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The Centre will be required to send to the Sugar Distribution Branch monthly a return which will be supplied by the Sugar Distribution Branch when sending the authority to obtain the sugar.

The sugar must be sold by the Centre to the mother at the ordinary price, except where the mother's circumstances justify the remission of a part of the cost.

It must be understood that the additional amount of sugar to be distributed under this scheme is strictly limited, and that the state of the sugar supply of the country may render it imperative to discontinue or to curtail the additional supply thus made available.

Ministry of Health,

Whitehall, S.W. 1.

November, 1919.

MEMORANDUM OF MINISTRY OF HEALTH.

Memo. 12/M.C.W.

MATERNITY AND CHILD WELFARE.

1. The vital importance of adequate provision for the welfare of mothers and infants has been widely recognised in recent years. It is obvious that their health lies at the foundation of sound national physique. It is recognised that the responsible Authorities, central and local, as well as Voluntary Associations and Societies all over the country, have taken such opportunities as occurred to exercise their powers to initiate or assist arrangements intended to promote the physical well-being of women and little children. These efforts, however, though extremely valuable and productive of much good result, have not hitherto been effectively co-ordinated owing in part to the diversity of administration under which it has been necessary for the work to develop.

2. Under the Ministry of Health Act, 1919, the powers hitherto exercised by the Local Government Board, the Board of Education, and the Home Office in regard to nursing and expectant mothers, and to young children under the age of five years, are now transferred to the Ministry of Health. Central unification of control has thus been secured, and it is hoped that increased local co-ordination will now take place.

3. Had it been practicable, the Ministry of Health would at once have proceeded to view in detail their future policy respecting Maternity and Child Welfare, and point out the way in which it was anticipated the work would develop. Unfortunately, it is not possible to do this immediately, as questions arise which involve complicated issues affecting other branches of the public medical services. It has been decided, however, for the convenience of those concerned, to issue statements on certain branches of the work where some guidance and definition of practice is immediately needed.

4. The Ministry of Health have already issued Memoranda relating to the Training of Health Visitors and on the Training of Midwives, simultaneously with the publication of Regulations of the Board of Education in this behalf. Memoranda dealing with the Organisation of Day Nurseries and Maternity and Infant Welfare Centres are now being issued, and it is hoped to follow these at an early date by a similar Memorandum on Maternity Homes and Hospitals.

November, 1919.

ROBERT L. MORANT,

Secretary.

MEMORANDUM OF MINISTRY OF HEALTH.

SUPPLY OF GOVERNMENT BUILDING MATERIALS TO PRIVATE PERSONS.

Arrangements have been made under which persons building houses for the working classes will be enabled to obtain. building materials through the Director of Building Materials Supply, who is already supplying materials required for State-aided schemes. The following conditions will apply:

A certificate must be obtained from the Clerk of the Local Authority or the Housing Commissioner of the Ministry of Health in whose district the houses are to be erected, to the effect that :

(a) The material is required for the purpose of erecting or improving houses for the working classes;

(b) The development, design, and construction are such as, having regard to the standards laid down by the Ministry of Health, the Local Authority or Commissioner approve;

(c) The houses proposed to be erected are needed, and the provision of the same in the manner proposed will, to that extent, relieve the programme of building by the Local Authority.

It will be a condition of the contract of sale that the purchaser enters into a written undertaking to use the materials forthwith for the sole purpose of erecting or improving houses for the working classes.

Applications for the purchase of building materials should be made to the Director of Building Materials Supply, Ministry of Munitions. Caxton House, Tothill Street, Westminster, S.W. 1, who will supply particulars and copies of the certificates and undertaking required.

It is anticipated that the above arrangements will enable builders to effect a saving of 5 per cent. on their materials.

Ministry of Health,

November 14th, 1919.

MEMORANDUM OF MINISTRY OF HEALTH. Memo. 13/M.C.W.

MEMORANDUM IN REGARD TO DAY NURSERIES.

1. Day Nurseries are intended primarily to provide for the care of healthy infants and young children whose mothers are obliged to engage in daily work which takes them away from their own homes or who are temporarily in distress; when circumstances permit, the nurseries should also be available for the needs of mothers who, for domestic or other reasons, are temporarily unable to provide satisfactory care for their little children in their own homes, or with suitable relatives or friends, or with good foster mothers. It is not intended to encourage the establishment or maintenance of Day Nurseries for children who do not come within any of the above categories.

2. Day Nurseries are most suitable for children under three years of age who mainly require special physical care and attention. Infants. under nine months should not as a rule be admitted, unless it is shown that their mothers for good and sufficient reason are obliged to work or are unable to continue breast-feeding. Even when some hand-feeding is necessary partial breast-feeding should always be encouraged. Children over three years of age should attend a Nursery School* instead of the Day Nursery whenever this is possible. If it is essential for them to remain at the Day Nursery, every endeavour should be made to provide for training in good habits and personal hygiene, and to accustom the children to help themselves and one another as much as practicable. When there are 15 or more children over three in regular attendance at a Day Nursery, a teacher having kindergarten or nursery school experience should be engaged. Careful inquiries should be made into the home conditions of children who are admitted, with a view to ascertaining the reasons for admission to the Nursery, and the nature of the care available for the child in its own home. No child should be refused admission solely on grounds of illegitimacy. The number of children in a Day Nursery should normally be 30 to 35, though in exceptional circumstances as many as 50 might be accommodated.

