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5
whole country. A voluntary committee was formed, of which I was a member,
and through the instrumentality of the Chairman—the Bishop of Stepney
(now the Archbishop of York)—Lord Derby paid for the services of a voluntary
health visitor for four years. I mapped out the worst district for her,
and supplied her with a list of births. The arguments used against the
appointment of a Health Visitor were, that the mothers would resent the
interference of a stranger—as they term it—with their domestic affairs. It
was also claimed that the weaklings died, and by the survival of the fittest,
more children would survive after the first year. Both opinions have been
proved to be fallacious. It was very seldom that the visit of the first
Health Visitor was resented, and at present it is always welcomed.
Mothers would now resent any neglect on the part of Health Visitors, if visits
were not systematically paid to them. With regard to the alleged survival
of the fittest, in the years 1896-1899, when the death-rate of infants under one
year of age was so high, 20 per cent. of the remaining deaths were between
1 and 5 years of age. In 1923, in the same district, 9 per cent. only of the
remaining deaths were between 1 and 5 years of age. Although the general
death-rate in 1923 was exceptionally low for the whole Borough, excluding
the deaths of children under 1 year of age, 7 per cent. of the remaining deaths
were between 1 and 5 years of age. The decrease in the mortality among
children between 1 and 5 years of age has been equally great.
Wherever the death-rate of infants under one year of age is high, the deathrate
of children above one year of age is also high.
The infantile mortality for the whole Borough for the four years 19011904
was from 150-170 per 1,000 births. The improvement has been steady
and regular, but has been more marked in recent years.
What are the causes that have effected this change, in which there has
been a reduction of 75 per cent. in some parts of the Borough:—
(a) Better education by improving the general intelligence of the parents.
Twenty-five years ago it was held by many that the health of the children
was the concern of the parents only. This idea has been modified, and it is
now recognised that the health of the children is also the concern of the State
as well.
Special education by health visitors in the course of home visiting and at
the infant welfare centres. It has led to a healthy rivalry among mothers
who attend at the Centres.
(b) Improved Sanitation.—I do not think this has had as much effect as
in the reduction of the general death-rate and the death-rate from Tuberculosis.
During the War. the houses deteriorated, due to the want of labour
and materials, yet the infantile mortality declined even during these years.