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Maternity and infant welfare
Public Health THE
JOURNAL
OF
The Society of Medical Officers of Health. No. 12.
SEPTEMBER, 1919.
Subscription price, 2IS. per annum, post free in advance. Single copies, is. 8d. post free.
EDITORIAL--
CONTENTS.
Maternity and Infant X¥-elfare. . . . . . . . .
PAGIL
I33
SPECIAL ARTIOLES-The H e a l t h A u t h o r i t y and H o s p i t a l Accommodation. (By ]. J. Buohan, M.D., D.P.H., Medical Officer of Health for Bradford) ...
134
M e m o r a n d u m on t h e T e a c h i n g of Sex ttygieme in the Public E l e m e n t a r y Schools. (By
Gee. F. Buohan, M.D., D.P.H., Medical Officer of Health, Willesden) . . . . . . . . . . The D e s t r u c t i o n of R a t s ... ...... ~Baghdad W a t e r S u p p l y . . . . . . . . . . . . Influenza a n d P n e u m o n i a ......... Memorial to the late Dr. Marsden ...... O B I T U A R Y - - D r . William A n g u s . . . . . . . . .
x39 i37 i38 i4x
144 i37
SOCIETY OF MEDICAL OFFICERS OF HEALTH-Annual D i n n e r . . . . . . . . . . . . . . . . i4i Council Meeting and B r a n c h N e w s
142- 4
; if0rid. M A T E R N I T Y AND I N F A N T WELFARE. our issue Of May last we made the following I Ncomments upon the new rules o f the Central Midwives Board. " I t is greatly to be regretted that together with rules issued by the Central Midwives Board for the guidance of midwives there should be issued a suggestion that they should call -their patient's attention to the provision of health visiting services when they are themselves ceasing attendance, as this suggestion practically implies that the health visitor will not have made her appearance within the period of ten days during which the midwife is in attendance. The primary object of the notification of Births Act was to secure the notification of births within thirty-six hours of their occurrence, and in making such provision-and in securing the means to inflict a penalty for failing to comply with it--Parliament must h a v e had some object in view. This object was, as is very wellTknown, to secure the xdsiting of mothers and children as soon as possible after the confinement, and if it had
VOL. XXXII.
not been intended t h a t visits should take place within the first ten days, there would have been no need to require the notification to be made within thirty-six hours. Unfortunately, some midwives are already too anxiofls to prevent the mother and Child being seen by the health visitor, or by anyone else during the time s h e is in attendance, and it is to be feared that women of this type will endeavour to use the remarks made by the Board as authority to defy the bodies charged with the administration of the Notification of Births Act, and to prevent the health visitor from calling during the first ten days. The experience of all Supervising Authorities, whose health visitors inspect within the first ten days, is that m a n y cases of discharging and inflamed, eyes (as well as other matters needing medical attention) are discovered for which medical help has not been advised by the midwife, although the Rules of the Board are probably more strict in that than in any other respect." I t is still more to be regretted that the Ministry of Health, in one of their earliest circulars (Circular 4, dated July i4th, I919), appear to support this indirect method ot defeating the objects of the Notification of Births Actl This circular states t h a t " The visiting of expectant mothers before confinement, and of infants during the first ten days after birth, is at present undertaken in some areas bY Health Visitors. The Ministry of Health are of opinion that this work should be assigned to the midwife (where a midwife has been engaged by t h e mother), wherever this can be done consistently with the discharge of the important duties involved." Can the Ministry of Health be really a w a r e of the" ~rcical position thus created, or is the Ministry allowing this Department to be guided by those who produced such confusion in this subject under the Local Government Board and the Central Midwives Board ? U n d e r the Notification of Births Act a midwife is compelled to notify the occurrence of the birth
134
PUBLIC HEALTH.
