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Reference has already been made to the reduction in the
staff and to the amalgamation of the Maternity and Child
Welfare and School Medical Branches. Under the re-arranged
scheme a reduction in staff, equivalent to the services of one
wholetime Health Visitor, has been brought about, and the
number of home visits during 1923 has been reduced by 1,256.
The increased control over all children from birth to 14 years
of age, the prevention of duplication of work, the visits made
to the schools and homes for school purposes, and the increased
amount of ''class'' teaching at the Centres, must all be placed
against the fact of this reduction. The staff, still on duty,
equivalent to two full-time Health Visitors, is still ample to
cover the work, and exceeds the standard laid down by the
Ministry of Health.
The value of Infant and Child Welfare work must not be
judged, however, by such figures as the number of home visits
made during the year. The "value of a visit" is exactly the
amount of good that results from it, and one mother may
require longer instruction to grasp a point than another. A
more correct estimate can be formed by studying the Infantile
Mortality rate in a district from year to year, but here again
many fallacies may creep in, for an outbreak of infectious
disease may cause a sudden rise in rate at any time.
In a residential area such as Wimbledon, all births are not
visited, and a selection is made as far as possible by streets.
The general medical practitioners of the district also frequently
send mothers to the Centres or advise them to attend in some
cases. Of the 838 total births, 570 (or 68 per cent.) were,
visited. Of these 570 visited, 198 (or 35 per cent.) subsequently
attended the Centres. It might be considered that some proof
of the /value of Infant Welfare work might be obtained by
calculating an Infantile Mortality rate for each of those three
groups, namely, a rate for all infants, a rate for those visited
in their homes by the Health Visitors, and a rate for those
attending the Welfare Centres, but such figures would be
absolutely worthless for the purpose of comparison. The first
few hours or days of life are of vital importance to all infants,
but more especially to the premature and weakly or those with
congenital defects, and of the 42 infants (including transferable)
dying within the first year, 21 (or 50 per cent.) died
within ten days. As the doctor, nurse, or midwife is still in
attendance on such cases, the Health Visitors do not visit, and
the statistics would be calculated on a wrong basis. It would
be just as reasonable to state that Infant Welfare work should
be abolished because 13 of the remaining 21 deaths occurred
among infants visited in their houses, and four other among
infants who had attended the Centres (17 in all).
Analysing the causes of these 21 deaths under ten days, it
is found that 12 may be attributed to "prematurity" varying
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