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questions connected with infant welfare, and secured as speakers many of the greatest experts not only here in England, but also in our Dominions, in America, and in the countries of our Allies. Further, an intensive course of lectures was arranged to meet the requirements of all sections of health workers, and practical demonstrations followed one another in endless succession during the week. As several delegates remarked to me, there was a regular orgy of education and 'instruction. The very latest and most up-to-date knowledge in connection with the organization and administration of ante-natal, maternity, and consultation centres, as well as of lying-in wards, homes for ailing babies, nursery training schools, and day nurseries was offered in very assimilable form for all those who chose to use their eyes or listen with their ears, while all the details of feeding, clothing, and managing infants were afforded in a most attractive manner. One of the great features of the exhibition was the ample supply of willing and informed demonstrators. The knowledge thus imparted to a comparatively small number of individuals will within the next few months spread like a living contagion throughout the length and breadth of the land, and penetrate into the homes of the people where it is so much required. Last year we had over 600 local celebrations in large towns, small towns, and villages. This year all reports are not yet in the hands of the Council, but we do know that in some of the large towns the celebrations have been carried out on almost a larger scale than in London itself, but so designed as to fan the flame and keep alive the enthusiasm for child welfare that was initiated by last year's events. I have been asked a good many times why we want so much money for this work, and how we spend it. Propaganda work is always very expensive, and especially so at the present time. It entails a large staff, much correspondence, much writing, and much publication. One of the really valuable and constructive pieces of work connected with the National Baby Week Council is that of its sub-committee, known as the Administrative Committee of the Jewel Fund. Through the energy and initiative of the Appeal Committee of this Fund nearly £40,000 has already been collected, and something like £10,000 already spent in opening new welfare centres wherever and whenever they are wanted, but the funds of this committee are not available for the propaganda work of the Baby Week Council. The more money we have to spend on this latter object the better pleased will be all those who are united in this Movement, and they can never have enough.
61, Harley Street,
ABSTRACTS AND EXTRACTS.
Under this heading are gathered thoughts from literature, both ancient and modern, which seek to provide information likely to be of assistance to students of child life and practical workers for child welfare. It is hoped that our readers will co-operate in making this section both suggestive and serviceable.
CHILD WELFARE AND A
MINISTRY OF HEALTH. Some of the strongest arguments in favour of the establishment of a Ministry of Health come from those engaged in child welfare work. All are agreed that if the existing deplorable heavy mortality and morbidity rates existing among infants and young children are to be lowered to any considerable extent powers making for effective co-ordination must be brought to bear upon the organization and administration of those departments of our National Service which deal with the protection of child life. It has been declared that it is safer to be a soldier at the Front than a baby in Britain. Be that as it may, it is a lamentable fact that we are wasting the man-power to-morrow by throwing away much of the child-power of to-day. And a considerable proportion of the wastage is preventable. In a recent issue of the Observer (July 7), the main points on which we base our claim for the immediate establishment of a Ministry of Health are forcibly presented. The case for a central co-ordinating brain to guide and govern matters relating to national health is formulated under the following heads: (1) The greatest asset of a nation is its health. (2) When the War is ended we shall require all the strength that the nation is capable of. (3) Loss of life to be made good: (a) Death of soldiers. (b) Infant deaths-number of infants under one year who died in England and Wales in 1916 was 71,646, of which it is estimated that probably 40,000 to 50,000 were "preventable." (c) Loss from decline in birth-rate Birth-rate, 1913, 24°1; birth-rate, 1917, 178. In 1913 there were 881,890 births, in 1917 there were 668,340 births, which is 213,550 less than in 1913. Thus, at what is perhaps the most critical period in the nation's history its population is decreasing. (d) Loss due to diseases and death of mothers, owing to
neglect during period of pregnancy and during confinement. (e) Loss due to maimed lives of those children who survive neglect. It is estimated that at one time there are not less than 1,000,000 children in public elementary schools who are seriously defective in either mind or body. This point has also been conclusively demonstrated during the last four years by the number of recruits found to be unfit for any strenuous work. In a healthy nation the vast majority of its manhood should be "Grade I." (4) To deal with epidemic diseases brought home by soldiers. (5) Adjust relations between preventive and curative medicine. (6) To be clearing house of all information on health, and to advise various health authorities not organized directly by Ministry, e.g., Army, Navy, Air, Pensions, &c. (7) At present various health authorities conducting their own research. (8) Will avoid present confusion, overlapping, departmental jealousies, and unnecessary expenditure. Our forces for meeting the difficulties of the present and preparing for combat with further dangers which must assail us as a people in the near future, are now comparatively feeble and lacking in effectiveness mainly because they are wanting in concentration. We must have co-ordination of work and co-operation of workers. Health problems are being dealt with by numerous central departments and not a few local authorities. Some are permanent institutions and others may be considered as more or less temporary. They are conveniently classified by the medical correspondent in the Observer in the following striking table :
