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It will be observed that in 1938 in Willesden this rate fell to 1.63 per 1,000. I am of opinion
that the puerperal mortality rate can be reduced to 1.0 per 1,000 and that this should be regarded
as the normal puerperal mortality rate.
It will be observed that the efforts of the Council have reduced the rate very nearly to this
figure, but there are still some gaps in the maternity organisation which require to be filled. I
referred to four of these in my memorandum to the Committee on Motherhood in Willesden, dated
November, 1936, namely:—
(1) The need for increased hospital accommodation.
(2) The need for adequate feeding to improve the fitness of the mother for childbirth and
the nursing of the baby.
(3) Better hospital provision for the care of the premature infant.
(4) The appointment of a physician skilled in the care of infants during the early days of life.
Effect has been given to the last of these recommendations, namely, the appointment of a
physician skilled in the care of infants, but the others still require attention.

Ante-natal care remains the most important factor in maternity and this will not be available
for the pregnant woman to the extent required until increased clinic accommodation and increased
hospital accommodation has been provided. Only then shall we be in a position to attain the
irreducible minimum of deaths of mothers in childbirth.
GEORGE F. BUCHAN
Medical Officer of Health.
APPENDIX C. 11th April, 1939.
MEMORANDUM ON THE CARE OF FOSTER CHILDREN.
{Report approved by the Council and forwarded to the Association of Municipal Corporations.)
The law relating to Child Life Protection is now contained in Part VII. of the Public Health
Act, 1936, which came into operation on 1st October, 1937. This Act is a consolidating Act and
although it contains certain amendments it was not devised to alter the existing law.
In administering the Child Life Protection provisions of the Act the point which has impressed
us most and with which this memorandum deals is the frequent changes of home to which a foster child
is subject so that it finds no security in life at all.
Frequent Changes of Home.
The Willesden records show that of the 449 individual foster children under observation
during the year 1937, 248 changed hands during 1937. 206 made one change, 31 made two changes,
8 made three changes and 3 made four changes. These changes do not include the first reception
of the child.
Of the 203 foster children under observation at the end of 1937, 66 had been in the foster
mothers' care less than six months, 47 between six months and one year, 38 between one and two
years, 32 between two and three years, 8 between three and four years, 4 between four and five years,
2 between five and six years, 5 between six and seven years, and 1 seven years.
Lack of Recognition of Responsibility of Parent.
There is no restriction on the frequency with which a mother may change her child's foster
home.
Indeed, in the law relating to Child Life Protection, the responsibility of the parent receives
very little recognition.