In most states there is very little supervision of midwives; in some cases practically none at all. New York, always rather prone to take pride in its record upon such matters, has regulations which are wofully inadequate. All that is necessary to enable a woman to practise as a midwife is: (1) a certificate or diploma from some school of midwifery, native or foreign, or (2) signed statements as to her fitness and character from two physicians. No inquiry whatever is made into the _bona fides_ or character of the school granting the certificate, nor are the physicians held responsible in any way for the women they recommend.[155] So long as the applicant meets either of the foregoing slight requirements, the authorities must issue her a permit to practise as a midwife. She becomes a “registered midwife,” and the title creates an altogether unwarranted confidence in the minds of the people. It is not only the poor, illiterate immigrants who are thus deceived, but many very intelligent citizens are under the impression that a “registered midwife” has had some sort of training. Immigrants coming from countries like Germany, where all midwives have to undergo a thorough training, are naturally unsuspicious of the fact that here we have nothing of the kind. It is impossible to present the evil results of the employment of untrained and incompetent midwives statistically, or even to estimate them. Some idea may be gathered from the fact that, while the physicians of the New York Lying-in Hospital, in 1904, attended over four thousand confinements, 2766 _of them in the tenement districts_ among the very poor, with only _three deaths_,[156] one midwife, in a very similar tenement district, showed me a list of _sixty-two cases_ she had attended with _five deaths_. And she spoke proudly of her “good record”! [Illustration: A FREE INFANTS’ MILK DEPOT (MUNICIPAL), BRUSSELS ]