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College Physics, 5e (Walker)

Chapter 4 Two-Dimensional Kinematics

4.1 Conceptual Questions

1) A boulder rolls off of a very high cliff and experiences no significant air resistance. While it is
falling, its trajectory is never truly vertical.
A) True
B) False
Answer: A
Var: 1

2) For general projectile motion with no air resistance, the horizontal component of a projectile's
velocity
A) remains zero.
B) remains a non-zero constant.
C) continuously increases.
D) continuously decreases.
E) first decreases and then increases.
Answer: B
Var: 1

3) For general projectile motion with no air resistance, the horizontal component of a projectile's
acceleration
A) is always zero.
B) remains a non-zero constant.
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C) continuously increases.
D) continuously decreases.
E) first decreases and then increases.
Answer: A
Var: 1

4) For general projectile motion with no air resistance, the vertical component of a projectile's
acceleration
A) is always zero.
B) remains a non-zero constant.
C) continuously increases.
D) continuously decreases.
E) first decreases and then increases.
Answer: B
Var: 1

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5) Which of the following statements are true about an object in two-dimensional projectile
motion with no air resistance? (There could be more than one correct choice.)
A) The speed of the object is constant but its velocity is not constant.
B) The acceleration of the object is +g when the object is rising and -g when it is falling.
C) The acceleration of the object is zero at its highest point.
D) The speed of the object is zero at its highest point.
E) The horizontal acceleration is always zero and the vertical acceleration is always a non-zero
constant downward.
Answer: E
Var: 1

6) A ball is thrown horizontally from the top of a tower at the same instant that a stone is
dropped vertically. Which object is traveling faster when it hits the level ground below if neither
of them experiences any air resistance?
A) It is impossible to tell because we do not know their masses.
B) the stone
C) the ball
D) Both are traveling at the same speed.
Answer: C
Var: 1

7) In an air-free chamber, a pebble is thrown horizontally, and at the same instant a second
pebble is dropped from the same height. Compare the times of fall of the two pebbles.
A) The thrown pebble hits first.
B) The dropped pebble hits first.
C) They hit at the same time.
D) We cannot tell without knowing which pebble is heavier.
Answer: C
Var: 1

8) A pilot drops a package from a plane flying horizontally at a constant speed. Neglecting air
resistance, when the package hits the ground the horizontal location of the plane will
A) be behind the package.
B) be directly over the package.
C) be in front of the package.
D) depend on the speed of the plane when the package was released.
Answer: B
Var: 1

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9) James and John dive from an overhang into the lake below. James simply drops straight down
from the edge. John takes a running start and jumps with an initial horizontal velocity of 25 m/s.
If there is no air resistance, when they reach the lake below
A) the splashdown speed of James is larger than that of John.
B) the splashdown speed of John is larger than that of James.
C) they will both have the same splashdown speed.
D) the splashdown speed of James must be 9.8 m/s larger than that of John.
E) the splashdown speed of John must be 25 m/s larger than that of James.
Answer: B
Var: 1

10) James and John dive from an overhang into the lake below. James simply drops straight
down from the edge. John takes a running start and jumps with an initial horizontal velocity of
25 m/s. Compare the time it takes each to reach the lake below if there is no air resistance.
A) James reaches the surface of the lake first.
B) John reaches the surface of the lake first.
C) James and John will reach the surface of the lake at the same time.
D) Cannot be determined without knowing the mass of both James and John.
E) Cannot be determined without knowing the weight of both James and John.
Answer: C
Var: 1

11) A player kicks a soccer ball in a high arc toward the opponent's goal. At the highest point in
its trajectory
A) both the velocity and the acceleration of the soccer ball are zero.
B) neither the ball's velocity nor its acceleration are zero.
C) the ball's acceleration is zero but its velocity is not zero.
D) the ball's acceleration points upward.
E) the ball's velocity points downward.
Answer: B
Var: 1

12) Mary and Debra stand on a snow-covered roof. They both throw snowballs with the same
initial speed, but in different directions. Mary throws her snowball downward, at 30° below the
horizontal; Debra throws her snowball upward, at 30° above the horizontal. Which of the
following statements are true about just as the snowballs reach the ground below? (There could
be more than one correct choice.)
A) Debra's snowball will have a higher speed than Mary's snowball.
B) Mary's snowball will have a higher speed than Debra's snowball.
C) Both snowballs will hit the ground with the same speed.
D) Both snowballs hit the ground at the same time.
E) Mary's snowball reaches the ground before Debra's snowball.
Answer: C, E
Var: 1

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13) Mary and Debra stand on a snow-covered roof. They both throw snowballs with the same
initial speed, but in different directions. Mary throws her snowball downward, at 30° below the
horizontal; Debra throws her snowball upward, at 30° above the horizontal. Which of the
following statements are true about just before the snowballs reach the ground below? (There
could be more than one correct choice.)
A) Debra's snowball will stay in the air longer than Mary's snowball.
B) Mary's snowball will stay in the air longer than Debra's snowball.
C) Both snowballs will take the same amount of time to hit the ground.
D) Debra's snowball has exactly the same acceleration as Mary's snowball.
E) Mary's snowball has a greater downward acceleration than Debra's snowball.
Answer: A, D
Var: 1

14) A rock is thrown from the upper edge of a tall cliff at some angle above the horizontal. It
reaches its highest point and starts falling down. Which of the following statements about the
rock's motion are true just before it hits the ground? (There could be more than one correct
choice.)
A) Its horizontal velocity component is zero.
B) Its velocity is vertical.
C) Its vertical velocity component is the same as it was just as it was launched.
D) Its horizontal velocity component is the same as it was just as it was launched.
E) Its speed is the same as it was just as it was launched.
Answer: D
Var: 1

4.2 Problems

1) A ball is thrown with an initial velocity of 20 m/s at an angle of 60° above the horizontal. If
we can neglect air resistance, what is the horizontal component of its instantaneous velocity at
the exact top of its trajectory?
A) 10 m/s
B) 17 m/s
C) 20 m/s
D) zero
Answer: A
Var: 2

