DR. F. E. FREMANTLE'S PAPER 45 



elementary sanitation which are not being practised in every 

 part of every town in this country. That they are not so being 

 practised is shown not only by the excessive mortality in 

 certain towns, but by the excessive mortality in certain wards 

 of towns, and these differences in infant mortality are found 

 to correspond with the sanitary arrangements. You find 

 with a high infant mortality you have scavenging arrange- 

 ments which are very bad; you find unpaved yards instead 

 of proper paving; ashpits instead of movable dustbins, and 

 you have, above all, privies and many other abominable sani- 

 tary arrangements instead of a water carriage system. Until 

 every house in every town in this country has those con- 

 ditions removed and replaced with more sanitary arrange- 

 ments; until every housewife has a water-supply in the 

 house and has access to ordinary sanitary conveniences with- 

 out having to go down three flights of stairs, it cannot be 

 said that we have made the conditions possible which ensure 

 the success of child welfare work. That is the message 

 which I want to give to you this morning that while recog- 

 nizing the importance of direct child welfare work (and its 

 importance is realized by no one more than myself), we 

 should not forget that, in order to make this direct work a 

 success, it is indispensable we should provide the elementary 

 conditions of sanitary life for every family in every town in 

 this country. (Applause.) 



THE RESPONSIBILITIES OF THE 

 CENTRAL AUTHORITIES. 



BY F. E. FREMANTLE, F.R.C.S., F.R.C.P. 



County Medical Officer of Health for Hertfordshire. 



AT 5 years of age the State draws the child out of 

 his home into school. Till then he is under parental 

 control. In what way should the State control or 

 supplement the parental care ? 



That there should be some such control is agreed. 

 The State has a right to preserve and strengthen infant 

 life in its own interests ; it has assumed a duty to 

 protect the individual infant even in its own home. 

 But State action does not begin at the infant's birth. 

 It is now agreed that the community has a right, and, 

 if so, a duty, to prevent some of the worst misfortunes 



