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inspectors to ensure that a proper standard of cleanliness and general efficiency is maintained. During
the year 461 inspections were thus made. Two lying-in homes have been opened under the Maternity
and Child Welfare Act under the auspices of the Lewisham and Hammersmith Borough Councils
respectively.
Children Act, 1908.—Part I.
This work was transferred in 1917 from the Public Control Department of the Council to the Public
Health Department. Part I. of the Act provides that a person who undertakes for hire or reward the
nursing and maintenance of an infant under the age of seven years apart from its parents shall give due
notice of such reception to the local authority, in London the Council, within 48 hours. In the case of
any change of address of a foster-mother, or the removal of an infant from her care, a similar requirement
is imposed upon the foster-mother. If an infant dies the foster-mother must notify the coroner within
24 hours of such death, and also the Council within 48 hours.

From this table it will be seen that since 1916 there has been a constant reduction in the number
of foster-mothers and nurse-infants which is probably due to economic conditions. The charges for
the care of nurse-infants have risen, owing to the extra cost of living, and the average charge now made
is 12s. 6d. and upwards, as compared with 5s. a week prior to the war. In special circumstances lower
charges than those above mentioned have been accepted. In my last report I expressed the hope that
the passing of the Maternity and Child Welfare Act, 1918, which gives powers to borough councils to aid
foster-mothers financially would have increased the number of foster-mothers, but it will be seen that
this hope has not been fulfilled. It is an exceedingly difficult matter to find a suitable home for a young
infant, and on the other hand, the number of applications for such homes continues to increase. I
understand that the various institutions established for the care and maintenance of infants have no
vacancies, and find it difficult to cope with the numerous applications made to them.
The work under this part of the Act is carried out by fifteen female visitors and two male inspectors.
The duties of the visitors comprise visiting the foster-mothers, to see that the infants are
receiving proper care and attention, and also to advise the foster-mothers as to methods of feeding,
etc., the infants entrusted to their care. The work of the two male inspectors is mainly of a detective
character. They watch the advertisements in the Press, trace unregistered foster-mothers by this
means and by information obtained in other directions, verify removals of infants from foster-parents
outside London to parents or other relatives within the county, and assist the visitors in tracing removals
where notice has not been given, and also co-operate with the visitors in difficult cases.
Power is given under the Act to remove to a place of safety, i.e., a workhouse, an infant in the
charge of a foster-mother who is unfit to have the care of it owing to negligence, ignorance, inebriety,
immorality, criminal conduct or other similar cause. Similar action may be taken where the premises
are overcrowded, dangerous or insanitary, or if the infant is being kept by a person or in any premises
in contravention of the Act. During the year 33 infants were removed in pursuance of this section as
compared with 48 the previous year. The Act also empowers a local authority to exempt either partially
or wholly premises which in the opinion of the authority are so conducted as to render ordinary inspection
unnecessary. Partial exemptions, limited to one or two visits a year, were granted in 11 cases, as
compared with five cases the previous year.
Special attention has been directed to the sanitary condition of the dwellings in which nurseinfants
are kept. On the receipt of information that a woman has taken or intends to take a nurseinfant
the premises are inspected by the sanitary staff. A similar inspection is made if the foster-mother
removes to new premises, or circumstances arise which raise a doubt in the mind of the visitor as to the
suitability of the premises. During the past year 1,124 reports have been made. In 592 cases the premises
were reported to be satisfactory, in 278 sanitary defects were discovered, in 134 cases overcrowding was
reported, and in 34 cases both overcrowding and sanitary defects were found. In 86 cases the infant
had been removed before the inspection could be made. The attention of the sanitary authorities was
drawn to all cases in which serious sanitary defects were found. In those premises where overcrowding
was discovered a rearrangement of the accommodation sometimes resulted in an amelioration of the
conditions, but in other cases the foster-mother was required to find more suitable premises or give up
the infant. The difficulty of obtaining suitable accommodation will always be acute so long as present
housing shortage and economic conditions continue; the delay in getting the necessary repairs to the
premises carried out contributes another practical difficulty.
The local infant welfare centre plays an important part in cases of illness, and foster-mothers are
urged and encouraged to take ailing infants there and obtain the necessary advice. The visitor follows
up such cases and sees that the treatment advised is duly carried out. This has been found to be attended
with very beneficial results.
On reaching the age of five years it is usually found that the nurse-infant is sent to school, and
thus comes within the purview of the school medical service.