within thirty-six hours. T h e apparent suggestion of the Ministry of Health is that after notifying the birth the midwife visits in a dual capacity; first as the midwife continuing her visits for ten days in accordance with the rules of the Central Midwives Board, and, secondly, as a Health Visitor whose inevitable d u t y in many instances is to criticise the slack work o f the midwife. Increased efficiency as the result of improved training of midwives will never prevent very serious mishaps occurring if the midwife is to be placed in this very extraordinary position and to be freed from regular supervision by an independent visit. It might be suggested to the Ministry of Health that the whole organization of the Department dealing with maternity and infant welfare needs overhauling. It is true that the confusion is due largely to the old antagonism between the Local Government Board and, the Board of E d u c a t i o n / b u t unfortunately the old errors appear likely to become stereotyped in the new Ministry. In one county area alone quite recently the following cases of overlapping and confusion have come to light. In several areas District Councils give donations to Local District Nursing Associations and claim from the Ministry of Health grants on account of these payments. In olle of these instances the District Council now proposes to give additional grants for the supply of milk through these organizations, applying for further grants from the Ministry for this purpose. These district nursing associations act entirely without any supervision in this matter and the public money is expended without any public control. In the same area the C o u n t y Council have maternity and infant welfare centres covering much the same work. In the second instance the District Council give a donation to the local welfare centre, one half of which is repaid by. the Ministry of Health. T h e B o a r d . o f Education also gives a grant to this centre, and. t h e County Council also render substantial financial aid. In this ease, therefore, the welfare centre •concerned draws public money from three distinct, a n d at present entirely unrelated sources, each one of which being presumably ignorant of what is being done b y the other two. Still further confusion and overlapping is caused b y t h e procedure of the Local Government Board in giving grants direct to voluntary nursing associations instead of through the
SEPTE~B~I~,
County or C o u n t y Borough Council concerned. Large sums of public money are at present being expended b y these associations without an?- public control, and with little or no public knowledge: T H E H E A L T H A U T H O R I T Y AND H O S P I T A l , ACCOMMODATION. By J. J~ BUCHAN, M.D., D.P.H., Medical Olficer o/Health [or Bmd/ord. O the student of social progress perhaps T the most striking feature of the movement that has led to the inauguration of a Ministry of Health in this country is the change which has slowly been taking place in public opinion with respect to the health of the individual. At the beginning, Public Health Authorities b o t h central and local concerned themselves solely with the protection of health of the c o m m u n i t y as a community, and only took cognisance of the health of the individual when the person was suffering from some specified diseases which were then regarded as likely to affect adversely the community as a whole. All that concerned the health o f the individual or his mental or physical well-being apart from this was considered essentially a matter of personal concern. With the advancement of know.ledge and the progress of public health work the intimate relationship between the welfare of the individual and the communal health was more and more recognised and it was impossible for local authorities to retain longer these separate ideals and there began to grow up i n health administration, apart altogether from the Poor Law, systems for the care and treatment of the individual when sick, q u i t e irrespective of whether the public health in the older sense was affected or not. The State was ~ no longer simplTg interesting itself in the environment of the persons composing it, b u t it was beginning to take an ever-increasing interest in the adaptation of each to the environment. We, too, are apt to think this conception of the duty of the State towards the health of the individual a new one, and there is too great a tendency to date it from the beginning of medical inspection of school children or the public care of the mother and infant, or w h a t e~er date w e began our history of modern public health. As a matter of fact, it is one of the oldest ideals of health reformers, and we have it written large in many of the sections of the Public ~ e ~ t h Aet of I875, b u t though
JOURNAL
OF
The Society of Medical Officers of Health. No. 12.
SEPTEMBER, 1919.
Subscription price, 2IS. per annum, post free in advance. Single copies, is. 8d. post free.
EDITORIAL--
CONTENTS.
Maternity and Infant X¥-elfare. . . . . . . . .
PAGIL
I33
SPECIAL ARTIOLES-The H e a l t h A u t h o r i t y and H o s p i t a l Accommodation. (By ]. J. Buohan, M.D., D.P.H., Medical Officer of Health for Bradford) ...
134
M e m o r a n d u m on t h e T e a c h i n g of Sex ttygieme in the Public E l e m e n t a r y Schools. (By
Gee. F. Buohan, M.D., D.P.H., Medical Officer of Health, Willesden) . . . . . . . . . . The D e s t r u c t i o n of R a t s ... ...... ~Baghdad W a t e r S u p p l y . . . . . . . . . . . . Influenza a n d P n e u m o n i a ......... Memorial to the late Dr. Marsden ...... O B I T U A R Y - - D r . William A n g u s . . . . . . . . .
x39 i37 i38 i4x
144 i37
SOCIETY OF MEDICAL OFFICERS OF HEALTH-Annual D i n n e r . . . . . . . . . . . . . . . . i4i Council Meeting and B r a n c h N e w s
142- 4
; if0rid. M A T E R N I T Y AND I N F A N T WELFARE. our issue Of May last we made the following I Ncomments upon the new rules o f the Central Midwives Board. " I t is greatly to be regretted that together with rules issued by the Central Midwives Board for the guidance of midwives there should be issued a suggestion that they should call -their patient's attention to the provision of health visiting services when they are themselves ceasing attendance, as this suggestion practically implies that the health visitor will not have made her appearance within the period of ten days during which the midwife is in attendance. The primary object of the notification of Births Act was to secure the notification of births within thirty-six hours of their occurrence, and in making such provision-and in securing the means to inflict a penalty for failing to comply with it--Parliament must h a v e had some object in view. This object was, as is very wellTknown, to secure the xdsiting of mothers and children as soon as possible after the confinement, and if it had
VOL. XXXII.
