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proper measures of preventive control. Deaths from tuberculosis come
under this latter heading also. Deaths from prematurity at first sight
appear to be beyond any public means of control, but these to a certain
extent may be lessened by teaching the mothers how to attend to their
own personal health.
The causes of these various groups of disease cannot be categorically
defined, but there are certain which are now generally recognised;
these we may classify into (1) conditions external to the individuals
and (2) conditions of a personal nature.
External conditions. Of these the most important are the provision
of a pure milk supply, the provision of adequate housing conditions,
and the maintenance of a high standard of cleanliness of the district.
All of these are matters which receive the continuous attention of the
Public Health Staff. The diarrhoeal group of disease, however, have a
specially fatal incidence during the hot summer months, and I would
take this opportunity of emphasizing the paramount importance of
maintaining a high standard of cleanliness, especially in the poorer pans
of the Borough during that period, and also of the great advantage .if
thorough watering of the roads to keep down the dust.
Personal conditions. These conditions depend practically entirely
upon the individual mothers; unquestionably, every mother is in the
deepest sense desirous of doing the best she can for her children, and in
saying that a considerable degree of the infant mortality is due to error
on the part of parents it is not in the very slightest degree intended to
cast a slur upon any individual or group of individuals. The conditions
of life (poverty, large families, etc.) often make it extremely difficult
for the mothers in such districts as the West Ward to give that attention
and care to the individual children which they would in other circumstances
do. It is my experience and the experience of practically all
medical officers of health who have had to deal with special schemes
for the reduction of infant mortality that any advice and help is eagerly
welcomed by the mothers for the sake of their children. It is inoi.ntestible
that the incidence of many of these diseases, and particularly
the diseases of the diarrhceal and atrophy groups, are directly consequent
upon errors of diet or conditions which inevitably lead to these,
and that this arises largely from want of knowledge on the part of
parents and consequent want of an intelligent personal care of the
infant. No amount of affectionate care can ward off the evils which
arise in this manner. It has, in practical experience, been found that
the most efficient means at our disposal of combatting infant mortality
in the poorer districts of towns is to institute a centre or centres where
the infants can be regularly examined by a medical man with the
assistance of health visitors or nurses, where advice can be given when
necessary for the welfare of the child, and where the mothers can be
taught the principles which underlie the successful rearing of healthy
children. These centres are generally termed "baby welcomes ' or
"infant consultation centres." The first of these names is the more
apt as there are many other directions in which the work may be
developed beyond the purely professional consultations. It seems
advisable to indicate in outline what would be done at such a baby
welcome.
Work done at a "Baby Welcome." Firstly, it is highly important
that all baby welcomes should be administered from the Public Heaith
Department, although it may be necessary to obtain voluntary assistance
to carry out the work thoroughly. This latter point can only be determined
by practical experience.