Start
nshd_48
STRICTLY CONFIDENTIAL
FOLLOW-UP SURVEY
ROYAL COLLEGE OF OBSTETRICIANS AND GYNAECOLOGISTS POPULATION INVESTIGATION COMMITTEE
INSTITUTE OF CHILD HEALTH
i

Mother's Name

Generic text
ii

Address

Generic text
iii

If she has moved what is her present address?

Generic text
iv

In what M. and C.W. Authority is it?

Generic text
IF SHE HAS MOVED TO ANOTHER M. AND C.W. AUTHORITY RETURN THIS FORM AT ONCE TO WHOEVER HAS BEEN DELEGATED BY YOUR MEDICAL OFFICER OF HEALTH TO RECEIVE IT.
Approach to the Mother.
Remind her that she was visited soon after her baby was born in March, 1946. We now want to find out what progress her baby has made. By giving as many details as she can, she will be helping us to plan better health services. All information she gives will, of course, be treated as ABSOLUTELY CONFIDENTIAL.
How to fill in this Form.
1. This inquiry refers throughout to THE BABY BORN IN MARCH, 1946.
2. Before you interview the mother read through the questionnaire and answer as many questions as possible from your records and those of the Infant Welfare Centre. Check with the mother, when you interview her, all the answers you have obtained from the records.
3. The questions are printed in heavy type and the mother's answers in light type. Instructions to the interviewer are in italics.
4. The answers to the questions are shown by putting a ring with a soft pencil round the code number or letter opposite the mother's answer. If the answer does not fit any alternative write it below the question itself. If a mother refuses or is unable to answer any question put a ring round "X " or "XX" for "No answer."
5. Please follow the order of the questions as set out in the questionnaire and keep as close to the phrasing as you can. When any question does not apply to a particular mother or baby ring the code number" Y" or ·" YY" for "does not apply". Do not strike through a question or leave it blank. EVERY QUESTION SHOULD BE ANSWERED. Before leaving the mother please check through the questionnaire to see that this has been done.
6. Some of the questions on illness are in tabular form. Deal with each illness in turn and record the answer to each question by putting a ring round the appropriate code number in the column referring to the illness with which you are dealing.
7. The comments on borne conditions at the end of this questionnaire should be filled in from your own knowledge and observation of the household. Do NOT ask the mother these questions.
8. If a baby has died please try .to .obtain all the details yo~ can about his health and development up to the date of death. It is just as essential to obtain information about a baby who has died as about one who is alive. However, use your judgment in leaving out any question that might cause embarrassment.
9. If the mother refuses to be interviewed try to find out her reasons and write them in the space provided. Then fill in as much of the questionnaire as you can from the records, and RETURN THE FORM WITH THE OTHERS YOU HAVE COMPLETED.
10. When you have completed your interviews, hand the questionnaires to whoever has been delegated by your Medical Officer of Health to receive them.
QUESTIONNAIRE
(Ring with a soft pencil the code number opposite the mother's answer.)
1

If mother not interviewed because she refused, was ill, etc., give reasons

Generic text
DETAILS OF CHILD BORN IN MARCH, 1946.
2

Is the baby born in March 3-9, 1946, living at home, with relatives, or adopted, or has he died?

1
Living at home
2
With relatives
3
Adopted
4
Ill in hospital
5
Living elsewhere, namely
6
Dead
X
No information
Generic text
If this baby has died, please fill in the following:-
qc_q2 == 6
3 a

Age at death ... months.

Age in months
Y
Question does not apply
X
No answer
3 b

Cause of death

Generic text
4

What is this baby's sex?

1
Male
2
Female
5

What was this baby's weight at birth? ... lbs. ... ozs.

Pounds
Ounces in pound
DEVELOPMENT.
6 a

How many months old was baby when he Sat up alone? ... months

Age in months
XX
No answer
6 b

How many months old was baby when he Stood alone? ... months

Age in months
XX
No answer
6 c

How many months old was baby when he Walked several steps without support? ... months

Age in months
XX
No answer
6 d

How many months old was baby when he Cut his first tooth? ... months

Age in months
XX
No answer
6 e

How many months old was baby when he Said more than "mum" "dad" or "nan"? ... months

Age in months
XX
No answer
7

Are you now using napkins for this baby?

1
Yes
2
No
X
No answer
(If " Yes.")
qc_7 == 1
7 a

Does he wear them by day only, by night only, or all the time?