not been intended t h a t visits should take place within the first ten days, there would have been no need to require the notification to be made within thirty-six hours. Unfortunately, some midwives are already too anxiofls to prevent the mother and Child being seen by the health visitor, or by anyone else during the time s h e is in attendance, and it is to be feared that women of this type will endeavour to use the remarks made by the Board as authority to defy the bodies charged with the administration of the Notification of Births Act, and to prevent the health visitor from calling during the first ten days. The experience of all Supervising Authorities, whose health visitors inspect within the first ten days, is that m a n y cases of discharging and inflamed, eyes (as well as other matters needing medical attention) are discovered for which medical help has not been advised by the midwife, although the Rules of the Board are probably more strict in that than in any other respect." I t is still more to be regretted that the Ministry of Health, in one of their earliest circulars (Circular 4, dated July i4th, I919), appear to support this indirect method ot defeating the objects of the Notification of Births Actl This circular states t h a t " The visiting of expectant mothers before confinement, and of infants during the first ten days after birth, is at present undertaken in some areas bY Health Visitors. The Ministry of Health are of opinion that this work should be assigned to the midwife (where a midwife has been engaged by t h e mother), wherever this can be done consistently with the discharge of the important duties involved." Can the Ministry of Health be really a w a r e of the" ~rcical position thus created, or is the Ministry allowing this Department to be guided by those who produced such confusion in this subject under the Local Government Board and the Central Midwives Board ? U n d e r the Notification of Births Act a midwife is compelled to notify the occurrence of the birth
134
PUBLIC HEALTH.
within thirty-six hours. T h e apparent suggestion of the Ministry of Health is that after notifying the birth the midwife visits in a dual capacity; first as the midwife continuing her visits for ten days in accordance with the rules of the Central Midwives Board, and, secondly, as a Health Visitor whose inevitable d u t y in many instances is to criticise the slack work o f the midwife. Increased efficiency as the result of improved training of midwives will never prevent very serious mishaps occurring if the midwife is to be placed in this very extraordinary position and to be freed from regular supervision by an independent visit. It might be suggested to the Ministry of Health that the whole organization of the Department dealing with maternity and infant welfare needs overhauling. It is true that the confusion is due largely to the old antagonism between the Local Government Board and, the Board of E d u c a t i o n / b u t unfortunately the old errors appear likely to become stereotyped in the new Ministry. In one county area alone quite recently the following cases of overlapping and confusion have come to light. In several areas District Councils give donations to Local District Nursing Associations and claim from the Ministry of Health grants on account of these payments. In olle of these instances the District Council now proposes to give additional grants for the supply of milk through these organizations, applying for further grants from the Ministry for this purpose. These district nursing associations act entirely without any supervision in this matter and the public money is expended without any public control. In the same area the C o u n t y Council have maternity and infant welfare centres covering much the same work. In the second instance the District Council give a donation to the local welfare centre, one half of which is repaid by. the Ministry of Health. T h e B o a r d . o f Education also gives a grant to this centre, and. t h e County Council also render substantial financial aid. In this ease, therefore, the welfare centre •concerned draws public money from three distinct, a n d at present entirely unrelated sources, each one of which being presumably ignorant of what is being done b y the other two. Still further confusion and overlapping is caused b y t h e procedure of the Local Government Board in giving grants direct to voluntary nursing associations instead of through the
SEPTE~B~I~,
County or C o u n t y Borough Council concerned. Large sums of public money are at present being expended b y these associations without an?- public control, and with little or no public knowledge: T H E H E A L T H A U T H O R I T Y AND H O S P I T A l , ACCOMMODATION. By J. J~ BUCHAN, M.D., D.P.H., Medical Olficer o/Health [or Bmd/ord. O the student of social progress perhaps T the most striking feature of the movement that has led to the inauguration of a Ministry of Health in this country is the change which has slowly been taking place in public opinion with respect to the health of the individual. At the beginning, Public Health Authorities b o t h central and local concerned themselves solely with the protection of health of the c o m m u n i t y as a community, and only took cognisance of the health of the individual when the person was suffering from some specified diseases which were then regarded as likely to affect adversely the community as a whole. All that concerned the health o f the individual or his mental or physical well-being apart from this was considered essentially a matter of personal concern. With the advancement of know.ledge and the progress of public health work the intimate relationship between the welfare of the individual and the communal health was more and more recognised and it was impossible for local authorities to retain longer these separate ideals and there began to grow up i n health administration, apart altogether from the Poor Law, systems for the care and treatment of the individual when sick, q u i t e irrespective of whether the public health in the older sense was affected or not. The State was ~ no longer simplTg interesting itself in the environment of the persons composing it, b u t it was beginning to take an ever-increasing interest in the adaptation of each to the environment. We, too, are apt to think this conception of the duty of the State towards the health of the individual a new one, and there is too great a tendency to date it from the beginning of medical inspection of school children or the public care of the mother and infant, or w h a t e~er date w e began our history of modern public health. As a matter of fact, it is one of the oldest ideals of health reformers, and we have it written large in many of the sections of the Public ~ e ~ t h Aet of I875, b u t though