the powers and duties so delegated may be exercised by a committee appointed by such district council and consisting either wholly or partly of members of the district council, and that women shall be eligible to serve on any such committee. Any expenses incurred by a district council in the execution of any powers or duties so delegated are, to an amount not exceeding such sum as may be prescribed by the county council, to be repaid to the district council as a debt by the