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The writer did not appear to attach any great importance to " such remedies as creches and
municipal supplie s of sterilized milk"—
"Far better is the plan adopted by some towns of appointing lady inspectors, who may
be reinforced, indefinitely, by voluntary assistants, to pay nursing visits. The mothers are
said to welcome the attention and the help, and most of them are found teachable; not only
in regard to the details of feeding and nursing—ignorance and neglect of which are the great
immediate causes of death—but also in regard to the whole maternal duty. The sense of
responsibility is awakened in them, no doubt, by the sympathetic interest taken in their
affairs by the visitor. The remedy is not complete, but it is real; and, so far as it goes, it
touches the root of the matter, and it illustrates, once more, the value of personal service,
which is still the great force in human affairs."
The above quotations express, in terms more impressive than any at my command, the
considerations which led me, in May, 1900, to report, to the late sanitary authority of Kensington,
on the desirability of appointing "Women Health Visitors," a subject dealt with below.
"Particulars of Births."—In connexion with the subject of infantile-mortality, reference may
be made to an interesting correspondence between the Southwark Borough Council and the Local
Government Board, communicated to the several sanitary authorities in November last. The chief
difficulty besetting the efforts of sanitary authorities in their endeavours to reduce infantile
mortality, arises from ignorance with regard to the occurrence of births. With a view to the
removal of this hindrance, the Southwark Council petitioned the Local Government Board "to
allow sub-district registrars to supply information as to the locality of births, to the Medical Officer
of Health, in the same way as he receives the locality of deaths." The Local Government Board
stated, in reply, that they had " already, after communication with the Registrar-General, approve d
of an arrangement for the supply to local authorities, by registrars of births and deaths, of particulars
as to births within their sub-districts." The value of such information will be by no means
inconsiderable; but registration is, as a rule, delayed so long, that " particulars as to births " of
infants who die within the first month of life, will not usually reach the Medical Officer of Health
any sooner than particulars as to their deaths.* This, at any rate, has been our experience during
the period (since January 1st, 1903), that we, in this Borough, have received the particulars as to
births which will, henceforth, be accessible to any local authority willing to incur the small cost of
the returns. The value of such particulars would be greatly enhanced could registration be made
compulsory within, say, seven days after birth. Meantime, efforts are being made to obtain the
desired information at the earliest possible date after the birth of children to the poorest classes,
through the agency of medical men, registered midwives, district visitors, and others. The
importance of early information may be emphasised by the fact that of the deaths of infants under
one year in Kensington, in 1902, 35 per cent, occurred within the first four weeks, and 50 per cent,
within three months after birth.
WOMEN HEALTH VISITORS.
In 1900, I recommended the appointment of women to assist in sanitary administration by
the performance of duties analogous to those discharged by "Health Visitors" at Manchester,
Birmingham, etc., some account of which was set out in my annual report for that year. The
Sanitary Committe of the late Vestry reported sympathetically on the subject, as being "deserving of
the careful attention of Sanitary Authorities;" but they felt that, having regard to the Vestry's
" waning existence," it was "undesirable that any new office should be created." Nevertheless, at
the meeting of the Vestry (18th July), on consideration of the Committee's report, there was a strong
expression of opinion that action should be taken, forthwith, in the direction recommended by me:
ultimately, however, a motion to that effect was negatived.
In the first monthly report in 1904, I renewed the proposal when dealing with the question
of Infantile Mortality, and the report was referred to the Public Health Committee. In a
memorandum submitted to the Committee for their further information, I recommended the
appointment of Health Visitors, for work primarily in three of the Northern Wards, St. Charles,
Golborne and Norland, the population of which is 72,300—22,180, 26,500, and 23,720, respectively.
*Births should be registered within 42 days, and may be registered, without fee, within three months. Of the 243
births chronicled in the twelfth monthly report in 1904, 7 were registered in the first week of life, and 11, 7 and 17 in the
second, third and fourth weeks, respectively: total 42. The registrations in the fifth and sixth weeks were 35 and 81 respectively
( = 116). Between the seventh and twelfth weeks inclusive, 85 births were registered. The deaths registered within the same
period included twelve within the first month of age, those in the second and third months being seven and three respectively.
The numbers of deaths at these ages are far greater in summer, when diarrhoea is prevalent, and during epidemics of other
infantile diseases.