1
Day only
2
Night only
3
All the time
Y
Question does not apply
X
No answer
8

Has this baby any DEVELOPMENTAL (CONGENITAL) ABNORMALITY, DEFECT or MALFORMATION?

1
Yes
2
No
X
No answer
(If " Yes.")
qc_8 == 1
8 a

What type of abnormality has he?

Generic text
DOMESTIC ACCIDENTS.
9
Has this baby ever had an accident in which he was BURNT or SCALDED, BROKE A BONE, or was BADLY CUT or BRUISED?
-

1 - Yes

2 - No

X - No answer
BURNS or SCALDS
BROKEN BONES
BAD CUTS or BRUISES
(If " Yes.")
qc_9 == 1
9 a(i)

How many months old was baby when he had the accident? BURNS or SCALDS Age ... months

Age in months
YY
Q doesn't apply
XX
No answer
9 a(ii)

How many months old was baby when he had the accident? BROKEN BONES Age ... months

Age in months
YY
Q doesn't apply
XX
No answer
9 a(iii)

How many months old was baby when he had the accident? BAD CUTS or BRUISES Age ... months

Age in months
YY
Q doesn't apply
XX
No answer
9 b(i)

Where or by whom was he treated? BURNS or SCALDS

0
Not treated
1
Hospital In-Patient
2
Hospital Out-Patient
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Q doesn't apply
X
No answer
9 b(ii)

Where or by whom was he treated? BROKEN BONES

0
Not treated
1
Hospital In-Patient
2
Hospital Out-Patient
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Q doesn't apply
X
No answer
9 b(iii)

Where or by whom was he treated? BAD CUTS or BRUISES

0
Not treated
1
Hospital In-Patient
2
Hospital Out-Patient
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Q doesn't apply
X
No answer
9 c(i)

What part was hurt? BURNS or SCALDS

1
Head or neck
2
Trunk
3
Arm or hand
4
Leg or foot
Y
Q doesn't apply
X
No answer
9 c(ii)

What part was hurt? BROKEN BONES

1
Head or neck
2
Trunk
3
Arm or hand
4
Leg or foot
Y
Q doesn't apply
X
No answer
9 c(iii)

What part was hurt? BAD CUTS or BRUISES

1
Head or neck
2
Trunk
3
Arm or hand
4
Leg or foot
Y
Q doesn't apply
X
No answer
9 d(i)

How did the accident(s) occur? Burns or scalds

Generic text
9 d(ii)

How did the accident(s) occur? Broken bones

Generic text
9 d(iii)

How did the accident(s) occur? Bad cuts or bruises

Generic text
INFECTIOUS DISEASES.
10 i

Has this baby ever had WHOOPING COUGH, GERMAN MEASLES, MEASLES or SCARLET FEVER? WHOOPING COUGH

1
Yes
2
No
X
No answer
10 ii

Has this baby ever had WHOOPING COUGH, GERMAN MEASLES, MEASLES or SCARLET FEVER? GERMAN MEASLES

1
Yes
2
No
X
No answer
10 iii

Has this baby ever had WHOOPING COUGH, GERMAN MEASLES, MEASLES or SCARLET FEVER? MEASLES

1
Yes
2
No
X
No answer
10 iv

Has this baby ever had WHOOPING COUGH, GERMAN MEASLES, MEASLES or SCARLET FEVER? SCARLET FEVER

1
Yes
2
No
X
No answer
(If " Yes.")
qc_10_i == 1 || qc_10_ii == 1 || qc_10_iii == 1 || qc_10_iv == 1
10 a(i)

How many months old was baby when it started? WHOOPING COUGH Age ... months

Age in months
YY
Q doesn't apply
XX
No answer
10 a(ii)

How many months old was baby when it started? GERMAN MEASLES Age ... months

Age in months
YY
Q doesn't apply
XX
No answer
10 a(iii)

How many months old was baby when it started? MEASLES Age ... months

Age in months
YY
Q doesn't apply
XX
No answer
10 a(iv)

How many months old was baby when it started? SCARLET FEVER Age ... months

Age in months
YY
Q doesn't apply
XX
No answer
10 b(i)

Where or by whom was he treated? WHOOPING COUGH

0
Not treated
1
Hosp. I-P
2
Hospital O-P
3
Nurs. Home
4
Private Dr.
5
Chemist
6
Other
Y
Q does'nt apply
X
No answer
10 b(ii)

