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144
only too clearly that there was a failure to supply what was needed. We
have learnt now to recognise a number of cases where the cause of failure
is clear. The remedy is no less apparent, yet neither at home nor at the
hospital is it possible to see how the necessary treatment can be applied.
It is my belief that "Welfare Centres" can, for the first time,
organise the means with very little alteration or extension of their scope
and personnel. "Treatment" is not properly part of their function.
But what follows will explain that the word is applied almost solely
to intensive investigation and education, coupled with the application
of certain necessary hygienic measures, which the mothers are taught
by demonstration and practice. Guesswork is thus reduced to a minimum.
To this end we have had at St. Katharine's for several years, a special
department, which started in a small way but which has grown statistically
to large dimensions. Its personnel now consists of a sister and two nurses.
The sister was formerly a Health Visitor in the neighbourhood; an
invaluable qualification enabling her, in a way that nothing else could,
to fit the advice to the individual, even to the street in which she lives.
A room has been set aside, furnished with scales, cots, screens, a basin
with hot and cold water and the apparatus for preparing bottle feeds.
Further, there is a strip of garden with a tiled shelter at the north end.
This department is used for infants from all the Clinics in the neighbourhood,
whose lack of progress is obscure; or, if clear, not amenable to the
other methods at our disposal. The mothers are asked to bring the babies
early in the morning and when, as is usual, breast feeding is in progress,
to attend for the purpose of nursing at the approximate feeding hours.
The staff carries out test weighing at each feed. If a deficiency of milk
has been suspected by the physician, he will have ordered a suitable
supplement to be added, should his suspicions be confirmed. The baby s
habits are observed; its sleep timed; any tendency to vomit and its
time with reference to feeds noted; the character of the vomiting, the
amount lost; the type, reaction, and the frequency of stools are all
considered. Records of temperature are made. A child's behaviour can
thus be intensively studied, and, what is of no less importance, the
mother's skill in handling it. For example, her reaction to its crying,
shown by her impulse to seize it and carry it about, replace it at the
breast or proffer a comforter, are suggestive of what is customary at home.
An experienced nurse can soon show the value of more gentle handling
for a few minutes in a position of comfort, and the right moment to replace
the child in a cot behind a screen or in the open. Sympathetic enquiry
not seldom draws out stories of stress and difficulty at home, trials at
first sight not strictly germane to the question of infant welfare and