329

Annotations.

THE EFFECT OF "MATERNITY BENEFIT" ONMIDWIFERY TRAINING.

"Ne quid nimls."

MOST medical men retain vivid recollections oftheir experiences when attending in their studentdays the midwifery cases prescribed by the medicalcurriculum. For most medical students obtain theirpractical obstetric experience on " the district "

system, where new aspects of life, some humorous,some horrible, are presented to their gaze. Norare medical students the only ministers of thisparticular form of charity; midwives in greatnumbers also derive their training very largely ona similar system. So that any social experimentwhich threatens to upset this kind of midwiferypractice among the poorest classes is bound to havefar-reaching effects upon the education of bothmedical men and midwives. " Maternity benefit "under the National Insurance Act endows a highproportion of the mothers amongst the labouringclasses with the sum of thirty shillings for each con-finement. It thus renders those mothers less de-pendent upon free attendance, and more able toengage a trained obstetrician, whether midwife orpractitioner, for the occasion. Such a position isbound to affect the working of the various charitieswhich have hitherto afforded free obstetric attend-ance to the poor, and incidentally to affect the"

district" system of education. In passing, it maybe remarked that this preference on the part ofthose entitled to maternity benefit for paid assist-ance by no means necessarily indicates any dis-satisfaction with the skill of the unpaid workers,but is more likely explicable on personal grounds.The drawback of the " district " system from thepoint of view of the patient is the impossibility ofknowing beforehand who will attend when thesummons is sent, and the natural dislike of beingin the hands of a total stranger on such an occasion.The extent to which the Insurance Act has actuallybrought about these changes has lately been investi-gated, at the instance of the Charity OrganisationSociety, in London by Mr. E. S. Kemp, who read apaper on the subject before the council of that bodyon May llth last. It appears from this report thatthere has been a very definite and considerabledecrease among the midwifery cases treated " onthe district " in London directly due to the Act.To some slight extent this is due to the fact thatsome institutions have increased the chargesformerly made, or have imposed charges wherenone were asked before. But in the main thedecrease has been due to the utilisation of

"maternity benefit" in securing the services ofa paid midwife. At the City-road Hospital thereduction of out-patient cases amounts to 59 percent., attributable mainly to this cause. In theout-patient maternity departments of the generalhospitals the reduction is smaller-namely, 13 percent. Mr. Kemp says that 6 out of the 12 generalhospitals which possess such departments find somedifficulty in obtaining a sufficient supply of patientsfor the instruction of their students, and thereis no likelihood of their risking any furtherdiminution by imposing any charge. Threeothers, however, do make, or propose to make, acharge ; these are St. Thomas’s, the London,and St. George’s. Of the competition for cases

in the region to the north of Oxford-street Mr.Kemp has some very scathing and pertinent remarksto make. This district is served by four generalhospitals, three lying-in charities, and a women’shospital. A great deal of bribery in the formof relief is stated to exist, and little properdiscrimination is exercised as to the circum-stances of applicants. Unsuitable patients are

accepted freely, and relief in the shape of food andmaternity outfits is distributed broadcast. It isquite common for one hospital to complain bitterlythat another is poaching on its preserves. That,in substance, is’ Mr. Kemp’s indictment; and it

requires an answer. He does not admit that the

plea, " We must keep up our school," is any

sufficient excuse for the abuses he describes. Thewhole subject is in need of consideration.

WILD MEN OF THE WOODS.

THE discovery in the woods near Naini Tal(United Provinces) of a wild-looking female child,whose back is covered with hair and whose actionsare those of an ape, carries on an immemorialtradition. Stories of wild men and women of thewoods abounded in Europe itself as long ago as thesixteenth century, when roads were few and desertand forest were everywhere. The most famous ofthese recitals is that of the boy of the Ardennes,.told by De Humiere, huntsman to Charles IX. in1563. He had killed a dozen wolves when henoticed a she-wolf approaching, followed by anaked child, about seven years of age, who showeda desire to tear the huntsmen with her teeth. The

story gained credence at the time from the fact.that a mother had some years earlier abandonedan infant girl at the same spot. Simon Goulardtells of a little girl discovered in -Hesse,who walked on all fours and made noises likethose of a bear. She was ultimately taught tospeak. The newly discovered Indian child is.

supposed by the natives to have been brought upby bears. It is to medical men that the task of

educating these remarkable creatures was usuallyconfided. Thus at the end of the eighteenthcentury the famous Virey, and then Dr. Itard, anable physician and well-known physiologist, under-took the education of a child known as the " savageof Aveyron," which had been taken in 1799, afterevading capture for months, as he leapt or creptfrom branch to branch of the trees in the wood ofLa Bassine. The boy, stark naked when captured,.appeared to be about 12 years old, and his bodyshowed the cicatrices of a number of wounds, whichled to the inference that an attempt had at onetime been made to kill him. He was well built,active, had piercing eyes, and was ambidextrous,but the conformation of his arms and hands wasthat of a savage. He ran occasionally on all fours,grew in time somewhat stout, and was always dumb,.but not deaf. He preferred raw to cooked food,and detested beds and clothes. Itard’s patientattempts to awake his faculties were only partiallysuccessful, but led to a number of very interestingobservations being made on him. He lived 20years of a semi-civilised life, and died, still un-able to use articulate speech, in 1828. His.career is an ample commentary on the simple lifeof the noble savage of Rousseau. His characterwas not bad, but not brilliant. He loved freedomand loathed all forms of alcohol, but was not con-spicuously grateful or amiable. His was really nota case of savagery, for any savage, even the lowest,