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opened in January under the title of "Keep Fit Class." The success of the class was so great that
it was necessary to arrange immediately for two further sessions to be held. The enthusiasm of the
mothers for these classes has been continuous, and I feel sure that whilst thoroughly enjoying the
classes, they have derived considerable benefit, particularly in regard to their muscular tone.
The classes for the younger mothers were during 1938, supplemented by three classes for
women at the baths. The ages of those attending now range from 19 to 69. During the summer
swimming classes were organised at the Fulham Baths, also with the co-operation of the London
County Council, and at the request of the mothers attending the classes special pocket badges were
made available for purchase. Several special displays by the members of the Keep Fit Classes have
been given in the Town Hall. The association of this active movement with the more static maternity
and child welfare services is a development of great importance, from which much good should result.
Maternity and Child Welfare.
The Growth of the Child Welfare Services.—The pioneer work in maternity and child welfare
was done in France, for whom the problem of saving infant lives to minimise the effect of the falling
birth rate became of serious importance in the last three decades of the 19th century. America also
devoted attention to this subject before us, and there has been practically no important pioneer
development of the work in this country.
Three groups of diseases kill children in infancy: developmental and wasting conditions, including
premature birth, the respiratory infections (pneumonia and bronchitis), and the diarrhæal
group of diseases. The last-named group arises mainly from wrong methods of infant feeding,
including wrong methods of storing and preparing milk, causing bacterial contamination. A large
field of activity was opened here, and the first Municipal Milk Depot in this country was opened in
St. Helens in 1899. Liverpool followed two years later, both these towns arranging for milk to be
sterilised and bottled in suitable quantities and dilutions at the centres. Each bottle contained
enough for one feed and was so shaped that a teat could be placed on the end of the bottle, thus
minimising any risk of contamination after preparation. Other towns quickly followed this example.
Facilities for weighing and measuring babies were provided from the commencement, but medical
examination and advice took a few more years to secure, Glasgow being one of the pioneers in this
direction, arranging in 1906 for classes of instruction to mothers in diet. Health-visiting had an
earlier start. The Ladies' Sanitary Reform Association of Manchester and Salford found their work
was so handicapped by prejudice and ignorance that in 1862 they employed "a respectable working
woman" in house-to-house visiting for elementary instruction in hygiene and infant care. Simple
tracts and leaflets were also left with the householder. In 1890 the salaries of these visitors were paid
by the Corporation and their work placed under the supervision of the Medical Officer of Health.
The idea that the teaching of infant hygiene and feeding is as much the business of the Health
Authority as the remedying of nuisances and provision of sewers may now be said to have received
official recognition, and St. Helens, Sheffield, Chesterfield, and Birmingham followed the Manchester
example. By 1905 about 50 towns employed Health Visitors.
The work of visiting infants had so far been handicapped by the absence of early knowledge
of births and, just as the first year is the most dangerous, so is the first month of that year the worst.
To Huddersfield, the pioneer of much valuable work in this field and still the possessor of certain
features which are unique, belongs the credit for the first step to remedy this defect. Notifications
of births on a voluntary basis was arranged by this Authority in 1905, a fee of 1/- being paid for every
notification received within 24 hours of birth. The scheme achieved such a wide measure of success
that in 1906 it was made compulsory in Huddersfield by a local Act. This in turn led to the
Notification of Births Act of 1907, an adoptive Act which was so universally accepted that its
provisions were made compulsory in 1915. These Notification Acts make it compulsory on the
father or anyone in attendance at a birth to notify it within 48 hours to the Local Authority. The
duty is usually undertaken by the doctor or midwife attending the case.