Public health and insurance: American addresses

by Sir Arthur Newsholme

The progress made in the organisation of ante-natal work is slow for reasons which are fairly obvious. There has been difficulty under war conditions in securing assistance from doctors and midwives. There is the well-known difficulty as to notification of pregnancy, which the government has not encouraged, except when the definite consent of the mother has been previously obtained. The facilities for help provided at the Centre have in some areas attracted patients; and health visitors and midwives have done much in other areas to persuade mothers of the advisability of safeguarding themselves against possible complications, as well as of securing adequate preparation for the lying-in period.

This subject is closely associated with that of abortions, still-births, and deaths in the first two weeks after birth. One of the most promising methods for securing the sound development of ante-natal work consists in the investigation of still-births and early infant mortality. When these inquiries are made mothers can be induced to obtain medical advice not only at the time, but also in the event of a subsequent pregnancy. The investigation at the patient’s home of all such cases and assistance in prevention of recurrence of unnecessary ante-natal, natal, and early post-natal deaths have as great an importance as the building up of a successful ante-natal clinic. The anti-syphilis work now being carried on will help greatly in this direction.

Dental Assistance

There has been a large extension of dental assistance at Centres for expectant and for nursing mothers, and for children, especially in the metropolis and its vicinity. The government has lately extended its grant to cover dentures for mothers who are nursing or pregnant, if the medical officer of the Centre is satisfied that the woman’s health will be materially improved by the denture, and that she is unable to provide it for herself.

Creches

Creches and day nurseries may be expected to exercise influence in educating mothers in the care of their children. For this purpose it is very desirable to have the creche attached to or near an infant welfare centre.

These creches, unless managed with the most rigid medical and general cleanliness, are very apt to spread infectious diseases; not merely such diseases as whooping cough, measles, and chickenpox, but also catarrhal and diarrhœal diseases. In the prevention of all of these the enforcement of the strictest cleanliness is essential, especially during the summer months for the last named diseases. For the prevention of catarrhal infections, it is essential that the creche should be conducted, so far as practicable, on strict open-air lines. Open-air creches give admirable occasional relief to mothers, even when these do not go out to work. The “toddler’s playground” is a blessing to all concerned, but the indoor creche may be, and often is, mischievous. The risks are greatly reduced by insisting on open-air conditions and by not allowing large groups of children to come together. Smaller groups mean greatly decreased possibility of cross-infection.

Observation Beds at Child Welfare Centres

At infant welfare centres infants are not infrequently seen who fail to make progress while living at home, and who yet are not ill enough to be sent to a hospital. This especially applies to cases of defective nutrition. For these cases beds in connection with centres have been found to be necessary for observation purposes and to initiate further treatment. In some instances, especially for failure of breast-feeding, it is advisable to admit the mother with the infant.

On July 30, 1914, the Local Government Board sent a circular letter and a covering memorandum by their Medical Officer which may be claimed to have been the starting point of maternity and child welfare work on a larger scale, more generally distributed throughout the country, and more completely covering the whole sphere of medical and hygienic work for this purpose than had previously been envisaged. Although the country at that time might be said to be already under the shadow of war, these documents had been previously prepared, and their appearance four days before the declaration of war was a coincidence. The chief burden of the additional work to which local authorities were urged was that there should be continuity in dealing with the whole period from before birth until the time when the child is entered upon a school register; and the memorandum contemplated that “medical advice and, where necessary, treatment should be continuously and systematically available for expectant mothers and for children till they are entered on a school register, and that arrangements should be made for home visitation throughout this period.” It was added that “the work of home visitation is one to which the Board attach very great importance and in promoting schemes laid down in the accompanying memorandum the first step should be the appointment of an adequate staff of health visitors.”