996

SU1ilmary.Dr. Sobel pleads for more money and more education in

order to be able properly to organise prenatal care, to controlmaternal morbidity and mortality, and to reduce the mor-tality rate from congenital diseases. The needs, he says, ofthe instruction and supervision of expectant mothers as theypresent themselves in New York may be summarised as

follows :-

1. Zoning or districting the city along lines of the babyhealth station service, for instruction or follow up by nursesor social workers in the home, of mothers during the periodof pregnancy, and for as long a period thereafter as necessaryor possible, preferably one year.

2. Assignment by maternity institutions, whether with anin- or out-service, of nurses or social workers, within pre-scribed districts, for the instruction and supervision ofexpectant mothers.

3. Referring all mothers and babies discharged frommaternity institutions to the baby health stations nearesttheir home addresses.

4. Cooperation of all private physicians in availing them-selves of the services of the nurses of the baby healthstations, so that mothers under their supervision may beinstructed in the hygiene of pregnancy and referred to themin the event of untoward signs and symptoms. Settlements,neighbourhood guilds, churches, and day nurseries shouldrefer to the baby health stations all expectant motherscoming to their notice.

5. An educational campaign of instruction for expectantfathers in order to arouse them to their duty and responsi-bility towards the mother and the future offspring.

6. Increased interest and cooperation of philanthropicorganisations and individuals in the establishment of aprenatal service within prescribed districts and in furnish-ing to worthy mothers necessary material aid in the formof food, clothing, after-care, baby outfits, and obstetricaloutfits.

7. A municipal or philanthropic employment organisationfor securing work for unemployed expectant fathers so asto reduce to the lowest possible minimum the gainfuloccupation of the mother before or shortly after delivery,until the possible passage of a Health Insurance Bill, whichincludes maternity insurance.

8. Enactment of legislation prohibiting the employmentof pregnant women in factories or manufacturing or mer-cantile establishments, for a period of two weeks prior to,and at least four weeks after, delivery, with provision forweekly stipends and care during this period, or, as a possiblesubstitute, the establishment of day nurseries in or adjacentto factories, in charge of trained nurses, where mothers maynurse their babies, or where properly regulated artificialfeeding can be maintained.

9. Increased appropriation by city authorities for theappointment of an augmented corps of nurses for instruc-tion and supervision of expectant mothers to act as a wedge,by educational propaganda, into the inertia which now existsas to the urgency and importance of this problem.

10. Intensive studies as to the causes of still and prematurebirths by careful analysis of the histories, examinations ofthe mothers, and autopsy findings on infants.

11. Provision for improved and increased obstetrical carein homes and institutions for those able to pay only amoderate fee or unable to pay at all. This presupposesgreater and better outdoor maternity service and a largernumber of properly equipped maternity institutions through-out the city. If the public could be taught that such servicemight be obtained the midwife problem and the meddlesomeaccoucheur would adjust themselves, and hospitalisation fordelivery would become popular.

12. The application of an excessive supply of breast-milkin mothers for the use of premature and delicate infantswithin the maternity institutions, or in the neighbourhood,rather than the sale of the same for babies of the betterclasses.

13. Follow up of newborn babies by maternity institutions,directly or indirectly, for the entire first year of life.

14. Education of the public to the importance of havingmothers who give birth to stillborn infants or who lose theirchildren during the first year of life act as wet-nurseswhenever possible, or give their breast-milk, for a limitedperiod at least, to the worthy poor.

15. Persistent education as to the care of the breasts andthe importance of maternal nursing, as the remedy parexcellence in the reduction of infant morbidity and mortality,especially during the first month of life.

16. Provision for an increased number of temporaryshelters, where mothers about to be delivered in institutionsmay place their infants and children during the period ofconfinement, and thus secure that peace of mind and con-tentment which is essential for the prospective mother.

17. The establishment at various centres throughout thecity of permanent exhibits showing the various phases of

prenatal and infant care, consisting of photographs, charts,convincing statistics, and literature. Periodical lectures,lantern slides, and moving pictures could be added as

indicated. In other words, prenatal care should bepopularised.

Attractive features in Dr. Sobel’s scheme are the suggestedcooperation of private physicians, the systematic investiga-tion of still and premature births, and the increasedobstetrical facilities for those of moderate means. The

report might with advantage be taken to heart by infantwelfare workers in this country. A perusal of it suggeststhat what is wanted here is a complete scheme drawn up forthe whole country (and particularly for London) by somecentral authority, such as a Ministry of Health, to ensureclose cooperation between all the various activities concerned.At present each child-welfare centre is largely a discreteentity, separate from hospitals, other centres, midwives,lying-in institutions, &:o. Whilst the object of the child-welfare movement is the preservation of health and the pre-vention of disease, the hospital should be the focus ofactivity, where all treatment and investigation would becarried out ; with increasing distance from the focusthe more should be the stress laid on the preventionof disease. Child-welfare centres would then becomeoutposts of the hospitals and accessory or collecting out-

patient departments, as well as health centres, where thescience of health, hygiene, and infant management is taughtto girls, young women, and expectant and nursing mothers.In the centres the first deviations from health wouldbe discovered, and by the close cooperation and help ofnurses and practising midwives every case of still and pre-mature births might be brought to light and investigated.

SOUTH AFRICA PUBLIC HEALTH BILL:CHANGES MADE BY SELECT COMMITTEE.

THE principal Government measure in the present sessionof the South African Union Parliament is the Public HealthBill. Owing to the recent influenza epidemic it hasattracted much more attention than it would otherwisehave done, and its scope has been widened considerablyin consequence.The Bill was published on April 12th as amended by the

Select Committee of the House of Assembly, and it has

undergone material alteration whilst in its hands. The firstof the new clauses provides for a Council of Public Health,to consist of the Minister as chairman, the chief healthofficer, and seven others nominated by the Governor-General, but apart from the officers of the Public Service,four of the latter to be medical practitioners.Power is given to the Minister to declare any disease to be

a notifiable disease.The onus is placed on local authority for seeing that

adequate measures are taken to prevent the spread ofinfectious disease, including the care of patients and theburial of the dead.The Minister may by regulation close all bars in the event

of a threatened outbreak.Extra power is given in regard to the establishment and

maintenance of special accommodation for the treatment ofpersons suffering from venereal disease who are liable todetention.New clauses provide for notification by port health officers

of disease conveyed in ships.Provision is made regarding conscientious objectors to

vaccination.A new clause prohibits the admission of any child to

school until a certificate is produced showing compliancewith the provisions dealing with vaccination againstsmall-pox.The duty is thrown on the Department of Public Health

of dealing with overcrowding, and the Minister is givenpower to make regulations with a view to preventing over-crowding.The power of the Minister to make regulations is restricted

in respect of districts of local authorities unless speciallyrequested by the local authority concerned.The final clause brings the Act into operation not later

than Jan. lst, 1920," except in regard to the Public HealthDepartment and Public Health Council, which are to comeinto operation before July 1st this year.