2) A ball is thrown at an original speed of 8.0 m/s at an angle of 35° above the horizontal. If
there is no air resistance, what is the speed of the ball when it returns to the same horizontal
level?
A) 4.0 m/s
B) 8.0 m/s
C) 16 m/s
D) 9.8 m/s
Answer: B
Var: 1

5
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Another document from Scribd.com that is
random and unrelated content:
the undisciplined patient, just as the soldier who has had routine drill
under a competent instructor is more efficient than the untrained recruit.
The preceding remarks as to the treatment of tuberculosis in sanatoria
illustrate certain well-known features in the natural history of this
disease. In the majority of instances of disease recognised under present
conditions we are dealing with a slowly progressing disease. This
sometimes become spontaneously arrested; occasionally it may be
arrested or its course delayed under medical treatment at home
associated with manageable changes in domestic and industrial life. In
still further instances it may be arrested by treatment in a sanatorium;
while for other cases sanatorium treatment, however prolonged, is
followed by only temporary improvement, and the chief benefit thus
received is that of training as to mode of life, which might have been
secured by a much less protracted stay in the institution, followed by
measures supplementing sanatorium treatment. We have further to
recognise the fact that, under present conditions of social life and
medical practice, many tuberculous patients will slowly, by intermittent
stages, but none the less surely, die from tuberculosis in the course of
one, three or five years. Regard must be paid to this fact if our total
measures for the control of tuberculosis are to be successful.

Hospital Treatment

This fact emphasizes the importance of adequate hospital treatment for

all patients acutely ill or bed-ridden, who cannot be hygienically treated
at home; and the importance becomes evident of exercising complete
supervision over and provision for the whole of the sick life of the
consumptive, whether he is trending towards complete recovery or to
death.
Such complete supervision and provision necessitates further
development in three directions in which beginnings have already been
made:

Industrial Colonies

These are the provision of “Farm or Industrial Colonies,” the

adaptation of domestic dwellings to meet the special needs of
consumptives, and the more complete organization of “Care” and “After-
care” arrangements.
 In a large proportion of cases, the patient on leaving the sanatorium is
unable at once to embark on full work without risk of early relapse, or to
refrain from this without endangering his nutrition and that of his family.
His work, furthermore, may be unsuitable for a consumptive.
This has led to many tentative efforts to train the consumptive in a
suitable occupation while under sanatorium treatment, or in an industrial
colony which should preferably be attached to or in close communication
with a sanatorium, in order that the patient may continue under skilled
medical supervision. The graduated labour which forms part of the
routine method of treatment in many sanatoria can be made a preparatory
stage in this industrial training. The training may be made to merge into
the pursuit of an actual livelihood; and then the sanatorium becomes an
industrial colony. Market gardening, pig-keeping, forestry, and other
occupations may be thus pursued for protracted periods, if the patients
are suitably selected. The ex-patients continue to live under protected
conditions, earning part at least of their livelihood. Attempts in this
direction are not likely to have wide success unless the patient is re-
instated in his family; and the most promising efforts are those which
install the ex-consumptive with his family in a cottage near a sanatorium,
where he can remain under partial medical supervision, while engaged in
his daily work. It remains to be seen to what extent such arrangements
are practicable on a considerable scale, and the experiments now being
made will be watched with interest.

Special Dwellings and Help in Support

An alternative to the “colony” proposal, which will probably be found

practicable in a much larger number of cases is to arrange for the ex-
patient to be housed at his home under special conditions and for his
work to be graduated according to his physical condition, assistance
being given by way of payment of rent, or otherwise to ensure that the
patient and his family live under satisfactory conditions. Proposals have
been made by Dr. Chapman in a report to the English Local Government
Board that in connection with new housing schemes a certain proportion
of the houses erected should have rooms providing free perflation of air
reserved for consumptive patients. If with this is combined the assistance
indicated above, the risk of the ex-patient relapsing will be materially
reduced, and the risk of other members of the family becoming
consumptive may be obviated.
 Whatever methods are employed, the principle already enunciated
must be maintained that the patient in his own interest and in that of his
family must be the subject of uninterrupted care and supervision.
In securing this end Care Committees play a valuable part. Owing to
the war their development has been retarded; but a local scheme for such
supervision and assistance as the members or agents of a Care
Committee can give forms an essential part of a complete tuberculosis
scheme.
These Committees are formed of non-official persons, inasmuch as a
large share of their work is at present beyond the scope of official
possibilities, outside the poor-law organization; they can help,

(a) in obtaining appropriate work for the ex-patients;

(b) in supplementing his wages;
(c) in providing separate sleeping accommodation for
the patient, additional food or clothing, or in
loaning out an additional bed or bedding;
(d) in aiding the family during the absence of the
patient in a sanatorium, and thus reducing the
temptation to terminate institutional treatment
prematurely, and
(e) in encouraging each patient to take the necessary
precautions and to adopt the special treatment
recommended for him.

Some of these activities overlap into the activities of the tuberculosis

officer and of the visiting nurse of the local authority; but there need be
no practical difficulty in adjusting this. It is important that Care
Committees should act in coöperation with local authorities, insurance
committees, and charitable agencies, and should have representatives of
these bodies on them. The medical officer of health and tuberculosis
should also be ex-officio members of their committee.
Summary.—The preceding review of the problem of tuberculosis may
be summarised in a few final statements.
1. Our knowledge of tuberculosis, if fully applied by combined attack
on the disease by all known methods, is adequate to secure a great
reduction in its prevalence, if not its absolute abolition.
 This is true, although certain problems respecting tuberculosis still
need elucidation, e.g., as to improved methods of treating the diseases,
and of increasing individual immunity during exposure to protracted
infection.
2. Domestic protection is at once practicable against infected cows’
milk; and control of this source of infection at its source is also
practicable.
3. Of the circumstances favouring the development of pulmonary
tuberculosis industrial dust and domestic overcrowding are the most
potent. More detailed and systematic supervision of factories and
workshops is needed, followed by general adoption of remedies, which
would increase industrial efficiency as well as reduce tuberculosis.
4. Tuberculosis is especially a “bedroom infection.” But improvement
in housing is a dual problem, and it is a blunder to assume that improved
housing, so long as the healthy and tuberculous sick continue to be
housed together, will produce a rapid decline in the prevalence of
tuberculosis. Hospital provision for the sick is as necessary as improved
general housing.