Local Government Board (including Regis trar-General's Department)
National Insurance Commissions
many district departments to deal with various portions of the one great question of national health is admitted by all. The prevailing overlapping and division of responsibility cannot be tolerated. The very future of our existence as a race is dependent upon the health of the people. We shall have thrown away in the furnace of war the very flower of our youth and manhood, and all in vain if we continue to squander our human seedlings so that there shall be a dearth of flowers and fruit for renewal of life in the coming days of peace. The writer in the Observer gives a striking example: "To take the somewhat extreme but quite possible case of a large poor family with one mentally defective child in a noncounty borough, we may find the following medical officers of various authorities actively interested in the family even at the same time: the County Medical Officer of Health with his Tuberculosis Officer and his Mental Deficiency Officer (County Council), the Borough Medical Officer of Health, the Maternity and Child Welfare Officer, who may be appointed to attend cases of measles and German measles (Town Council), the School Medical Officer or Officers (Education Committee, or possibly two Education Committees, County and Borough), the Insurance Practitioner or Practitioners (Insurance Committee), the Poor Law Medical Officer or Officers (Board of Guardians). Such a family would, for medical advice and treatment, be in the following position: The father in most illnesses would have the attention of his insurance practitioner, but when he required treatment as an in-patient he would go either to a voluntary hospital or to a Poor Law infirmary. If he required special treatment he would probably seek it at a voluntary hospital. suffering from tuberculosis he would see the tuberculosis officer and would be entitled to treatment at home (by his insurance practitioner) or at a tuberculosis clinic (by the tuberculosis officer), or both, and might be admitted for a period to a sanatorium. The mother, if employed, would be in the same position as the father, but if not an insured person would get her ordinary attendance from a private practitioner, who probably would be, but might not be, the same
person as the insurance practitioner who attends the father. She might have occasional recourse to a hospital or dispensary, or, if impoverished, to the Poor Law doctor of the district. In matters concerned with pregnancy and childbirth she would be advised by the officer of the maternity centre. The children under school age would be attended by a private practitioner, or, for conditions which did not entail home visits, at the child welfare centre, or at the out-patient department of a general or children's hospital, but they would probably be vaccinated by the public vaccinator. Those under 14 years of age going to school would be examined by the school medical officer and treated by him or by another for a few conditions at the school clinic, and for other disorders at the local hospital, or at home by a private practitioner. The children over 14 years of age and going to a secondary or continuation school might be examined and attended by the medical officer of a second education authority; those going to work in a factory or workshop would be examined by the certifying factory surgeon, and if over 16 years of age would have the services of the insurance practitioner of their choice, or (if the Education Bill becomes law) have a double provision by means of both the insurance practitioner and the school medical officers of the higher education authority. Any member of the family might contract a notifiable infectious disease; if this be purulent inflammation of the eyes, occurring shortly after birth, it may be the business of one practitioner; if it be measles or German measles, of another; if it be one of a number of other such diseases the patient probably goes into the local fever or isolation hospital, where he is treated by yet another. The mother of such a family will usually be attended at childbirth by a midwife, who in an emergency must call upon the services of a doctor (either
private, or the Poor Law Medical Officer). Notification that this has been done must be made to the medical officer of the county; the birth must be notified to the medical officer of health of the borough, and registered with the registrar of births, marriages, and deaths, who is appointed by the Board of Guardians, and is responsible to the Registrar-General. The house will be visited by the inspector of midwives, by the sanitary inspector, by the health visitor, by the vaccination officer, by the infant life protection visitor, by the school nurse, by a visitor under the Mental Deficiency Act, possibly also by the relieving officer and by semiofficial or unofficial, but kindly, persons (as, for example, district nurses), interested in the health and well-being of its inmates." Such a summary of the existing chaos will convince even the most heedless that some speedy and effective way out of the impasse must be found. Many minds are now being focused on the problem and public opinion is being vitalized. A Ministry of Health there must be. The child life of the nation demands it.