Where or by whom was he treated? GERMAN MEASLES

0
Not treated
1
Hosp. I-P
2
Hospital O-P
3
Nurs. Home
4
Private Dr.
5
Chemist
6
Other
Y
Q does'nt apply
X
No answer
10 b(iii)

Where or by whom was he treated? MEASLES

0
Not treated
1
Hosp. I-P
2
Hospital O-P
3
Nurs. Home
4
Private Dr.
5
Chemist
6
Other
Y
Q does'nt apply
X
No answer
10 b(iv)

Where or by whom was he treated? SCARLET FEVER

0
Not treated
1
Hosp. I-P
2
Hospital O-P
3
Nurs. Home
4
Private Dr.
5
Chemist
6
Other
Y
Q does'nt apply
X
No answer
11 i

Has this baby ever had CHICKEN POX, MUMPS, or DIPHTHERIA? CHICKEN POX

1
Yes
2
No
X
No answer
11 ii

Has this baby ever had CHICKEN POX, MUMPS, or DIPHTHERIA? MUMPS

1
Yes
2
No
X
No answer
11 iii

Has this baby ever had CHICKEN POX, MUMPS, or DIPHTHERIA? DIPHTHERIA

1
Yes
2
No
X
No answer
(If " Yes.")
qc_11_i == 1 || qc_11_ii == 1 || qc_11_iii == 1
11 a(i)

How many months old was baby when it started? CHICKEN POX Age ... months

Age in months
YY
Q doesn't apply
XX
No answer
11 a(ii)

How many months old was baby when it started? MUMPS Age ... months

Age in months
YY
Q doesn't apply
XX
No answer
11 a(iii)

How many months old was baby when it started? DIPHTHERIA Age ... months

Age in months
YY
Q doesn't apply
XX
No answer
11 b(i)

Where or by whom was he treated? CHICKEN POX

0
Not treated
1
Hospital In-Patient
2
Hospital Out-Patient
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Q doesn't apply
X
No answer
11 b(ii)

Where or by whom was he treated? MUMPS

0
Not treated
1
Hospital In-Patient
2
Hospital Out-Patient
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Q doesn't apply
X
No answer
11 b(iii)

Where or by whom was he treated? DIPHTHERIA

0
Not treated
1
Hospital In-Patient
2
Hospital Out-Patient
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Q doesn't apply
X
No answer
IMMUNISATION.
12

Has this baby been immunised against DIPHTHERIA?

1
Yes
2
No
X
No answer
(If " Yes.")
qc_12 == 1
12 a

How old was he when immunised (i.e., had his first injection)? ... months

Age in months
YY
Question does not apply
XX
No answer
(If " No.")
qc_12 == 2
12 b

Why hasn't he been immunised?

(Please give answer in mother's own words)

Generic text
MISCELLANEOUS ILLNESSES.
13 a

At what age did this baby have his first cold? ... months

Age in months
XX
No answer
13 b

How many colds has he had during the three months, December 1, 1947 to March 1, 1948? ... colds

How many
X
No answer
13 c

Does he have them in Winter or Summer or both?

1
Winter
2
Summer
3
Both
Y
Question does not apply
X
No answer
13 d

Does anybody else in the family have frequent colds or catarrh. If so, who?

1
Mother
2
Other children
Other person, namely
X
No answer
Other
14

Has this baby ever had a LOWER RESPIRATORY INFECTION, i.e., bronchitis, broncho pneumonia or pheumonia?

1
Yes
2
No
X
No answer
(If " Yes.")
qc_14 == 1
14 a

How many months old was baby when he first had a lower respiratory infection? ... months

Age in months
YY
Question does not apply
XX
No answer
14 b

How many times has he had a lower respiratory infection? ... times

How many
Y
Question does not apply
X
No answer
14 c

Where or by whom was he treated?