FOOTNOTES:
[17] The substance of two lectures at the Summer School on Tuberculosis,
Trudeau Sanatorium, Saranac, N. Y., July, 1919.
 CHAPTER X

[18]
C W W E

The subject of child welfare, in its chief developments, cannot be

separated from that of Public Health, of which it forms a constituent part,
though I do not ignore the fact that child welfare is largely dependent
also on the extent to which child labor is exploited, and to which
expectant and nursing mothers,—as also other mothers whose extra-
domestic employment or whose employment for gain is within the home
itself,—involves neglect of young children.
Improvement in child welfare has occurred as the sanitary and social
progress of the country has advanced. Whereas in the decade 1871-80,
when money began to be spent more freely on elementary sanitary
reform, the expectation of life or mean after-lifetime at birth of males
was 41.4 years and of females was 44.6 years; in the years 1910-12 these
had increased to 51.5 and 55.4 years respectively. The greater part of the
saving of life which this addition of ten years to the average duration of
life was the result of reduced mortality in children under five years of
age.
The first direct steps towards the reduction of infant mortality were
directed against epidemic or summer diarrhœa. Medical officers of
health have always been required in their annual reports to summarize
the vital statistics in their districts; and since 1905 a more detailed
statement of infant mortality during each part of infancy has been
required. Annually, therefore, as well as when they received the weekly
returns of deaths from the local registrars, there was forced upon their
attention the fact that deaths of infants under one year of age formed a
high proportion of total deaths at all ages (12.9 per cent. in 1917), and
that of these infantile deaths a large proportion were caused by diarrhœa,
the number varying with the temperature and the deficiency of rainfall in
the summer months. In 1912, a year of relatively small mortality from
diarrhœa, this disease caused 8.1 per cent. of all deaths under one year of
age.
 For many years past it has been customary for medical officers of
health to issue warnings as to summer diarrhœa, to arrange for the
distribution of leaflets of advice concerning the disease, and to urge the
necessity of more thorough cleanliness both municipal and domestic
during the summer months. Even before the early notification of births
became obligatory, in many areas the addresses of infants were obtained
from the registrars of births and special visits were made to the mothers
of infants during the months of June and July and especially to the
mothers of those infants who were known to be artificially fed.
The reports of medical officers of health of many of the large towns
from 1890 onwards show that much valuable work was being
accomplished, and the way was being prepared for more general
measures against infant mortality.
The importance of municipal sanitation in aiding the elimination of
diarrhœal mortality is illustrated in the experience of many towns, and
strikingly by the comparative experience of Leicester and Nottingham.
The chief difference between the sanitary condition of the two towns was
that in Nottingham in 1909 pail closets still served more than half the
houses, while Leicester had abandoned this system entirely, substituting
water-closets. Between 1889-93 and 1909 the diarrhœal mortality in
Leicester had declined 52 per cent.; in Nottingham it had only declined 4
per cent.
Diarrhœa is not the only disease of infancy which can be greatly
diminished by improved public health administration. Tuberculosis and
whooping cough and measles figure largely in the infantile death returns.
Over 21 per cent. of the total deaths in infancy are due to these three
diseases and to diarrhœa. The amount of syphilis appearing in the death-
returns is small; but its actual amount is much greater than the figures
show. If pneumonia and bronchitis, which account for 19 per cent. of the
deaths in infancy, be regarded—as they should—as infective diseases,
then it may be said that the problem of saving child life and securing the
correlative improvement in the standard of health of children who
survive to higher ages, consists very largely in the prevention of
infections, including diarrhœal diseases and acute respiratory diseases.
It follows from this that even if the limited and erroneous view be
taken that Sanitary Authorities are concerned only with the prevention of
infectious diseases, the reduction of infant mortality is a duty devolving
on these authorities, and cannot be effectively carried out without their
coöperation. Voluntary effort must therefore always, in large measure, be
directed towards stimulating local authorities to perform their duties.
The influence of diarrhœal summer mortality on the progress of child
welfare work is further shown by the fact that among the earliest efforts
were those to provide pure cows’ milk to infants. In England official
Milk Depots for this purpose were never numerous; and little voluntary
effort went in this direction. There now remain very few such Milk
Depots; but many local authorities provide milk, more particularly dried
milk, to infants for whom it is specially prescribed at Infant
Consultations. Early investigations at Brighton and elsewhere showed
that the mortality of infants fed on condensed milk,—chiefly of the
sweetened variety,—was greater than that of infants fed on fresh cows’
milk, and directed attention to the supreme importance of domestic
cleanliness in the prevention of summer diarrhœa. The Milk Depots and
the concurrent agitation for purer cows’ milk served a useful purpose;
though it cannot yet be said that the cows’ milk ordinarily supplied in
England is satisfactorily clean.
It became evident ere long that the broadcast distribution of
instructions as to how cows’ milk might safely be stored and prepared
for infants had but a limited utility, and that the directions given were
liable to be misinterpreted by mothers as an encouragement to abandon
breast-feeding; and there is reason to believe that these directions did
sometimes have this effect. Hence the importance of the work initiated
by the late Dr. Sykes at the St. Pancras School for Mothers, which
brought into relief the importance of encouraging breast-feeding by
every possible means. In towns in which the aided supply of milk was
continued, advice as to its use was also initiated; and thus gradually
Infant Consultations, in which the main element was the giving of
individual advice and treatment as required, superseded Milk Depots,
and were established in very large numbers where Milk Depots had
never been started. These had educational as well as medical and
hygienic activities; and there need be no dispute as to the relative value
of these two aspects of the work of Infant Consultations (also known as
Schools for Mothers, Child Welfare Centres, Baby Weighings, Mothers’
Welcomes, etc.); for whether advice and instruction are given to the
individual mother or to mothers collectively,—or as is advisable in both
ways,—it should be exactly the advice which a physician skilled in the
hygiene of infancy as well as in the treatment of infantile complaints
would give to his individual patient. In this sense it remains true, as
Professor Budin, the distinguished founder of Infant Consultations said:
“An infant consultation is worth precisely as much as the presiding
physician.” This is true whether it is possible to arrange for a physician
to be present at each meeting of a Child Welfare Centre; or whether, as
has happened during the Great War in England, nurses or health visitors
trained under such a physician have given hygienic advice in his
absence.

