Public health and insurance: American addresses

by Sir Arthur Newsholme

For many years before the Notification of Births Act was passed, it had been customary, especially in towns, to arrange for inquiry by a sanitary inspector or female visitor into death occurring under one year of age, and in many instances for the giving of systematic advice to mothers concerning their infants. More than twenty years ago the Manchester and Salform Sanitary Association had initiated a system of home visitation by volunteer ladies and by women workers paid by the Association who went from house to house, gave elementary sanitary advice, and reported serious defects to the Sanitary Authority. The City Council at an early stage showed its appreciation of the importance of this work by giving grants towards the expenditure incurred.

In order to enable early visits to be made, the town council of Salford had begun as early as 1899 a system of voluntary notification of births by midwives.

Prior to the stage at which early notifications of births was obtained, the medical officer of health was dependent for his information on the registration of births, for which an interval of six weeks after birth was permitted before it became compulsory. During this interval a large proportion of the total mortality of infancy had occurred,—approximately one-fifth of the total deaths in the first year after birth occur in the first week and one-third in the first month after birth,—and the possibility of successfully influencing the mother to continue breast-feeding had gone. The action of the town of Huddersfield in 1906 in obtaining Parliamentary power to secure the compulsory notification of births within thirty-six hours of birth represented a rapid growth of opinion based on experience in that and other towns to the effect that in the absence of early information of birth the necessary sanitary precautions and counsel as to personal hygiene could not be given with the greatest prospect of success. This local pioneer work doubtless facilitated the passing of the Notification of Births Act in 1907.

Much important work followed the notification of births. Home visits to the mother were regarded and continue to be regarded as the most important part of this work; but there also grew up rapidly the present system of Infant Consultations and similar organizations.

The Notification of Births (Extension) Act, 1915, not only made the enforcement of this act universal, but it also empowered each local authority administering the Act to exercise any powers which a sanitary authority possesses under the Public Health Acts “for the purpose of the care of expectant mothers, nursing mothers, and young children.” In drawing the attention of Local Authorities to the terms of the Act the Local Government Board, as well as earlier in the war, deprecated false economy during the war. They said:

At a time like the present the urgent need for taking all possible steps to secure the health of mothers and children and to diminish ante-natal and post-natal infant mortality is obvious, and the Board are confident that they can rely upon local authorities making the fullest use of the powers conferred on them.

The Board in the same circular laid stress on “the importance of linking up this work with the other medical and sanitary services provided by local authorities under the Public Health and other Acts.”

The passing of this Act has been followed by an increasingly rapid development of Maternity and Child Welfare work, and the Maternity and Child Welfare Act passed in August, 1918, made it obligatory on each Council exercising powers under the Act to appoint a Maternity and Child Welfare Committee, which must include at least two women, and may include persons specially qualified by training or experience in subjects relating to health and maternity who are not members of the Council.

In the circular letter sent out to local authorities explaining the new Act, the Local Government Board reëmphasizes its previously stated views that child welfare work was second only in importance to direct war work, and was really a “measure of war emergence,” and added:

although we have enjoined as local authorities the necessity of the strictest of economy in public expenditure, we have urged increased activity in work which has for its object the preservation of infant life and health. We are glad to note that the great majority of local authorities have realized the value of continuing and extending their efforts for child welfare at the present time.