2 There has also been organized a National Association for the Study and Prevention of Tuberculosis, with headquarters in New York City.
in 1898 midwives attended 45 per cent of the births reported ; that in 1900 the percentage increased to 49, while by 1903 it fell again to 45 per cent. Whichever of the two periods may afford the more accurate indication of present tendencies, it would appear that the midwife, in New York City, at least, is being only very slowly, if at all, displaced by the physician. It is possible that the proportion of midwifery cases is merely kept up by the inflow of immigration. In confirmation of this view is the fact that a very large proportion of the cases occurring in the families known to the United Hebrew Charities are now treated by the physicians of a free lying-in hospital, whereas only seven years ago nearly all were attended by midwives.
That the midwives are in large part totally ignorant of aseptic treatment, that many cases result fatally because of their lack of knowledge and skill, and that a very much larger number of women suffer more or less permanent injury from such defects, is generally believed. Whether the remedy lies in a prohibition of midwifery ; in an increase in the amount of free treatment provided by charitable institutions ; in an increase in the number of women physicians ; in the official regulation and licensing of mid wifery ; or in the laissez-faire policy of the present, is a problem in which social considerations are quite. as im portant as those which are of direct professional impor tance to physicians.
Assuming that the number of deaths from puerperal fever is a trustworthy index of the comparative efficiency of physicians and midwives, the author caused an investi gation to be made as to who was responsible for the treat ment in each of the 46 deaths from this cause in the first three months of 1902 in Manhattan Borough, New York City. It was surprising to find that in 21 of these cases the pa tient was under the exclusive charge of a physician, while in 21 cases, an exactly equal number, the patient was origi nally attended by a midwife, although in most of the latter cases a physician was called after the fever had developed. Eighteen of these 46 patients died in hospitals, all of these having been treated outside by physicians and removed to the hospital shortly before death. In two
cases it was probable that abortion had been produced by unknown persons. In four cases the physician believed that infection was due to the nurse employed by the patient, who was ignorant or did not observe instructions. In two cases physicians had reported that midwives had been employed where investigation showed the statement to have been incorrect. It is probable that the official records at the department of health do not show all deaths from puerperal fever, since the opinion has been freely expressed that there are cases in which death occurs from this cause, but is reported to have occurred from some other cause. These statistics, although the period may be too brief to justify any generalization, point toward the conclusion that infection resulting in death occurs as fre quently in the practice of physicians as in that of mid wives, and they point also toward the conclusion that the regulation of midwifery and the licensing of such as have shown their competence would probably lessen or eliminate the existing evils resulting from their practice. If so, the fact that the use of the midwife is a long established custom among immigrants of several nationalities, the lower expense and the widespread preference for employ ing the services of women in this capacity would become decisive in deciding what legislation should be enacted.' Other illustrations of the advantage to society from such cooperation as has been described lie at hand if they are needed. Twice in as many years the physicians of New York joined with the reformers, the charity workers, the clergymen, the public press, and a host of good citizens to defend the charitable institutions of the state from what they believed to be vicious political attack, and the acquaintance and common experience gained in those controversies proved to be of great service in later, more agreeable tasks. Physicians in public offices, not only in health and sanitary departments, but in such allied branches of the public service as street cleaning, in administrative positions connected with charitable and correctional work, in public education and in legislative bodies, give everywhere evidence of the value of medical 1 " Obstetrics in the Tenements," Ralph Folks, Charities, Vol. IX, p. 429.