There are several of what may be called secondary influences also, which must affect to a certain extent the results of comparison of death-rates among different groups of lying-in cases. Such are the ages of women, the number of the pregnancy, the duration of labour, and the like. It is impossible, in the present state of our information, to attribute to each, or all of these, their due influence; neither, if we could do so, would it materially affect the general result just stated. But it is otherwise with another class of conditions, of which statistics take no cognizance. Such are the general sanitary state of hospitals, wards, houses, and rooms where deliveries take place; the management adopted; the classes of patients; their state of health and stamina before delivery; the time they are kept in midwifery wards before and after delivery. These elements are directly connected with the questions at issue, and yet our information regarding them is by no means so full as we could wish—indeed is almost nothing. Our only resource at present is to deal with such statistical information as we possess, and to ascertain fairly what it tells us. This we shall now endeavour to do, beginning with an estimate of the normal mortality due to childbirth in various European countries. _NORMAL DEATH-RATE OF LYING-IN WOMEN IN ENGLAND._ In the Registrar-General’s Thirtieth Annual Report, 1867, there is an instructive series of tables, giving approximately the present normal death-rate among lying-in women in England. One of these tables (abstracted on Table I.) shows that, including deliveries in lying-in hospitals, there were in England, during the year 1867, 768,349 births, and that 3,933 women died in childbed. This gives an approximate total mortality of 5·1 per 1,000 from all causes. TABLE I.—_Mortality after Childbirth in England, 1867_ (_Registrar-General’s Thirtieth Annual Report_). ┌────────┬──────────┬─────────┬─────────┬───────────┬────────┬────────┐ │ Total │ Deaths │ Deaths │ Deaths │Deaths from│ Deaths │ Total │ │ Births │ from │ from │ from │Consumption│from all│ Deaths │ │ │Accidents │Puerperal│Miasmatic│ and Chest │ Other │ │ │ │ in │Diseases │Diseases │ Diseases │ Causes │ │ │ │Childbirth│ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ ├────────┼──────────┼─────────┼─────────┼───────────┼────────┼────────┤ │768,349 │ 2,346 │ 1,066 │ 137 │ 230 │ 154 │ 3,933 │ └────────┴──────────┴─────────┴─────────┴───────────┴────────┴────────┘ The causes of mortality are also given in Table I. as follows:— 1. There were 2,346 deaths by accidents of childbirth (hæmorrhage, convulsions, exhaustion, mania, &c.).