The Influence of School Medical Inspection
In the development of child welfare work in England important place must be given to the system of medical inspection of school children initiated in 1907. The numerous physical defects found in school children have led to the beginning of measures for remedial action, confined in some areas to measures for securing greater cleanliness and the treatment of minor skin diseases; but extending in other areas to such measures as the remedial treatment of adenoids, the cure of ringworm, the correction of errors of refraction, and the provision of dental treatment. Perhaps the chief value of the system of medical inspection of school children has been the fact that it has demonstrated the extent to which children when they first come to school are already suffering from physical disease which might have been prevented or minimized by attention in the pre-school period. The information thus accumulated has had much influence in encouraging the institution of Infant Consultations, with a view to the early discovery of disease or of tendency to disease.
The Influence of Statistical Studies
The intensive study of our national and of local vital statistics has also had a most important bearing on the further development of maternity and child welfare work. In successive official reports it has been shown that infant mortality varies greatly in different parts of the country, irrespective of climatic conditions; that it varies greatly in different parts of the same town, in accordance with variations in respect of industrial and housing conditions, of local sanitation, of poverty and alcoholism; that the variations extend to different portions of infant life, the death-rate in infants under a week, or under a month in age, for instance, being two or three times as high in some areas as in others; and that the distribution of special diseases in infancy similarly varies greatly. Intensive studies of infant mortality on these and other lines have pointed plainly the directions in which preventive work is especially called for; and have incidentally demonstrated the fundamental value of accurate statistics of births and of deaths in the child welfare campaign. Surveys of local conditions both statistical and based on actual local observations form an indispensable preliminary to and concomitant of good child welfare work; and it is to combined work on these lines that the improvement of recent years is largely attributable. To act helpfully we must know thoroughly the summation of conditions which form the evil to be attacked.
One important result of investigations such as those already mentioned has been to bring more clearly into relief the fact, which previously had been partially neglected, that child welfare work can only succeed in so far as the welfare of the mother is also maintained.
This may imply extensions of work involving serious economic considerations; but apart from such possibilities and apart from questions of housing, and of provision of additional domestic facilities for assisting the overworked mother, there is ample evidence that medical and hygienic measures by themselves can do much to relieve the excessive strain on the mother which childbearing under present conditions often involves.
The Course of Mortality from Childbearing
The general course of mortality from childbearing (including deaths ascribable to pregnancy) in England and Wales is shown by the following table:
Average Annual Death-rates per 100,000 births from
| Puerperal | Other Diseases | |
| Septic | of Pregnancy | |
| Diseases | and Childbirth | |
| 5 years, 1902-06 | 185 | 228 |
| 5 years, 1907-11 | 152 | 215 |
| 3 years, 1912-14 | 148 | 233 |
| 2 years, 1915-16 | 151 | 239 |