The passing of Viscount Rhondda is a sad blow to the great cause of child welfare, and all workers for maternity and child betterment have experienced the sense of a heavy personal loss, for in him they recognized a great and inspiring leader. Lord Rhondda, shortly before his death, sent this message to child welfare workers: "The care of the children is a sacred duty we owe to those who are giving their lives for us at the Front, and we can best help our country, in these critical times by helping the children." The establishment of child welfare work as a Special Department of a Ministry of Public Health would be a worthy memorial to this great patriot and wise statesman.
CHILD WELFARE AND STATE SERVICES.
In this section are inserted records of the progress of Child Welfare Work as carried out by various • State Services dealing with Health, Education, Industry, Delinquency, Defectiveness, and other questions relating to the care and control of the young. We shall be glad to receive copies of reports and all other official publications as soon after issue as may be possible.
INDUSTRIAL HEALTH AND
The Health of Munition Workers Committee of the Ministry of Munitions were appointed in September, 1915, by the Rt. Hon. David Lloyd George "to consider and advise on questions of industrial fatigue, hours of labour, and other matters affecting the personal health and physical efficiency of workers in munitions factories and workshops. The Committee have prepared twenty-one memoranda, of which all save one have been published and placed on sale. They have issued an Interim Report, entitled "Industrial Efficiency and Fatigue," a handbook on the "Health of the Munition Worker," and now concurring “in the propriety of the decision of the Ministry to discharge their reference and to establish in their place an Office Committee in association with the Executive"; they present a Final Report on "Industrial Health and Efficiency" [Cd. 9065], copies of which can be obtained through H.M. Stationery Office, Imperial House, Kingsway, W.C.2 (price 25. net). This Blue Book is a particularly notable one, and demands the serious study of all welfare workers. After a brief introduction and preliminary and historical survey, the work of the Committee is admirably summarized in a series of sections under the following headings: Relation of Fatigue and Ill-health to Industrial Efficiency; The Industrial Employment of Women; Hours of Labour; Shifts, Breaks, Spells, Pauses and Holiday; Sunday Labour and Night Work; Lost Time and Incentive; Food and Canteens; Sickness and Illhealth; Injuries and Accidents; Eye Injuries; Special Industrial Diseases; Cleanliness, Ventilation, Heating and Lighting; Sanitary Accommodation; Washing Facilities and Cloak Rooms; Seals, Weights, Clothing, and Drinking Water; Welfare Supervision for Women
and Girls; Welfare Supervision for Boys and Men; and Welfare Outside the Factory. The Report proper closes with a concise summary of conclusions. These illuminating pages contain an immense amount of information and guidance which will be invaluable to those engaged in endeavours aiming at maternity and child welfare, as well as material which employers and employees and all advisers and supervisors in connection with industrial enterprises will do wise to study. The five essentials for the work of a welfare supervisor are compactly expressed thus: “(a). An intimate knowledge and sympathy with women and girls. This can best be acquired by such methods as teaching in a primary school, life in a settlement, work in a woman's trade union office, living at the same time in a poor neighbourhood. Without this fundamental experience no one should take up welfare work. (b) A careful study of industrial problems which affect women's labour-such problems as the displacement of men by women, married women's work, the educational needs of 'young persons,' the home life of women and girls, the working of such Acts as the Insurance Acts and the Workmen's Compensation Act. (c) A knowledge, both theoretical and practical, of the health of women and girls, and how it is affected by speed of output, the kind of commissariat provided, the questions of ventilation and heating, and questions of housing accommodation. (d) A knowledge of the technical side of the work, indexing, filing, account keeping, domestic arrangements in rest rooms, cloak rooms, the organization of a factory, and the relations between general managers, managers, foremen and forewomen. (e) A conception of the right relation between the life of the factory with all its agencies for good, and the life of the community, the inter-action of each upon the other. This involves a serious study of the social