Welsh Journals

need for economy in other directions, to make full pro- visions for the effective care of infant life and of expectant mothers. They pointed out that the smaller areas could be more economically and efficiently served by a County than by a purely Local Scheme, inasmuch as with its more extended area a County Council could secure the services of a highly qualified officer who might combine the duties of Health Visitor, School Nurse, Mental Deficiency Visitor, and Inspector of Midwives. The grant in aid is paid to meet the expenditure incurred on (i.) Inspection of Midwives. (ii.) Health Visitor. (iii.) Provision of Midwifery. (iv.) Provision of Doctors. (v.) Maternity Nursing. (vi.) Clinic Centres. (vii.) Hospital Treatment. An approved Scheme, organised in its direct bearing on infantile health would thus comprise (a) Ante Natal, (b) Natal, and (c) Post Natal supervision, assistance, and treatment. Some portions of these duties were already being under- taken in certain large centres of population, but very little, if anything, was being done as a rule in ordinary Urban and Rural Areas. Among the Authorities which had anticipated these recommendations of the Local Govern- ment Board was the Carnarvonshire County Council, which in 1913 appointed its County Medical Officer Supervisor of Midwives in the County; and in 1914 a part-time Superintendent Inspector of Midwives, sub- ordinate to the County Medical Officer, was also appointed. At this period there were many districts in the County where the services of a trained midwife could not be secured. Fifty per cent. of the registered midwives were only qualified by virtue of being in practice in 1901. Many of these have now given up practice, realising they could not attain the standard now demanded. The trained midwives, with few exceptions, were Queen Victoria Jubilee Nurses, and Village Nurses (twelve months trained in Midwifery and Hospital, and holding the C.M.B. Certificate). It is upon this simple foundation of the inspection of midwives that the existing Scheme of Maternity and Child Welfare in Carnarvonshire has been erected, and is being developed, with results, as shown below, so satisfac- tory that some of the highest authorities in the Kingdom already class it as a Model County Scheme for the guidance of other authorities. It may be said in passing that the County Council was exceptionally fortunate in having as the Chairman of its Health Committee (Dr. Robert Parry) not only a qualified and experienced Medical Practitioner, but an enthusiast in the cause of Public Health. To his enlightened and progressive leadership is largely due the rapid and effective development of the original Simple Scheme to its present widely embracing and still increasing proportions. Encouraged by a grant voted by the County Council for the purpose, and assisted by the cordial co- operation of the North Wales Nursing Association (to which the Local Government Board had made a grant of £ 400 for its Midwifery Service in 1916), the Health Com- mittee was enabled, by the commencement of 1918, to establish a trained midwife in practically every district in the County with the exception of a few isolated and sparsely populated areas where the services of a wholetime midwife would not be required. Even in these cases arrangements have been made whereby the services of a trained and fully qualified midwife located in the adjoining district can be available in any case of need. (How these trained midwives are distributed in the various centres will be seen from attached map). It was in 1916 that the County Council adopted the Scheme of wider work which embraces Maternity and Child Welfare. The County Nursing Association had already divided the County into Nursing Districts, each in charge of a District Nurse. The Association readily co-operated. Its District Nurses were appointed Health Visitors, following up the notifica- tions of births in their districts while the whole-time School Nurse and Health Visitor performed this duty in areas not included in the Nursing Association Districts. The general supervision of the work was in the hands of the County Medical Officer and the two whole-time District Medical Officers of Health. The Superintendent Midwife was appointed Superintendent Health Visitor. District Committees were formed in each Nursing Associa- tion District, including representatives nominated by the County Council, Urban and Rural District Councils, Boards of Guardians, and the Insurance Committee. The selection of Voluntary Visitors, the inspection of books, and the general superintendence of the work in each district was left in the hands of a Ladies' Executive Committeee. The establishment of Infant Clinics in suitable centres covering the whole County formed a prominent and essential feature of the Scheme. These clinics are held fortnightly with a medical man and a nurse always in attendance at each. They are intended to be educational and advisory the babies are examined and weighed, and advice is given to the mothers in individual cases, while simple lectures are delivered on relevant subjects, e.g., How to feed and dress the baby suitable clothing; home hygiene food values, and household cooking. An initial difficulty was that of securing the attendance of mothers with their babies, and of expectant mothers. In some cases a considerable measure, not only of persuasion, but of diplomacy had to be exercised to ensure this. The gatherings were made as social in character as possible free teas were provided for all who attended, and the further inducement was given of providing mothers with such reauisities as household drugs and dressings, Virol, dried milk, etc., either at bare cost price, or free in cases of real need. During the potato shortage of 1916, a quantity of potatoes was sent to the Clinics for distribution. As indicated above the results of the first year's working of this very modest scheme proved satisfactory. The infantile death-rate dropped from 112 to 84 per 1 ,000 registered births. Public Authorities assisted in the work by placing their buildings at the service of the Committee when necessary. Two of the six Clinics originally estab- lished were held in Public Libraries, two in Chapel School-