70 The statistics for 1919 are as follows:— New cases ' ... ... ... ••• 55,384 Old cases ... ... ... ... ••• 235,831 Total attendances ... ... ... 291,215 Maternity Schools.

The seven schools for dayas and maternity homes which were working well at the beginning of the year, had to be closed on account of the March disturbances, so that only an average of 163 working days were obtained. Nevertheless, a total of 2,223 cases were attended—a larger number than in any previous year. Fifty-nine dayas were trained and received the higher certificate; 21,209 yisits were paid by matrons and pupils to patients in their own homes, but a great deal of night work was necessarily curtailed on account of the disturbed state of the towns.

By a method of selection of candidates a more receptive type of pupil has been found. The matrons report that the dayas now in possession of the higher certificate are fairly reliable midwives, but point out the necessity of constant inspection and the desirability of refresher courses. Ifi is interesting to note that many women applied to these centres for treatment of gynaecological troubles—women who in no circumstances would seek assistance or admission to a general hospital with a male stall.

Great help could be given to the work of the schools by the formation of ladies’ benevolent societies in each province, as the cases of real distress met with by the matrons are numerous, and very little can be done for them other, than professional ' attendance. The gift or loan of suitable clothing at these times would be a most valuable aid in treatment, besides helping in many other ways, and bring these institutions more into line wdth the infant welfare centres in America and Europe.

The hope expressed in the 1918 report that the Maternity Horae and Nurses’ Training School in Cairo might be reopened without delay has not yet been realised. It is an undoubted fact tt until a better class of midwives and nurses is available the high infantile mortality for 'which Egypt is notorious will continue. At present three classes of mid wives exist in Egypt:— 1. Women in possession of foreign midwifery diploma, which can be recognised as such by the Health authority. 2. The‘‘Hakima.” 3. The “ daya.”

The “ Hakima,” or, as she is more properly styled, “ Kabila,” holds a licence to practice midwifery granted by the Egyptian Govermnent after she has passed a satisfactory examination at the Medical School at Kasr-el-Aini. Althougn termed a “ Hakima,” she cannot be considered in any way as a doctor, nor is she entitled under the pharmacy law to prescribe medicines containing poisons.

The ‘ ‘ daya,’ ’ who is chosen from a lower grade of society, undergoes no practical training, but only a short three weeks’ course of theoretical training at a Government hospital, and if successful in passing a somewhat perfunctory examination is given a permit to practice midwifery.

Unsatisfactory though she be, no legal powers exist at present to withdraw her licence to practise. Be she blind, deaf, ignorant or dirty, she remains a “ daya ” until the end of her days. It is perfectly clear that until the “ dayas ” schools are re-established in connection with the maternity homes in the provinces, these women are a constant means of spreading puerperal fever and death amongst the poorer classes.

A beginning has been made in this line by the establishment of midwifery schools for “dayas” under the Provincial Councils, but staffed by experienced European matrons. The “ dayas ” attending these schools are picked women, and pass a complete course of midwifery under the instruction of the matron, nor can they obtain the special certificate granted by these schools until they have themselves conducted, under the supervision of the matron, the prescribed number of labour cases.

It is necessary that power to withdraw the permit should be provided, and it is proposed to do this in the Midwives Act which is contemplated.

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