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Three other measures deserve mention in this brief consideration of the development of the
maternity and child welfare services. The Midwives Act of 1902 made it illegal for untrained women
"habitually and for gain" to attend women in childbirth. The Midwives Act of 1936 definitely
abolished the handywoman and laid upon Local Supervising Authorities the duty of employing salaried
domiciliary midwives.
Secondly, the National Health Insurance Act of 1911 provided a maternity benefit, and this
has helped to ease the financial burden of childbirth.
Thirdly, the Maternity and Child Welfare Act of 1918 provided Local Authorities with wide
powers to take steps to safeguard and promote the health of mothers and children. Although this
Act has now been repealed, its provisions are incorporated in the Public Health Act and the Public
Health (London) Act of 1936.
The national interest in and responsibility for these services was signalised in 1914 when the
Local Government Board (now the Ministry of Health) commenced to give money grants to Local
Authorities and Voluntary Associations. These crystallised into the 50 per cent. grant on the services
which the Ministry made until 1929, when, in accordance with the provisions of the Local Government
Act, they were swallowed up in the block grant. Whilst Local Authorities now have more freedom
in the development of services to suit local conditions, the obscuring of the 50 per cent. grant is not
an unmixed blessing.
No form of national and municipal activity has secured more striking results than the child
welfare services. In the fifty years 1851-1900 the infant mortality rate of the country varied between
138 and 163 (the latter is the 1899 figure). During this period one child in every seven born failed to
reach its first birthday. The present century has seen a striking reduction in this rate, particularly
since 1910, and since 1930 the rate has been well below 70 per thousand; 40,000 children now continue
to live every year who a generation ago would have died.
Maternity and Child Welfare Work in Fulham.—The local Fulham figures are equally striking.
The infant mortality rate for the ten years from 1891 to 1900 averaged 167 per thousand. The infant
mortality rate for 1934 to 1938 averaged 56, the figure for 1938 being 51. In 1902 the Borough
Council wished to set up a milk depot on the lines of the St. Helens and Battersea schemes, but the
Local Government Board informed them that they had no power to sanction the expenditure, and in
view of the probable cost to the rates, the Council decided not to proceed with the scheme. In the
following year, the Medical Officer of Health drew attention to the alternative of appointing "Lady
Inspectors" to pay nursing visits in an endeavour to procure a reduction in the infant mortality rate.
A start was made in 1905 with an arrangement under which the woman sanitary inspector (appointed
in 1903) devoted part of her time to visiting cases of birth notified by the London County Council
from information received from midwives, and to the distribution of a leaflet on the feeding of infants.
It was estimated at the time that about 40 per cent. of the births were reported to the London
County Council. In 1906, the Medical Officer of Health drew attention to the need for more frequent
visiting of infants and advocated the utilisation of voluntary workers under the supervision of a
woman medical practitioner. He stressed the point that the relative high infant mortality in Fulham
was due to the mortality from diarrhoea, "an eminently preventible disease mainly caused by careless
or ignorant methods of feeding." In the following year, the Borough Council adopted the Notification
of Births Act, 1905, and a public meeting was held in the Town Hall with a view to the formation of
a voluntary local agency to carry out the objects of the Act, but unfortunately no agency was formed,
although the resolution to form one was unanimously adopted. In his Annual Report, the Medical
Officer of Health again stressed the need for the appointment of "two ladies to act exclusively as
health visitors" and eight years later "I have repeatedly urged upon the Council the need for the
appointment of a health visitor." Fortunately the visiting of infants had been increased by the
work of the voluntary committee formed in 1907, and the Fulham maternity and child welfare
services may be said to date from then, with the opening in Greyhound Road of the Fulham School
for Mothers by a voluntary committee, of which the then Medical Officer of Health was an enthusiastic
member. The centre was popularly known as "the Mothers' and Babies' Welcome," and although
two doctors gave their services voluntarily for medical consultations and home visits were paid by