Rectangular booklet of 25 forms documenting problematic births. The booklet has tan sheets of thick paper in front and back and thin white sheets with black printing inside. The leaves are perforated at 1/3 the width of sheet.
Printed in margin: "This slip to be used by MIDWIVES in all abnormal cases, cases of miscarriage or abortion and all cases where Physician is called."
Left portion of sheet includes space for documentation of name of child, name of mother, address, reason, physician, midwife, and date of notification of the Department of Health. Right portion includes space for name of child, date of birth, name of mother, hour of birth, address, term, presentation, complications, laceration, miscarriage, reason for calling physician, condition of baby on day, condition of mother on day, midwife, date and hour of arrival, physician, date and hour of arrival.
The booklet was part of a midwife's kit from Buffalo, NY, about 1920.