In Germany for some years midwives have had to pass a regular examination. In England, under the Midwife Act of 1902, they are placed under a much stricter supervision than ever before, and are made responsible for the cleanliness and care of mother and child during the lying-in period of ten days. While it is felt that this law is inadequate, it is believed that its enforcement tends to improve conditions materially. For years the New York County Medical Association and other medical societies of standing, supported by Boards of Health and the leaders of the medical profession, have tried to get legislation enacted providing for the establishment of a standard of education and training for midwives. In every state legislation of a uniform character should be enacted providing that no person shall practise as a midwife or accoucheur without having first undergone a thorough training and passed an examination set by the State Board of Regents or some similar authority. They should be held responsible for malpractice, incompetence, or neglect, just as physicians are held responsible. While it is true that such a reform would inflict a certain amount of hardship and suffering upon many women, on the other hand, it would raise midwifery to the dignity of a profession, and provide lucrative avocations for many other women. In any case, it is a most tragic folly to set the hardship involved against the enormous gain to society. It is probable that such trained midwives would command a much higher rate of remuneration for their services than many of the incompetent women who now act in that capacity, and that many poor mothers would be unable to afford to employ them. Even now there are thousands of women who cannot afford attendance of any kind at their lying-in, and doctors tell of children, little girls ten years old,[157] for instance, caring for their mothers through the pain and peril of parturition and for the newly born children. The remedy for such a condition lies, not in the employment of incompetent midwives licensed to destroy life because they are willing to do it “cheaply,” but in the extension of free medical service, maternity hospitals, and properly trained midwives as part of our district nursing services. This subject of the extension of our public medical service is a most important one. There is a tendency in some quarters to decry everything of this nature, and to magnify unduly the extent to which such services are abused. That they are sometimes abused, if by that term is understood their use by those who could afford to pay for such services, is undoubtedly true, though it would be easy to overestimate the extent of such abuses. On the other hand, it is certain that in many of our cities we have scarcely begun to make provision for the needs of the suffering poor. It is astonishing to find a manufacturing city of more than sixty thousand inhabitants, with a