Act of 1911 have no doubt been contributory measures to the im- provement in this matter, as well as the School Medical Service that was organized in 1907, and the Maternity and Child Welfare Act of 1918. The death-rate of women in childbirth, however, has re- mained about the same during the last 25 years, and there is a large amount of abortion, miscarriage, etc., and many children are dis- abled when born and become chronic invalids. The maternity mortality-rate from all causes remains between 4 and 5 per 1,600 births The steps necessary to be taken are to secure (l) the super- vision of pregnancy and the wise administration of maternity bene- fit ; (2) the supervision of midwifery, including the establishment of maternity homes; (3) health visiting and nursing and (4) the es- tablishment of infant welfare centres. In this work voluntary as- sistance is most desirable.
A very important fact is that by the Ministry of Health Act of 1919 the physical care of maternity, infancy and childhood is now under one state department and the work of the Education Au- thority is coordinated so far as possible with that of the Sanitary Authority which primarily deals with the child to its fifth year. The same centres and clinics are now used for both. There is a special department of the Ministry for supervising this work. A scheme of maternity and child welfare has been inaugurated in every county (excepting one county in Wales), and in every county borough and many of the large urban districts. On March 31 1920 not only were there 1,754 maternity and infancy welfare centres and 3.359 visitors as stated before, but also 221 day nurseries or creches, and 89 maternity homes with 1,360 beds.
The hospital provision for infants is not (1921) large, and there is often a high mortality found in hospitals owing to the spread of infectious conditions which are rather obscure. About 220 new beds have been provided for infants and young children in connexion with welfare schemes. In cases where young children must be separated from their mothers a good foster-mother sufficiently remunerated is recommended as being the most satisfactory guardian.
Scotland. The Maternity and Child Welfare Act of 1918 does not apply to Scotland, but in the Notification of Births (Extension) Act of 1915 it is provided that any local authority " may make such arrangements as they think fit, and as may be sanctioned by the Local Government Board for Scotland, for attending to the health of expectant mothers and nursing mothers and of children under five years of age within the mea ing of Sect. 7 of the Education (Scotland) Act 1908."
As in England, Exchequer grants-in-aid are given for certain services in connexion with child welfare, and the extent to which these services extend depends on the local authority concerned. There is, however, an important difference between England and Scotland. In England certain institutions such as schools for mothers and play centres receive grants direct from the Board of Education and are under its control. In Scotland all the institutions included in a child welfare scheme were controlled by the Local Government Board and are now controlled by the Ministry of Health. In Scot- land, also, the grants are only made to the local authorities and not, as in England, to the institution. These grants cannot exceed 50% of the local authority's approved outlay. The schemes that are carried on are similar in character to those in England. The infant mortality (deaths of children under one year old per 1,000 births registered) is considerably higher than in England and Wales and Ireland though it is gradually decreasing. In 1917 it was 107; in 1918, 100; in 1919, 102; and in 1920 it was 92.
Since the coming into operation of the Scottish Education Act of 1918 there has been a considerable accession of energy in the matter of attending to the health of school-children, and that Act gives powers to the Education Authority to carry on nursery schools. Education Authorities often take advantage of the services of dis- trict nurses in following up their cases in the rural areas, and this is sometimes also done by the county council in regard to its schemes for infant welfare. In such cases the nurses may work through a County Nursing Federation. The Highland districts naturally present special difficulties owing to the scattered nature of the pop- ulation and the difficulty of providing adequate attendance.
Ireland. A system of Imperial grant for child welfare obtains in Ireland similar to that in England. The infant mortality in Ire- land has always been low as compared with that in England and Wales and still more with that of Scotland, but it has not declined in the same regular manner that it has done in the other countries. The deaths of infants under one year per 1 ,000 births in the years 1891-1900 averaged 104. In 1918 they were 86, and in 1919, 88. It is notable that the infant mortality in the towns in Ireland is immensely higher than in the rural districts. In 1919 the infant mortality in Dublin area was 141 per 1,000 births, while in London it was 85. Notification of births was made compulsory in all urban districts by the Extension Act of 1915.
