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every street in London is now covered by the activities of one or another of these, and arrangements
exist by means of which a nurse can always be obtained when wanted for the home treatment of this
disease. Considerable use has been made of St. Margaret's Hospital assigned by the Metropolitan
Asylums Board for the reception of cases of ophthalmia neonatorum. This provides accommodation
for 30 infants and 18 mothers, and up to the present has proved adequate to meet the calls made
upon it.
During the year 1,219 notices were received from midwives, stating that medical assistance had
been advised on account of inflammation of the eyes of infants and in addition to these 105 other cases
came to light in which either medical help was not called in by the midwife or in which she did not notify
the Council of having done so. Of these 1,324 cases 665 proved to be ophthalmia neonatorum. In
addition, 408 cases of ophthalmia neonatorum not occurring in the practice of midwives were notified,
making a total for the year of 1,073 cases. The percentage occurring in the practice of midwives was
thus 62. The Council's inspectors investigated all cases occurring in the practice of midwives. 622
cases were reported to be completely cured. 13 cases died while still suffering from the disease. In 7
cases there was serious impairment of the vision or injury in one or both eyes, in 16 cases there was
slight impairment,whilst in 7 instances the result could not be ascertained owing to the removal of the
patients, who could not be traced. 88 cases received in-patient hospital treatment at St. Margaret's.
With regard to instances in which impairment of vision occurred, in 3 cases there was total blindness
in 3 cases, blindness of one eye; in one case, serious injury to one eye; and in 16 cases slight impairment
to vision in one or both eyes.
Lectures to
midwives.
Lying-in
homes.
The classes arranged by the Council for the further instruction of midwives have met with much
success.
The Council's action with regard to the registration of lying-in homes is dealt with later.
All registered premises are regularly inspected by the Council's medical inspectors to ensure that
a proper standard of cleanliness and general efficiency is maintained and during the year 506 inspections
were thus made.
Children
Act, 1908—
Part I.
The Council s powers, etc., under the Children Act, 1908, with regard to infant life protection are
dealt with later in Chapter XXVII.
The inspection work under this Act is carried out by 14 female visitors and 2 male inspectors.
The number of nurse infants who were removed to poor law institutions during 1921, was 20 as
compared with 15 in the previous year. Partial exemptions from inspection limited to one or two a
year were granted in two cases as compared with seven in the previous year.
A very important point is the ascertainment that the sanitary condition of the home of the foster
mother is satisfactory. All new premises or premises to which a foster mother has removed after registration,
are therefore inspected by an officer of the Council's sanitary staff. Similar action is taken if doubt
subsequently arises as to the suitability of the premises, or if any complaint is made as to any serious
defect or nuisance. The number of such reports during 1921 was 1,006 as compared with 966 during 1920.
In 668 cases the premises were found to be satisfactory as compared with 573 in the previous year. In
146 homes sanitary defects were discovered as compared with 186 in the previous year; over-crowding
was reported in 131 as compared with 138 homes in the year 1920. Both over-crowding and sanitary
defects were discovered in 29 homes as compared with 22 in the previous year. In the remaining 32 homes
no action could be taken owing to the removal of the infant before the visit of the inspector.
Where serious sanitary defects are discovered the attention of the borough council is drawn to the
matter. In a case of overcrowding it may be possible by re-arrangement of the accommodation to secure
an improvement of the conditions, but if this is found not to be possible, the foster mother is instructed
to obtain more suitable premises, or return the nurse infant to its parents. Attention may be drawn to
the fact that the present shortage of housing accommodation renders the enforcement of this requirement
difficult in some instances.
The assistance of the local Infant Welfare Centre is frequently obtained in the case of illness of a
nurse infant. Foster mothers are urged and encouraged to take ailing infants there and to follow the
advice given. The visitors watch such cases with a view to making sure that the treatment advised is
duly carried out. The Children Act provides that the infant shall remain under the care of the infant
protection visitor until it reaches the age of 7 years, but as is well known the child generally goes to
school at the age of 5 years and as a consequence comes under the supervision of the school medical service.
The number of deaths of nurse infants was greater during 1921 than in 1920, viz., 42 cases as
compared with 26 ; the number of deaths during 1920 was exceptionally low. Inquests were necessary
only in six cases, while the verdict in every case was death from natural causes.
In 1920 the Home Secretary appointed a Departmental Committee to deal with the question of child
adoption. One of the Council's medical officers gave evidence. During 1921 the Committee made a report
[Cmd. 1254] indicating (a) proposals for legalised adoption and (b) proposals for the amendment of the
Children Act, 1908. Generally speaking, it may be noted that the Committee appear to be of opinion that
the sanction for adoption should be given by a regular judicial authority rather than by an administrative
department or local authority. With regard to the proposals for an amendment of the Children Act the
Committee suggested, inter alia, that the age limit should be extended to 14 years and should cover cases
of children below the age of 14 years received without payment. With regard to adoptions for lump
sums, the Committee were of opinion that the local authority should be empowered to see that the sum
so paid is applied for the benefit of the child. In connection with this question of lump sum adoptions a
considerable number of children coming under this heading were examined during the year by a member
of the medical staff of the public health department in order to ascertain the general standard of maintenance
as compared with foster children for whom periodic payments were being made. The results