0
Not treated
1
Hospital In-Patient
2
Hospital Out-Patient
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Question does not apply
X
No answer
15 i

Has this baby ever had FITS or CONVULSIONS or DIARRHOEA (i.e., the passage of liquid stools)? FITS OR CONVULSIONS

1
Yes
2
No
X
No answer
15 ii

Has this baby ever had FITS or CONVULSIONS or DIARRHOEA (i.e., the passage of liquid stools)? DIARRHOEA

1
Yes
2
No
X
No answer
(If " Yes.")
qc_15_i == 1 || qc_15_ii == 1
15 a(i)

How many months old was baby at the first attack? FITS OR CONVULSIONS Age ... months

Age in months
YY
Question does not apply
XX
No answer
15 a(ii)

How many months old was baby at the first attack? DIARRHOEA Age ... months

Age in months
YY
Question does not apply
XX
No answer
15 b(i)

How many attacks has he had in all? FITS OR CONVULSIONS No. of attacks ... fits

How many
Y
Question does not apply
X
No answer
15 b(ii)

How many attacks has he had in all? DIARRHOEA No. of attacks ... attacks

How many
Y
Question does not apply
X
No answer
15 c(i)

Where or by whom was he treated? FITS OR CONVULSIONS

0
Not treated
1
Hospital In-Patient
2
Hospital Out-Patient
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Question does not apply
X
No answer
15 c(ii)

Where or by whom was he treated? DIARRHOEA

0
Not treated
1
Hospital In-Patient
2
Hospital Out-Patient
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Question does not apply
X
No answer
FEEDING.
16 a

At what age was the baby completely weaned from the breast? ... months

Age in months
OO
At birth
YY
Not yet weaned
XX
No answer
16 b

At what age was he completely weaned from the bottle? ... months

Age in months
OO
Never bottle fed
YY
Not yet weaned
XX
No answer
INFANT WELFARE.
17

Have you ever taken the baby to an Infant Welfare Centre?

1
Yes
2
No
X
No answer
(If " Yes.")
qc_17 == 1
17 a

How many weeks old was he when you first took him to the L.W.C.? ... weeks

Age in weeks
YY
Question does not apply
XX
No answer
17 b

How many times did you take him in the first year? ... times

How many
YY
Question does not apply
XX
No answer
17 c

How many times did you take him in the second year? ... times

How many
YY
Question does not apply
XX
No answer
BABY'S SLEEPING ARRANGEMENTS.
(Health Visitors please check these answers if possible.)
18

Does he sleep in a room by himself or in a room with others?

1
By himself
2
With others
X
No answer
(If " with others ")
qc_18 == 2
18 a

How many others sleep in his room? ... children (under 15) ... adults (15 and over)

How many
How many 2
Y
Question does not apply
X
No answer
18 b

Does he sleep in his own cot or with others?

1
Own cot
2
With others
Y
Question does not apply
X
No answer
USE OF NURSERIES.
19

Does this baby go (or has he ever gone) to a day or other nursery?

0
No
1
Yes, Municipal or voluntary day nursery
2
Yes, Municipal or voluntary residential nursery
3
Yes, factory day nursery
4
Yes, other, namely
X
No answer
Other
(If baby is going or has gone to a day or other nursery)
qc_19 >= 1 && qc_19 <= 4
19 a

How many months old was he when you first took him? ... months

Age in months
YY
Question does not apply
XX
No answer
19 b

Why did you take him?

1
Mother working
2
Mother ill
3
When Mother confined
4
Other reasons, namely
Y
Question does not apply
X
No answer
Other
19 c

Is he still being taken?

1
Yes
2
No
Y
Question does not apply
X
No answer
(If baby not sent to nursery)
qc_19 == 0
19 d

Would you have liked him to go to a nursery?

1
Yes
2
No
Y
Question does not apply
X
No answer
(If mother would have liked him to go to a nursery)
qc_19_d == 1
19 e

Why didn't he go to one?

1
None available
2
Mother not eligible
3
Baby ill
4
Other, namely
Y
Question does not apply
X
No answer
Other
THE MOTHER.
20

Are you helped with the housework?

1
Yes, all the time
2
Yes, regularly part-time
3
Yes, occasionally
4
No
X
No answer
21

Are you working now? (i.e. doing paid work inside or outside the home.)

1
Yes
2
No
X
No answer
(If " Yes.")
qc_21 == 1
21 a

What is your occupation?

Generic text
21 b

Is it whole-time or part-time?

1
Whole-time
2
Part-time
Y
Question does not apply
X
No answer
21 c

Who looks after the children when you are at work?

1
Relations or friends
2
Day Nursery
3
Residential Nursery
4
Mother works at home
5
Paid help at home
6
Other, namely
Y
Question does not apply
X
No answer
Other
22

Did you have a post-natal examination by a doctor after your child was born in March, 1946?