There are many voluntary societies, such as the Women s Na- tional Health Association and the United Irishwomen, working in connexion with infant welfare, and in establishing milk depots, etc., and since the Treasury grant became available a number of au- thorities have submitted schemes of a comprehensvie character.
See Annual Report of the Chief Medical Officer 1919-1920 (Minis- try of Health) ; First Annual Report of the Scottish Board of Health
1919 (Appendix to ditto pub. 1920); Twenty-fifth Final Annual Report of the Local Government Board for Scotland 1919 (pub. 1920) : Annual Report of the Local Government Board for Ireland 19181919; Janet E. Lane-Claypon, The Child Welfare Movement (1920); Nora Milnes, " Child Welfare "from the Social Point of View (1920) ; Edith V. Eckhard, " The Mother and the Infant (Social Science Library 1921): Carnegie United Kingdom Trust's Report on " The Physical Welfare of Mothers and Children " for (l) England and W 7 ales, E. W. Hope; (2) Scotland, W. Leslie Mackenzie; (3) Ireland, E. Coey Bigger (1917). Sir J. E. Gorst, The Children of the Nation and how their Health and Vigour should be Promoted by the State (1906); Margaret Macmillan, Early Childhood (1900), The Nursery School (1919). (E. S. H.)
UNITED STATES
In the field of child welfare considerable progress was made in the United States during the decade 1910-20. The first work of the Federal Children's Bureau (established 1912) was a num- ber of remarkable studies on infant mortality, particularly its social and economic aspects. As a result of emphasis by the American Medical Association, by the Children's Bureau and by other children's agencies of the necessity of basing any pro- gramme for reducing the infant mortality upon reliable statistics, all but three of the states had adopted in 1921 the uniform reg- istration plan recommended by the Census Bureau, and all but five states now have good registration laws.
Popular education in child care has been greatly developed in the last decade. Aided by the Children's Bureau, Baby Week Campaigns were inaugurated in a few large cities in 1914. In 1916 the General Federation of Women's Clubs and the Chil- dren's Bureau cooperated in a nation-wide " Baby Week " cam- paign, as a result of which Baby Week was observed in every state. In 1918 the Bureau and the Child Conservation Section of the Women's Committee of the Council of National Defense cooperated in a year's educational propaganda known as " Children's Year." As a result of the interest awakened through these campaigns as well as by the previous efforts of many child welfare organizations, child hygiene divisions were established by law in 30 states from 1918 to 1921, as compared with eight states between 1912 and 1918. There were also in 1921, special child hygiene divisions in the health departments of 45 mu- nicipalities. The Children's Bureau report on maternal mor- tality in 1917, followed in 1919 by one on maternity benefit systems in certain foreign countries, resulted in a general demand by women's organizations for public provision for the protection of maternity.
Prior to 1910 pre-natal care for mothers was confined to ma- ternity hospitals. During the decade 1910-20 there were dem- onstrations in Boston, New York, and a number of other cities of the reductions that can be effected in maternal mortality and in infant mortality due to maternal causes, through mater- nity centres, where pre-natal and post-natal instruction and care have been given. As a result of the wide-spread interest in the subject, bills have been introduced in a number of the state legislatures; and the Sheppard-Towner bill, providing for Federal aid toward public provision for maternity and child care, was passed by the U.S. Senate in 1921. Medical in- spection of school-children was in 1921 required by law in 39 states, and the first legislation had been passed making spe- cific provision for dental inspection. Without this specific legislation increased attention has been given to the care of school-children's teeth in recent years. Nutrition clinics for undernourished children have been widely established during the past five years in connexion with schools, dispensaries, and child welfare agencies. Since 1915 eight states, including .Illi- nois and New York, have passed laws providing for physical education in elementary schools.
REFERENCES. Infant Mortality Series, Nos. I to 8; Grace L. Meigs, Maternity Mortality (Miscellaneous Series, No. 6, 1917). (G. An.)
CHILE (see 6.142). The term of office of President Don Pedro Montt, inaugurated in Sept. 1906 to serve for a term of five years, was terminated by his death abroad on Aug. 16 1910. Sr. Don Elias Fernandez Albano, the Minister of the Interior, succeeded under the title of vice-president,