The Notification of Births

For many years before the Notification of Births Act was passed, it
had been customary, especially in towns, to arrange for inquiry by a
sanitary inspector or female visitor into death occurring under one year
of age, and in many instances for the giving of systematic advice to
mothers concerning their infants. More than twenty years ago the
Manchester and Salform Sanitary Association had initiated a system of
home visitation by volunteer ladies and by women workers paid by the
Association who went from house to house, gave elementary sanitary
advice, and reported serious defects to the Sanitary Authority. The City
Council at an early stage showed its appreciation of the importance of
this work by giving grants towards the expenditure incurred.
In order to enable early visits to be made, the town council of Salford
had begun as early as 1899 a system of voluntary notification of births
by midwives.
Prior to the stage at which early notifications of births was obtained,
the medical officer of health was dependent for his information on the
registration of births, for which an interval of six weeks after birth was
permitted before it became compulsory. During this interval a large
proportion of the total mortality of infancy had occurred,—
approximately one-fifth of the total deaths in the first year after birth
occur in the first week and one-third in the first month after birth,—and
the possibility of successfully influencing the mother to continue breast-
feeding had gone. The action of the town of Huddersfield in 1906 in
obtaining Parliamentary power to secure the compulsory notification of
births within thirty-six hours of birth represented a rapid growth of
opinion based on experience in that and other towns to the effect that in
the absence of early information of birth the necessary sanitary
precautions and counsel as to personal hygiene could not be given with
the greatest prospect of success. This local pioneer work doubtless
facilitated the passing of the Notification of Births Act in 1907.
Much important work followed the notification of births. Home visits
to the mother were regarded and continue to be regarded as the most
important part of this work; but there also grew up rapidly the present
system of Infant Consultations and similar organizations.
The Notification of Births (Extension) Act, 1915, not only made the
enforcement of this act universal, but it also empowered each local
authority administering the Act to exercise any powers which a sanitary
authority possesses under the Public Health Acts “for the purpose of the
care of expectant mothers, nursing mothers, and young children.” In
drawing the attention of Local Authorities to the terms of the Act the
Local Government Board, as well as earlier in the war, deprecated false
economy during the war. They said:
At a time like the present the urgent need for taking all possible steps to secure
the health of mothers and children and to diminish ante-natal and post-natal infant
mortality is obvious, and the Board are confident that they can rely upon local
authorities making the fullest use of the powers conferred on them.

The Board in the same circular laid stress on “the importance of

linking up this work with the other medical and sanitary services
provided by local authorities under the Public Health and other Acts.”
The passing of this Act has been followed by an increasingly rapid
development of Maternity and Child Welfare work, and the Maternity
and Child Welfare Act passed in August, 1918, made it obligatory on
each Council exercising powers under the Act to appoint a Maternity and
Child Welfare Committee, which must include at least two women, and
may include persons specially qualified by training or experience in
subjects relating to health and maternity who are not members of the
Council.
In the circular letter sent out to local authorities explaining the new
Act, the Local Government Board reëmphasizes its previously stated
views that child welfare work was second only in importance to direct
war work, and was really a “measure of war emergence,” and added:
although we have enjoined as local authorities the necessity of the strictest of
economy in public expenditure, we have urged increased activity in work which
has for its object the preservation of infant life and health. We are glad to note that
the great majority of local authorities have realized the value of continuing and
extending their efforts for child welfare at the present time.
 The Causes of Child Mortality

For detailed consideration of the causes of infant mortality and of

mortality during the next four years of life in England and Wales, the
reader may be referred to official reports by the writer.
No consistent and continuous decline had taken place in infant
mortality prior to 1900, although there had been marked reduction of the
mortality in each of the next four years of life. This difference
corresponds in the main with the facts that greater success had been
achieved in the general measures of sanitation and in the reduction of
prevalence of and mortality from such infectious diseases as scarlet
fever, diphtheria, and enteric fever, than in respect of the special causes
of mortality in infancy. These special causes may be placed under three
headings: First, infections,—acute respiratory diseases, measles,
whooping cough, syphilis, tuberculosis, and diarrhœa; second, errors of
nutrition, due largely to poverty, to mismanagement, and to imperfect
provision of facilities for healthy family life; and third, developmental
conditions present at the birth of the infants. Under none of these
headings had marked success been achieved prior to 1900, though the
steady work devoted to the subject of diarrhœa had already begun to
show fruit.
The statistics of infant mortality may be stated as follows:
England and Wales
Deaths of Infants under
Period 1 Year per 1,000 Births
1896-1900 156
1901-1905 138
1906-1910 117
1911 130
1912 95
1913 108
1914 105
1915 110
1916 91
1917 96
1918 97

The above are the crude rates, the infantile death-rate being stated by
the usual method per 1,000 births during the same year. Owing to the
great decline of births during the war, this method overstates the infant
mortality in recent years. In a table given in the Registrar-General’s
annual report for 1917, this unusual source of error is corrected. When
this is done, and the infantile deaths are stated “per 1,000 of population
aged 0-1,” the rates for the years 1912-17 inclusive in successive years
became respectively
104, 117, 113, 111, 98, and 94.
In other words, there has been a steady and uninterrupted decline in
the death-rate of infants during the war.
This decline has followed similar declines in preceding years, and it is
to be noted that much of this decline occurred during the period when the
hygienic work effecting child-welfare was confined to general public
health measures. Thus it anticipated the more direct and active measures
adopted by voluntary societies and by local authorities for the prevention
of infant mortality. Comparing the five year periods 1896-1900 and
1901-05, a decrease in the death-rate of 12 per cent. is seen; comparing
1901-05 with 1906-10, a decline of 15 per cent. occurred; comparing
1906-10 with the average experience of the three years 1911-13
mortality declined 5 per cent.; comparing these three years with the
average experience of the five years 1914-18, during which war
conditions prevailed more or less, a reduction 9 per cent. was
experienced. The actual reduction during war time is greater than is
indicated by these percentages, when allowance is made for the
statistical error indicated above. The exceptional experience of the year
1911 illustrates one of the chief sources of error in forming conclusions
on the experience of a single year. In this year the summer was
excessively hot, and summer diarrhœa prevailed to an exceptional extent;
and the illustration is important, as serving to remind us of the
limitations of the value of statistical tests and of the fact that increase of
good work tending to improve child life may be associated temporarily
with increase of total infant mortality.

