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instructions are most likely to be followed if given during A,
period of special danger. In districts and towns in which the
Notification of Births Act has been adopted, the records obtained
under that Act would give valuable information in selecting the
homes to which visits are now most urgently required.
" Secondly, the full value of the personal instructions indicated
above cannot be realised unless vigorous efforts are made to
prevent the accumulation in or in the vicinity of the house of
decomposing animal and vegetable matter. It is not necessary to
do more than mention the importance of efficient scavenging, of
frequent and, if practicable, daily removal of house and stable
refuse, of domestic cleanliness, and of keeping all food properly
protected. The Council may consider it advisable during the next
few weeks to divert the sanitary inspectors from less urgent work,
and to instruct them to make rapid visits with a view to securing
efficient sanitation, especially in and about the houses of the working
classes.
" Thirdly, it is important that the Council should promptly
ascertain in which parts of their district diarrhoea is especially
prevalent, and should devote close attention to street and court
scavenging and to the removal of stable and domestic refuse in
these areas. Without waiting for the weekly death returns, efforts
should be made to obtain information of cases of diarrhcea from
health visitors and others who make domestic visits; and to
impress upon parents the importance of immediate treatment
of infantile diarrhoea. Apart from the medical notification of
cases of epidemic diarrhoea in children, the visits of health
visitors can be utilised for impressing upon parents the seriousness
of diarrhoea amongst young children and the desirability of information
being given to the Medical Officer of Health should a case
of diarrhoea occur.
" The Board will be glad if the Medical Officer of Health, in his
annual report dealing with the current year, will set out the course
of action adopted in the district to prevent diarrhcea and child
mortality generally, in the special circumstances of the present
year."
It is on the lines of these recommendations that the City Council
have been working for some years. In addition to the methods
described earlier in this report and in previous reports, visits are
paid where practicable to every house in which a death from diarrhoea
occurs. In a number of instances it has been found that the child had
not been born in Westminster and so had not been previously visited by
the Health Visitors.