OXYGEN THERAPY

for suitably qualified medical practitioners in rural areas to give treatment at their surgeries during norma) attendancehours. The section of the report dealing with mothers and children shows that, although two years of war have dislocated family life and all concerned with maternal and child welfare serviceshave been forced to concentrate on maintenancerather than development, progress has still been made. We read that the fall in the maternal mortality rate which began in 1934 has continued; the figure of 2·61 per thousand total births for 1940 is the lowest that hasbeen recorded. Among the factors regarded as chiefly responsiblefor the decline is the advancemade during recent years in the treatmentof sepsis; but some credit is also stated to be due to the improved standard of domiciliary midwifery, and a tribute is paid to the devotion to duty that has been shown by practising midwives. When the intensive bombing of London began it. was realized that persons in charge of air raid shelters might have to deal with women llJ.Iddenly in labour and have no experienceto guide them. Two leaflets of simple instructions were issued, the main object of which was to give advice on the care of mother and child if no expert help could be obtained in time, and to prevent untrained people from interfering more than was absolutely necessary. Though the fall in infantile mortality has not progressed,the position is far from discouraging. In 1939 the mortality rate had fallen to 50 per thousandlive births (the figure was 53 in 1938); the rate rose in 1940 to 56 per thousand. That great strides have been made in maternaland child welfare is shown by the fact that in the second year of the war of 1914-1918 the infant mortality rate was 110 per thousand. The National Milk Schemewhich was introducedin June,1940, has made it possible for every expectant or nursing mother and every child under the age of five years to obtain every day a pint of liquid milk for the sum of twopence or if necessaryfree of cost. "The result has been a vast increase in the consumptionof milk by the classeswho need it most." It has been calculated that 84% of the eligible populationof Englandand Wales get milk cheaply or free of cost and that 25% of these beneficiariesare in the latter category. Mention is made of the welfare of young children-those evacuated from dangerous areas and those who have remained behind. A . great deal has been done for these children by health visitors and others, and medical inspection has also been undertaken. This subject was discusseda few months ago in these columns at considerablelength. It is pointed out that the problem will have to be solved on a permanentbasis. No matter how much conditions are altered and how careful the supervision,therecan be no permanentsolution without the cooperation of the parents. In the future "more time and effort must be devoted to instructing young mothers in such important, if elementary,matters as the necessity for cleanlinessand for training infants and toddlers in good habits". This cannot be done until peace "affords relief from more urgent work". By the end of March, 1941, 61 nursery centres had been established in reception areas, where children between the ages of two and five years could be cared for and given occupationduring school hours. This has provided much iel ief for householderson whom the children have been hilleted. The care of the children of women workers has not been neglected. In districts where the Ministry of Labour and National Service advised that there was a special need, welfare authorities were asked to establish day nurseries for children up to five years of age. At first this was not a particularly urgentmatter, but towards. the end of 1941 the demandson woman power began to develop rapidly and urgent steps had to be taken to meet the needsof children whose mothers sought employment. Approved expenditure on all nurseries, for evacuated children and for the children of women in employment, were accepted as a charge on the exchequer and the Government made itself responsible for the bulk of the necessaryequipment. By December 31, 1941, there were operating in England and Wales 93 whole-time and 130 part-time day nurseries; 245 whole-time and 68 part-time nurseries were approved but not yet in operation, and 267 were in preparation. In the foregoing only the two first, but perhaps the more obviously important, sections of the report have been described. Those that remain deal with such subjects as the supply of nurses, housing, town and country planning, ョ 。 エ ゥ セ ョ 。 ャ health insurance and contributory pensions, war emergencyorganization and the emergencyservices. Thesecannotbe consideredat present. Much of the work mentionedin this report covers ground usually traversed by these reports in normal times; but it is clear that in many directions work had to be intensified and extended; in other spheresentirely new undertakingshad to be establishedand put into working order. The Minister admits that mistakes have been made, and this in such a colossal task can easily be understood. His claim that much has been done will be freely admitted. For this many persons have been responsible--publicservants,voluntary organizationsand so on. But the Minister's final tribute must be mentioned, He writes that in operationswhich have affected in one way or another every district and almost every householder, successhas ultimately dependedon the cooperation and goodwill of the people generally. "Their kindliness, tolerance, and practical efficiency have been beyond praise." • <[.unent <[.omment.