The Influence of School Medical Inspection

In the development of child welfare work in England important place

must be given to the system of medical inspection of school children
initiated in 1907. The numerous physical defects found in school
children have led to the beginning of measures for remedial action,
confined in some areas to measures for securing greater cleanliness and
the treatment of minor skin diseases; but extending in other areas to such
measures as the remedial treatment of adenoids, the cure of ringworm,
the correction of errors of refraction, and the provision of dental
treatment. Perhaps the chief value of the system of medical inspection of
school children has been the fact that it has demonstrated the extent to
which children when they first come to school are already suffering from
physical disease which might have been prevented or minimized by
attention in the pre-school period. The information thus accumulated has
had much influence in encouraging the institution of Infant
Consultations, with a view to the early discovery of disease or of
tendency to disease.

The Influence of Statistical Studies

The intensive study of our national and of local vital statistics has also
had a most important bearing on the further development of maternity
and child welfare work. In successive official reports it has been shown
that infant mortality varies greatly in different parts of the country,
irrespective of climatic conditions; that it varies greatly in different parts
of the same town, in accordance with variations in respect of industrial
and housing conditions, of local sanitation, of poverty and alcoholism;
that the variations extend to different portions of infant life, the death-
rate in infants under a week, or under a month in age, for instance, being
two or three times as high in some areas as in others; and that the
distribution of special diseases in infancy similarly varies greatly.
Intensive studies of infant mortality on these and other lines have pointed
plainly the directions in which preventive work is especially called for;
and have incidentally demonstrated the fundamental value of accurate
statistics of births and of deaths in the child welfare campaign. Surveys
of local conditions both statistical and based on actual local observations
form an indispensable preliminary to and concomitant of good child
welfare work; and it is to combined work on these lines that the
improvement of recent years is largely attributable. To act helpfully we
must know thoroughly the summation of conditions which form the evil
to be attacked.
One important result of investigations such as those already mentioned
has been to bring more clearly into relief the fact, which previously had
been partially neglected, that child welfare work can only succeed in so
far as the welfare of the mother is also maintained.
This may imply extensions of work involving serious economic
considerations; but apart from such possibilities and apart from questions
of housing, and of provision of additional domestic facilities for assisting
the overworked mother, there is ample evidence that medical and
hygienic measures by themselves can do much to relieve the excessive
strain on the mother which childbearing under present conditions often
involves.

The Course of Mortality from Childbearing

The general course of mortality from childbearing (including deaths

ascribable to pregnancy) in England and Wales is shown by the
following table:
Average Annual Death-rates per 100,000 births from
Puerperal Other Diseases
Septic of Pregnancy
Diseases and Childbirth
5 years, 1902-06 185 228
5 years, 1907-11 152 215
3 years, 1912-14 148 233
2 years, 1915-16 151 239

It will be noted that although there has been a marked decline of

deaths from puerperal sepsis, the death-rate from other complications of
childbearing has not declined. The decline in puerperal sepsis is general
throughout the country, and evidences the greater care in midwifery both
on the part of doctors and of midwives. The administration of the
Midwives Act, 1902, has doubtless done much to secure this. The death-
rate from conditions other than puerperal fever continues to differ greatly
throughout the country. It is highest in Welsh counties, Westmoreland,
Lancashire and Cheshire coming next in order of unfavourable portion;
in many industrial, including textile, towns it is also excessive. The
general conclusion reached by the writer in an elaborate official report on
the subject is that “the quality and availability of skilled assistance
before, during, and after childbirth are probably the most important
factors in determining the remarkable and serious differences in respect
of mortality from childbearing shown in the report.”—“The differences
are caused in the main by differences in availability of skilled assistance
when needed in pregnancy, and at and after childbirth.”

The Midwives Act, 1902

 This Act forbade any woman after April 1, 1906, who was not
certified under the Act, from using the title of midwife or any similar
description of herself. It forbade after April 1, 1910, any such woman
from “habitually and for gain attending women in childbirth, except
under the direction of a qualified medical practitioner”; and it forbade
any certified midwife to use an uncertified person as her substitute. The
Act defined the limits of function of the midwife by stating that the Act
did not confer upon her any title to give certificates of death or of still-
birth, or to take charge of any abnormality or disease in connection with
parturition.
The Act set up the Central Midwives Board, giving it special
disciplinary powers over midwives. It also imposed on county councils
and the councils of county boroughs the duty of supervising the work of
midwives. For further details the Act itself and the Rules of the Central
Midwives Board made under the Act should be consulted.
The Midwives Act, 1918, gave further powers to the Central
Midwives Board and to local supervising authorities, and made it the
duty of the latter to pay the fee of a doctor called in by a midwife in any
of the emergencies for which Rules are made by the Central Midwives
Board, the fee paid to be in accordance with a scale prescribed by the
Ministry of Health.
As at least three-fourths of the total births in England and Wales are
attended by midwives with or without the assistance of doctors, their
work has great importance in relation to the reduction of maternal
disablement and mortality and to the prevention of early infant mortality,
and it is of happy augury that they are being enlisted more and more in
official work for safeguarding the health of the mother and her unborn or
recently delivered infant. An important recent addition has been made to
the rules of the Central Midwives Board, which makes it obligatory on
the midwife to notify to the medical officer of health any instance, while
the patient is under her charge, in which for any reason breast-feeding
has been discontinued.
Administrative Work.—Largely through the machinery provided by the
Midwives Act and the Notification of Births Act a system of supervision
of maternity and child welfare has been organized in every county and
county borough, and this has been responsible for a large share of the
improvement experienced in recent years. The character and extent of
development of the work varies greatly in different centres; and as a rule
the work is more fully developed in county boroughs than in counties. In
county districts it has sometimes been found necessary to unite the
offices of assistant inspector of midwives, infant visitor and tuberculosis
visitor in one adequately trained health visitor, thus saving time in
travelling by enabling the visitor to have a smaller district allotted to her
than if she undertook only one branch of work. In some counties the
school nurse’s work is also undertaken by the health visitor. In some
country areas arrangements have been made for infant visiting to be
carried out by district nurses who are also midwives.
Voluntary Workers.—Much of the success so far achieved in
improving the health conditions of infancy and childhood has been
secured by coöperation between voluntary and official health visitors.
Excellent work has been done by local and other societies, particularly
during the last ten years, in educating public opinion and in direct
assistance to mothers and their infants. It is essential that such voluntary
work should have a nucleus of highly trained and well-paid workers; but
given this condition, a large amount of good work can be accomplished
by voluntary aid.
The main work has been that of the health visitor. The details of this
work, the conditions of qualification of workers, the number of visits
which it is desirable to make, the character of the advice intended to be
given at these visits are set out in an official memorandum of the
Medical Officer of the Local Government Board and it is unnecessary to
repeat this information in these pages.
A similar remark applies to the next most important development of
work, the institution of Maternity and Child Welfare Centres. The
conditions of work of these institutions are set out in the same document.

