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prevalent; whooping cough and primary pneumonia more so. The
district was free entirely of smallpox, typhoid fever, ophthalmia in the
newborn, and the infections of the central nervous system, namely
poliomyelitis, polio-encephalitis, cerebro-spinal fever and encephalitislethargica.
Diphtheria incidence calls for special mention, particularly
in view of the intensive efforts which for years have been made to secure
the immunisation of the child population. Only four cases occurred
among the residents. Of these, one was a hospital nurse and the other
three were members of one family. Never in any one year before has
diphtheria been limited to one domestic dwelling.
Mainly as a result of the substantial increase in the number of births
the Maternity and Child Welfare scheme had an exceptionally busy year
and its activities were conducted at a new high level. The Council's
scheme, like the medical practitioners, nursing organisations and
hospitals, constitutes one of the principal agencies in the district for the
promotion of maternal and child health. As from July next great changes
in these health services affecting mothers and children will be instituted.
Under the provisions of the National Health Service Act the Maternity
and Child Welfare scheme will pass out of the control of the District
Council, which has administered it from its inception, and will become
the responsibility of the County Council; the medical practitioners will
work under a very different set of conditions; the nursing associations
will largely lose their voluntary character, and the hospitals will be
vested in the Minister and administered by Boards chosen and appointed
by him. This might then be an appropriate opportunity briefly to
review the record of our long established arrangements in this special
field.
The Carshalton Maternity and Child Welfare scheme was born in
1909 when one health visitor was first appointed to visit the homes of
babies whose births were notified under the Notification of Births
Act, 1907. She was a district nurse employed part-time by the Council,
and her duties were to visit on two occasions and advise mothers on
infant care and feeding. From this small beginning successive Councils
built steadily and wisely until to-day the district has the benefit of
a comprehensive scheme which includes five health centres at which 14
welfare sessions per week are conducted, an establishment of six full
time health visitors, a day nursery of 74 places and the many and diverse
ancillary services set out in the body of this report. How has the health
of Carshalton mothers and children fared during this period ? That,
of course, is the true test of the effectiveness of the local services. The
average annual infant mortality for the ten years immediately prior
to the commencement of the scheme was 117 deaths per thousand live
births; that for the most recent ten years 38, and, as stated above,
that for 1946 was the record low one of 18. Maternal mortality in the
decennium 1900 1909 was 2.5 per thousand births; in the last ten
years 1.5. How do these local indexes compare with the national
figures ? At page 15 will be found comparative statistics for the last
ten years, from which it will be seen that our local infant mortality
has been consistently less than for England and Wales, and for the whole
decennium approximately two-thirds only of the national rate. Maternal
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