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MATERNITY AND CHILD WELFARE SERVICES.
Under the council's scheme of maternity and child welfare, complete arrangements are made
for the care of expectant and nursing mothers, and children up to five years of age. The scheme
includes ante-natal and post-natal clinics, infant consultation sessions, day nurseries, a maternity
home, a municipal midwife, the provision of an obstetric consultant for difficult confinements, hospital
and convalescent treatment for mothers and young children, home nursing and home helps,
arrangements for the boarding-out of children while the mother is in hospital, facilities for the
skilled nursing and treatment of cases of puerperal sepsis, and the supply of free milk, dinners and
cod liver oil or its equivalent to necessitous cases. During the year the council inaugurated a further
scheme for the provision of free dentures for necessitous expectant and nursing mothers. These
dentures are supplied at the dental clinics attached to the infant welfare institutions, and the cost of
the scheme to the council during 1935 was £203 5s. 10d.
The year has been one of considerable expansion in the existing services due to the awakening
response of public opinion to the council's propaganda and to the spreading knowledge and
appreciation of the facilities offered by the council's health services. The increase in the antenatal
work performed in the borough since the council's whole-time medical officer, who was
appointed in 1934, has been in charge of the clinics is now apparent. In 1934, the number of
individual mothers attending the ante-natal sessions was 692, the total attendances being 2,345 ;
the corresponding figures for 1935 are 1,120 and 4,402. It has been necessary to increase the number
of ante-natal sessions from 237 in 1934 to 393 in 1935 ; the establishment of a post-natal clinic
is an important addition to the service. The popularity of the ante-natal clinics proves more than
the wisdom of the council's policy in appointing a whole-time officer to work under the direction of
the medical officer of health—it proves the appreciation of the value of the borough ante-natal
clinic by the expectant mothers. The latter come voluntarily for advice and education in health
and in the upbringing of their children and not to book for confinement. One may claim that the
educational side of the health services has made very considerable progress of late years, and in no
direction is this more evident than in the ante-natal clinic. With every year the latter widens the
scope of its teaching : the preparation for the infant's arrival, hygiene, dietetics, dental treatment,
the removal of any septic focus, the treatment of anaemia and malnutrition and, perhaps as
important as any of these, the mental treatment of the patient—the removal of those fears of
child birth which are present in most young expectant mothers, and their change into a glad expectancy
of the coming baby with entire confidence in the normality of the confinement.
The high rate of infant mortality in the borough in 1934 determined the council to appoint two
whole-time medical officers to conduct the infant consultation sessions in place of the fourteen parttime
doctors previously engaged on this work, and in May, 1935, Dr. Helen Buck and Dr. Hilda
Davis were appointed to the council's whole-time staff. The attention of these medical officers has
been specially directed towards improving the nutrition and consequent resistance to disease of the
children attending the welfare centres by attention to diet and education in the simple rules of health.
The true function of the clinics as centres of preventive medicine is now established and no medical
treatment is carried out, cases in need of such treatment being referred to their own doctors or to
hospitals. In this way, the risk of a spread of infection to other children from ill babies brought
to the centres is removed and the medical officers are able to concentrate upon their teaching on the
maintenance and improvement of health in each infant, which one hopes will cause a definite rise
in the general standard of health in Kensington children within the next few years. In order to come
into line with the council's scheme, the committee of the baby clinic and hospital have resolved to
use the clinic at No. 92, Tavistock Road, as a treatment centre only, to which infants from all the
welfare institutions in the borough may be referred, and to send all healthy children attending the
clinic to their own welfare centres. This arrangement is proving most satisfactory, and the council's
medical officers are receiving very great assistance in their work from the co-operation of the medical
staff of the baby clinic and hospital whom they meet in consultation every week. The co-ordination
of the various services connected with infant welfare has notably improved since the appointment
of the whole-time staff and the council's officers are in frequent communication with the local doctors
whose patients attend the clinics and with the hospitals to which any of the children are referred.
Very great attention is paid to the quality of the work performed in the clinics and careful and
complete examinations are made at regular intervals of every child attending the centre. A certain
amount of malnutrition and rickets was evident in a number of the children attending the welfare
institutions, and in order to facilitate the treatment of these conditions and to prevent their develop
ment in other cases, the council have provided for the free supply of cod liver oil or its equivalent in
necessitous cases. The supply of free milk has also been greatly increased. Particular attention is
paid by the medical staff to securing early remedial treatment for any orthopaedic deformities found
in the children attending the centres.
Owing to the time occupied by a thorough examination of each new case and the desire for the
advice of the medical officers by an increasing number of mothers, the time taken up by each infant
consultation session has greatly increased since the whole-time medical officers were appointed, and
at some of the centres the sessions have lasted more than four hours. This is inconvenient for the
mothers as well as tiring for the staff, and at the request of the advisory committee, which is
composed of representatives of the voluntary committees of the centres, the council have decided
to appoint a fourth whole-time medical officer to assist in the maternity and child welfare work in
the borough ; this will permit of the establishment of the extra sessions which are needed.
In addition to the measures which the council have taken to improve the health of the children
in the borough, great attention has been paid to the methods by which the nutrition of the expectant
mothers might be improved. Two comprehensive reports on nutrition have been considered by the