Training and Provision of Midwives

The provision of additional trained midwives is a pressing problem.

The increased cost of living, longer training required, and the rapid
development of less laborious and more lucrative occupations, have
made it difficult to secure women to train as midwives, or to continue to
practise in this capacity after qualification. In many industrial areas the
older bonâ fide midwife is preferred, although it is the almost universal
experience that the trained midwife more quickly detects conditions
endangering the life of the mother or infant, and sends for medical help.
In order to encourage further the supply of practising midwives, the
government gives grants for increased remuneration to midwives newly
appointed by local authorities, sufficient to recoup them in the course of
a few years’ service for the cost of their training.
At a recent date, of some 30,543 trained midwives on the Roll, only
6,754 were returned as being in actual practice as such.
In order to make midwives available for all women needing them, the
Board repays to local authorities and voluntary associations half the cost
of the provision of a midwife for necessitous women. During the Great
War a woman might receive assistance in her confinement from several
central sources; for in addition to the above

(1) If she was the wife of an insured person, or if she

herself is insured, she received under the conditions
of the National (Health) Insurance Act
30s. in cash, or if she is insured and the wife of
an insured person 60s. in cash.
(2) If she was the wife of a soldier or sailor and not
entitled to maternity benefit she received from
10s. per week up to £2 from the Local Pensions
Committee.
(3) If she was a munition worker she might be aided
under a scheme provided under the Ministry
of Munitions.
(4) She also might obtain priority for the supply of
milk, or obtain free milk or milk at cost price
under the Local Committee Board Food Control
Order, No. 1, 1918, empowering local authorities
to supply milk and food and an extra
ration under the Food Controller’s Order. In
addition, after confinement she had available
the ration apportioned to the infant and its
allowance of milk under the priority scheme.

There was evidently need for simplification and unification of effort in

the above cases.
In many instances maternity nursing is required. The midwife may
have too many patients to be able to give this during the ten days in
which she is in charge of the patient; and even when she carries out her
duty in this respect in accordance with the Rules of the Central Midwives
Board additional help is required in the feeding and care of the mother
and infant, and in the care of the household. Often also nursing is
required for both mother and infant for a considerable period beyond the
ten days. For these persons the government gives grants for maternity
nursing and for “home helps.”
Even when all the above requirements are or can be fulfilled, there
remain a large number of cases of pregnant women, and especially of
unmarried women, who cannot be satisfactorily confined at home, either
because of their social or sanitary circumstances, or because abnormal or
complicated childbirth is expected. For such cases hospital provision is
needed. This is one of the most urgent requirements of the present time.
Under present conditions, institutional lying-in provision is chiefly
voluntary in character; and the government has advised local authorities
to contract for its use, rather than wait for the erection of special
hospitals. In other instances houses are being taken and adapted as
maternity homes.

Ante-natal Work

The progress made in the organisation of ante-natal work is slow for

reasons which are fairly obvious. There has been difficulty under war
conditions in securing assistance from doctors and midwives. There is
the well-known difficulty as to notification of pregnancy, which the
government has not encouraged, except when the definite consent of the
mother has been previously obtained. The facilities for help provided at
the Centre have in some areas attracted patients; and health visitors and
midwives have done much in other areas to persuade mothers of the
advisability of safeguarding themselves against possible complications,
as well as of securing adequate preparation for the lying-in period.
This subject is closely associated with that of abortions, still-births,
and deaths in the first two weeks after birth. One of the most promising
methods for securing the sound development of ante-natal work consists
in the investigation of still-births and early infant mortality. When these
inquiries are made mothers can be induced to obtain medical advice not
only at the time, but also in the event of a subsequent pregnancy. The
investigation at the patient’s home of all such cases and assistance in
prevention of recurrence of unnecessary ante-natal, natal, and early post-
natal deaths have as great an importance as the building up of a
successful ante-natal clinic. The anti-syphilis work now being carried on
will help greatly in this direction.

Dental Assistance

There has been a large extension of dental assistance at Centres for

expectant and for nursing mothers, and for children, especially in the
metropolis and its vicinity. The government has lately extended its grant
to cover dentures for mothers who are nursing or pregnant, if the medical
officer of the Centre is satisfied that the woman’s health will be
materially improved by the denture, and that she is unable to provide it
for herself.

Creches

Creches and day nurseries may be expected to exercise influence in

educating mothers in the care of their children. For this purpose it is very
desirable to have the creche attached to or near an infant welfare centre.
These creches, unless managed with the most rigid medical and
general cleanliness, are very apt to spread infectious diseases; not merely
such diseases as whooping cough, measles, and chickenpox, but also
catarrhal and diarrhœal diseases. In the prevention of all of these the
enforcement of the strictest cleanliness is essential, especially during the
summer months for the last named diseases. For the prevention of
catarrhal infections, it is essential that the creche should be conducted, so
far as practicable, on strict open-air lines. Open-air creches give
admirable occasional relief to mothers, even when these do not go out to
work. The “toddler’s playground” is a blessing to all concerned, but the
indoor creche may be, and often is, mischievous. The risks are greatly
reduced by insisting on open-air conditions and by not allowing large
groups of children to come together. Smaller groups mean greatly
decreased possibility of cross-infection.

