┌────────────────┬────────────────┬─────────────────────────────────┐ │ YEARS │ MONTHS │ MORTALITY PER 1,000 │ ├────────────────┼────────────────┼────────────────┬────────────────┤ │ „ │ „ │ 1st Clinique │ 2nd Clinique │ │ │ │ Students │ Midwives │ ├────────────────┼────────────────┼────────────────┼────────────────┤ │ 1838 │June │ 9│ 247│ │ 1839 │July │ 150│ 34│ │ 1840 │October │ 293│ 58│ │ 1842 │December │ 313│ 37│ │ 1844 │November │ 170│ 33│ │ 1844 │March │ 110│ 7│ │ 1845 │October │ 148│ 13│ │ 1846 │May │ 134│ 4│ │ 1847 │April │ 179│ 7│ │ 1856 │September │ 13│ 105│ │ 1862 │December │ 63│ 2│ └────────────────┴────────────────┴────────────────┴────────────────┘ Is it not quite clear that some bad influence was at work in this case on the students’ side, which was not in force on the pupil midwives’ side? That there was something else in operation besides epidemic influence is shown by the much greater frequency and severity of puerperal diseases in the one clinique than in the other. We may assume the fact without attempting to explain it, as a proof of the necessity of separating midwifery instruction altogether from ordinary hospital clinical instruction; and does not this Vienna history throw fresh light on the experience already alluded to of our midwives’ school in King’s College Hospital? _INFLUENCE OF TIME SPENT IN A LYING-IN WARD ON THE DEATH-RATE._ This very important element in the question of mortality has been already referred to. There appear to be no extant statistics to show the relation of the death-rate to the period of residence. This much, however, is known—that in the establishments where the death-rate is highest the probable effect of length of residence appears not to be considered, while in the cases cited where the death-rates are lowest the women leave the hospital as soon as they are able to do so. Dr. Le Fort, however, quotes Tarnier and Lasserre of Paris, and Späth of Vienna, as holding that the death-rate is lower among women admitted some time before labour. ‘They become acclimatised’ (an odd expression, when applied to the foul air of an establishment where there should be no foul air). He also says that puerperal fever is very rare among women brought into hospital _after_ delivery, and he asks whether ‘contamination does not take place principally and almost solely at the moment of accouchement.’