3. A Day Nursery may be established and maintained either by a local authority or by a voluntary body; many of those maintained by voluntary bodies receive financial assistance from the local authority; this tends to secure close co-operation between the local authority and the voluntary body, which is essential to the complete success of a general scheme for Maternity and Child Welfare. Whether the institution is maintained by the local authority or by a voluntary body, it is eminently desirable that it should have a Managing Committee containing voluntary workers and including working women. This assistance, both on the Committee and in the practical work of the

* See regulations under which grants are payable by the Board of Education to Nursery Schools in England and Wales (Cmd. 87).

institution, creates an atmosphere of human sympathy and friendship which is eminently desirable. The value of disinterested work of this kind is immeasurable. But voluntary helpers will only be of use if they are competent, attend regularly, and have definite duties allotted to them.

4. The Ministry are aware that it is impracticable to require uniform conditions at all Nurseries, but they consider that a minimum standard of efficiency must be secured, and the following points should be borne in mind in the organisation and conduct of a Nursery:

(a) Provision should be made for the medical supervision of all infants and young children on admission to the Nursery, and for their examination when necessary. The Medical Officer should be suitably remunerated, and should be appointed to visit the Nursery at frequent intervals. His or her services should also be available at other times in case of emergency. The frequency with which individual children should be examined by the Medical Officer will depend on the state of their health. The Medical Officer should be responsible for arrangements for the feeding and physical care of the children. Daily watch should also be kept over the physical condition of the children in order to deal promptly with any cases of illness or possible infectious disease. While much of this work will necessarily be undertaken by the Matron, it should all be subject to the control of the Medical Officer, and under the general supervision of the Medical Officer of Health.

(b) It is essential that the Matron should be adequately trained. For all new appointments a woman should be selected who has had definite training and experience in the care of healthy children, and either full training in a general or children's hospital, or such training and experience in infantile ailments as will enable her readily to detect the first symptoms of infectious disease. She should also have had satisfactory experience of work in a Day Nursery. Some knowledge of housekeeping is important. A house committee to supervise the domestic arrangements is advisable. Besides the Matron, at least one person will be required, even in a small Nursery, who is competent to assume responsibility in the temporary absence of the Matron. The number of probationers or other assistants required will depend on the number of children admitted. It will usually be found that not less than one nursery-trained assistant in addition to the Matron is needed for every 8-10 children under two years of age; a nursery-trained assistant and probationer for 15-20 children; a nursery-trained assistant and two probationers for 25 children. Domestic assistance will also be required.

(c) Adequate provision should be made for the suitable feeding of the infants and young children attending the Nursery. The

food provided should be appropriate to the varying needs of the children; this is of special importance where the child is suffering from malnutrition. Separate diet sheets should be kept for infants under 12 months and for older children. There should be a daily record of the dinner actually given. (d) If any child attending a Day Nursery is found to be insufficiently nourished, arrangements should be made to secure that it is supplied with sufficient pure milk and with such other foods as the Medical Officer prescribes for it, not only during the time of its attendance at the Nursery, but also while it is at home. Local authorities are empowered, with the sanction of the Ministry, to supply milk and other food to children under five either at cost price, or, where the parents cannot afford to pay the full cost, at such price as they can afford. Most authorities carrying out Maternity and Child Welfare Schemes have arranged for a supply of milk for children under five, and any child attending a Day Nursery who is found to be insufficiently nourished at home should be referred to the Health Visitor or to the Medical Officer of Health of the district, who should take such steps as may be necessary to rectify any errors or neglect. The actual distribution of the milk can often be conveniently arranged through the Nursery.

(e) Since a large amount of sleep is essential to the wellbeing and progress of children of this age, adequate opportunities should be afforded the children for sleeping under healthy conditions. They should be taken into the open air as much as possible. Attention should also be paid to the training of the children in the elementary rules of health and conduct. The importance of a high standard of cleanliness should not be overlooked. The organisation of the children's play will require consideration.

(f) Children of tender age are specially susceptible to measles and certain other forms of epidemic disease, and the greatest care must be exercised to prevent the admission to the Nursery of any child who is suspected of suffering from any infectious or contagious disease, and at times the temporary closure of the Nursery may be found essential. Every closure of a Nursery, whether for infectious disease or other cause, should be reported to the Ministry. Every child should be seen by a responsible person daily on arrival. The rules for controlling infectious disease should be approved by the Medical Officer of Health. Arrangements should be made to store separately and to disinfect the clothes of the children, and to provide them with special clothes to wear while at the Nursery. From time to time the disinfection of the whole premises will be desirable. of age

(g) As a general rule, all children under two years should be bathed daily and dressed in Nursery clothes.

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