Observation Beds at Child Welfare Centres

At infant welfare centres infants are not infrequently seen who fail to
make progress while living at home, and who yet are not ill enough to be
sent to a hospital. This especially applies to cases of defective nutrition.
For these cases beds in connection with centres have been found to be
necessary for observation purposes and to initiate further treatment. In
some instances, especially for failure of breast-feeding, it is advisable to
admit the mother with the infant.
On July 30, 1914, the Local Government Board sent a circular letter
and a covering memorandum by their Medical Officer which may be
claimed to have been the starting point of maternity and child welfare
work on a larger scale, more generally distributed throughout the
country, and more completely covering the whole sphere of medical and
hygienic work for this purpose than had previously been envisaged.
Although the country at that time might be said to be already under the
shadow of war, these documents had been previously prepared, and their
appearance four days before the declaration of war was a coincidence.
The chief burden of the additional work to which local authorities were
urged was that there should be continuity in dealing with the whole
period from before birth until the time when the child is entered upon a
school register; and the memorandum contemplated that “medical advice
and, where necessary, treatment should be continuously and
systematically available for expectant mothers and for children till they
are entered on a school register, and that arrangements should be made
for home visitation throughout this period.” It was added that “the work
of home visitation is one to which the Board attach very great
importance and in promoting schemes laid down in the accompanying
memorandum the first step should be the appointment of an adequate
staff of health visitors.”
The main provisions of this memorandum are printed on page 135.
The increase of work since that date may be gathered from the
following table, which shows the increase each year in the number of
health visitors, of child welfare centres, and of grants given on the 50 per
cent. basis by the Local Government Board and the Board of Education.
Amounts of Grants (pounds sterling) in Each Financial Year to Local Authorities and
Voluntary Agencies, on the Basis of 50 Per Cent. of Total Approved Local Expenditure
Financial Year Local Government Board Board of Education
1914-15 11,488 10,830
1915-16 41,466 15,334
1916-17 67,961 19,023
1917-18 122,285 24,110
1918-19 (estimated) 209,000 44,000

These grants do not cover the entire scope of child welfare work
carried out throughout the country, and their amount must not be taken as
a complete indication of the extent of this work.
 The increase during the war period has been very great; and this can
be attributed to the desire to do everything practicable for mothers and
children, especially those belonging to soldiers and sailors who were
risking their lives for the country; and to the increased realisation of the
importance of preserving and improving our chief national asset which
consists in a healthy population. During this period there was a great
increase in the industrial employment of women, including married
women, in factories including munition and other works. This increase it
is believed amounted to a million and a half workers.
Notwithstanding the many adverse influences, to which must be added
great overcrowding in many industrial areas, especially those in which
new industries were hurriedly started, and the increasing cost of food and
especially of milk with a scarcity of supply, it has been seen that infant
mortality remained low and on the whole declined during the whole
period of the war.
To what circumstances can this be ascribed?
It is unnecessary to assume that this result was entirely due to the
active measures favorable to maternity and child welfare which were
taken as an unexampled scale, though these measures can claim an
important share in the result.
A number of contributory factors were at work:
1. In none of the years in question did the summer weather favor an
excess of diarrhœal mortality. With this factor, however, eliminated the
infant mortality each year was lower than in previous years.
2. Although so many husbands were away from home, in a large
proportion of cases the wife, in virtue of her separation allowance, was
financially in a more favorable position than when she was dependent on
her husband’s wages or such portion of it as he allowed her for the
support of the household.
3. In addition, every soldier became an insured person, and his wife
was therefore entitled to the Maternity Benefit of 30 shillings on the birth
of a child, and an additional 30 shillings if she was herself an employed
person.
4. There can be no reasonable doubt that the restrictions on the
consumption of alcoholic drinks and the limitation of hours for opening
public houses were a factor in improving domestic welfare.
 But attaching full value to these and other similar factors which
undoubtedly were at work, chief place must, I think, be given to the
awakening of the public conscience on the subject, and to the
concentration on the mother and her child which had been urged in
season and which now became a fact. An indication of the public mind is
given by the advice issued by the Local Government Board in August,
1918, which is quoted on page 248.

FOOTNOTES:
[18] Extracted from addresses given at Conferences held by the Children’s
Bureau of the Department of Labor, Washington.
 INDEX
Abbott, J., 2
Abbott, S. W., 2
Alcoholic drinks, 123, 149, 187
Anaesthetics, 77
Ante-natal work, 261

Bacteriological diagnosis, 85
Banks, N. P., 2
Biggs, H., 77
Bowditch, 2
Budd, Wm., 15
Burns, John, 44
Burton, R., 71

Care Committees, 237

Causation, 147
Causation, specific, 20
Cerebro-spinal fever, 23, 76, 126
Chadwick, 2, 3, 11, 12, 25, 52, 54
Chalmers, 70
Chapman, 221, 237
Character and health, 173
Childbearing, care of, 137, 254
Child mortality, causes of, 248
Child welfare work, 240
Cholera, 12
Colonies for consumptives, 235
Consumption, see Tuberculosis.
Contacts in tuberculosis, 212
Creches, 263

Decadence, 121
Democracy and public health, 47
Dental assistance, 262
Destitution (see also Poor Law), 31, 65, 87
Deterrence, principle of, 29
Diarrhœal diseases, 20, 241
Dirt and disease, 11
Dispensaries for tuberculosis, 216
” general, 218
Domiciliary treatment, 35

Education authorities and public health, 56, 58, 86

Educational propaganda, 130, 168
” work of sanatoria, 233
Enteric fever, see Typhoid.
Epidemiology, present limitations of, 22, 81
Eugenics and public health, 44
Expectation of life, 20, 74, 192

Factory hygiene and legislation, 8, 26

Farr, Wm., 2, 25
Fulton, J. S., 24

Gerhard, 15
Goodnow, 60, 63
Grants in aid, 56, 135, 265
Historical development of public health, 42
Holmes, O. Wendell, 16
Hospitals, see Institutional treatment.
” as housing auxiliaries, 38, 77, 79, 98
” and private practice, 146
Housing, 38, 79
” and tuberculosis, 203
Huddersfield, 246

Ideals of public work, 4

Ignorance and sickness, 168
Immunity to tuberculosis, 196
Industrial colonies, 235
Industry and public health, 50, 161
Infant consultations, 243
Infant mortality, 144, 250
Infant mortality and poverty, 153, 185
Infants, care of, 30
Influenza, 23, 76, 127
Inspectors of factories, 51
Institutional treatment, 37, 79, 98
Insurance and public health, 33, 59, 66, 88, 92, 95, 103
Intemperance, 149

Jefferson, President, 6
Jenner, Wm., 15

Kay, 2, 11
Koch, Robert, 192
” and segregation in tuberculosis, 201
Laissez faire policy, 6
Lay workers, utilisation of, 3
Loans for public health work, 14
Local Government Board, 53, 58, 77
Lowe, Robert, 28

Mackenzie, L., 57
Maclean, D., 31
Malaria, 147
Malthus, 6, 162
Malthusian hypothesis, 164
Massachusetts, 2, 4
Maternity benefit, 34, 95, 111, 134
Measles, 20, 126
Measurement of results in life saving, 19
Medical benefit, 34, 106, 110
Medical practice and public health, 27, 83
Medical officers of health, 63
Midwives Act, 255
Midwifery nursing, 260
Milk depots, 243
Mill, James, 6
Ministry of Health, 49
Mother and child, 132, 180
Murchison, Chas., 15, 17

National Health Insurance Act, 33, 59, 88, 104

National medical service, 32, 36
New England, 1
Notification of tuberculosis, 206
” of births, 245
Nursing, training of, 122
” public health work of, 126

Oastler, 177
Overcrowding, 7, 199
Over-population, 166
Owen, 177

Panel doctors, 215

Pasteur, 21
Percival, 177
Pettenkofer, Von, 13
Philanthropy and public health, 9, 37
Physical defects, 81
Pneumonia, 76
Poliomyelitis, 23, 76
Political pull, 102, 175
Poor law and public health, 27, 29, 31, 46, 49
Population problem, 163
Poverty, causes of, 31, 182
” control of, 46, 114
” tests, 139
” and sickness, 148, 162, 167, 184, 189
Preventive medicine, 99
Progress of public health, 1
Public health nurses, 128, 154

Racial immunity, 196

Red Cross workers, 127, 132, 143
Registrar-General’s returns, 18, 25
Relief v. prevention, 109, 190
Relief v. prevention, 48
Research, 24, 35
Resistance v. infection, 195
Respiratory diseases, 23, 125
Rumsey, 54
Rural conditions, 161

Sanatorium benefit, 34, 94, 111, 129, 214, 222

Sanatorium treatment, 228
Sanitation and infant mortality, 242
Scarlet fever, 20
Schools for mothers, 244
School medical inspection, 30, 57, 252
Scope of public health work, 44
Sedgwick, 16
Segregation of feeble-minded, 44
” in tuberculosis, 200
Sex teaching, 151
Shaftesbury, 177
Shattuck, L., 2, 3
Shop hygiene, 9
Sickness and pauperism, 67, 68
Sickness insurance, 10, 32, 65, 67, 87, 116
Sickness registration, 26
Simon, Jno., 2, 4, 5, 9, 12, 13, 22, 25, 28, 55
Smallpox, 21
Smith, Adam, 6
Smith, Southwood, 2, 9, 11, 12
Smith, Theobald, 2
Snow, Jno., 13
Socialization of medicine, 82, 102, 115
State treatment of disease, 112, 137
Statistical studies, influence of, 252
Still-births, 137
Syphilis, 137
Sykes, J. F. J., 244

Town living, influence on health, 43

Tuberculosis, 20, 23, 34, 76, 78, 129, 192
Tuberculosis and hospital treatment, 198
” and overcrowding, 199
” and housing, 203
” notification of, 206
Typhoid fever, 15
Typhus fever, 17, 20

Unqualified practice, 31
Urbanization, 7, 159

Venereal diseases, 30, 85, 131, 150

Victoria, Queen, 10
Vital statistics, importance of, 24
Voluntary agencies, 141

Walcott, 2
War, 81, 120, 158, 179
Water supplies and health, 16
Wells, 159
Whooping cough, 20
Women, work of, 122
” position of, 184
 Transcriber’s Notes
pg 14 Changed groups of diarrhoeal to: diarrhœal
pg 19 Changed and that diarrhoeal to: diarrhœal
pg 20 Changed one-sixteenth to diarrhoeal to: diarrhœal
pg 34 Changed doctor or mid-wife to: midwife
pg 34 Changed in a sanatorum to: sanatorium
pg 42 Changed of the excessive diarrhoea to: diarrhœa
pg 49 Changed and the feebleminded to: feeble-minded
pg 89 Changed England was not actuarily to: actuarially
pg 101 Changed if the latters to: latter
pg 105 Changed for the benfits to: benefits
pg 114 Added period after: due to sickness
pg 115 Changed assistance by cooperative to: coöperative
pg 118 Changed period to comma after: Pre-school clinics
pg 145 Changed their satisfactory cooperation to: coöperation
pg 159 Changed rows of unsatistory to: unsatisfactory
pg 164 Changed power of finding enployment to: employment
pg 171 Changed she is over-worked to: overworked
pg 176 Changed facts, they villify to: vilify
pg 178 Changed more and more entagled to: entangled
pg 184 Changed accompaniments of overfatigue to: over-fatigue
pg 221 Changed Examination of a register kept for faciliating to: facilitating
pg 228 Changed efficiency in a santorium to: sanatorium
pg 241 Changed caused 8.1 percent to: per cent
pg 246 Changed total deaths in ths to: the
pg 259 Added period after: Insurance Act 30s
pg 262 Changed that of abortions, stillbirths to: still-births
pg 262 Changed investigation of stillbirths to: still-births
pg 267 Changed it as he ollowed to: allowed
pg 268 Changed Antenatal work, 261 to Ante-natal
pg 268 Added period after: Enteric fever, see Typhoid
pg 268 Added period after: Hospitals, see Institutional treatment
pg 270 Sickness and pauperism had no page references added 67, 68
Table of contents used lectures, but refers to chapters
Many hyphenated and non-hyphenated word combinations left as written.