1
Yes
2
No
X
No answer
(If " Yes.")
qc_22 == 1
22 a

How many weeks after the birth of your baby were you examined? ... weeks

How many
Y
Question does not apply
X
No answer
(If mother not examined)
qc_22 == 2
22 b

Why did you not have a post-natal examination?

Generic text
23
Have you suffered, since the birth of your baby in 1946, from BREAST ABSCESS, BACKACHE, BLADDER TROUBLE, VAGINAL DISCHARGE, PROLAPSE (fallen womb), or PILES?
-

1 - Yes

2 - No

X - No answer
BREAST ABSCESS
BACKACHE
BLADDER TROUBLE
VAGINAL DISCHARGE
PROLAPSE
PILES
(If " Yes.")
qc_23 == 1
23 a(i)

Where or by whom were you treated? BREAST ABSCESS

0
Not treated
1
Hospital In-Patient
2
Hospital O-P
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Q doesn't apply
X
No answer
23 a(ii)

Where or by whom were you treated? BACKACHE

0
Not treated
1
Hospital In-Patient
2
Hospital O-P
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Q doesn't apply
X
No answer
23 a(iii)

Where or by whom were you treated? BLADDER TROUBLE

0
Not treated
1
Hospital In-Patient
2
Hospital O-P
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Q doesn't apply
X
No answer
23 a(iv)

Where or by whom were you treated? VAGINAL DISCHARGE

0
Not treated
1
Hospital In-Patient
2
Hospital O-P
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Q doesn't apply
X
No answer
23 a(v)

Where or by whom were you treated? PROLAPSE

0
Not treated
1
Hospital In-Patient
2
Hospital O-P
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Q doesn't apply
X
No answer
23 a(vi)

Where or by whom were you treated? PILES

0
Not treated
1
Hospital In-Patient
2
Hospital O-P
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Q doesn't apply
X
No answer
23 b(i)

Are you still suffering from any of these? BREAST ABSCESS

1
Yes
2
No
Y
Q doesn't apply
X
No answer
23 b(ii)

Are you still suffering from any of these? BACKACHE

1
Yes
2
No
Y
Q doesn't apply
X
No answer
23 b(iii)

Are you still suffering from any of these? BLADDER TROUBLE

1
Yes
2
No
Y
Q doesn't apply
X
No answer
23 b(iv)

Are you still suffering from any of these? VAGINAL DISCHARGE

1
Yes
2
No
Y
Q doesn't apply
X
No answer
23 b(v)

Are you still suffering from any of these? PROLAPSE

1
Yes
2
No
Y
Q doesn't apply
X
No answer
23 b(vi)

Are you still suffering from any of these? PILES

1
Yes
2
No
Y
Q doesn't apply
X
No answer
24

Have you been fitted with a ring to keep your womb in place?

1
Yes
2
No
X
No answer
25

Have you had either an increased or a decreased loss of blood at your menstrual periods since the birth of your baby in 1946?

1
Increased
2
Decreased
3
Same as before
X
No answer
26

Have you been pregnant since your child was born in March, 1946?

1
Yes, once
2
Yes, twice
3
Yes, more than twice
4
No
X
No answer
(If " Yes.")
qc_26 == 1 || qc_26 == 2 || qc_26 == 3
26 a

How did the pregnancy end? (i.e. live birth, still birth, etc.)

Generic text
26 b

At what date did the pregnancy end?

Generic date
THE DWELLING AND HOUSEHOLD.
27 a-d
How many are there in your household (including the baby born in 1946 and any later births) who are-
-
How many
Less than 5 yrs. of age ... infants
5 yrs-14 yrs. 11 mths. of age ... children.
15 yrs. or older (including self, husband, older children, relations, lodgers and domestics) ... adults
Total in household
28 a

How many living rooms and bedrooms (including kitchen if used as a living room but excluding if other type of kitchen, scullery or bathroom) are occupied by you or the members of your household ... rooms

How many
29

Is there a kitchen for your use?

1
Yes
2
No
X
No answer
(If " Yes.")
qc_29 == 1
29 a

Is the kitchen shared with another household?

1
Yes
2
No
Y
Question does not apply
X
No answer
29 b

Do you use the kitchen as a living room?

1
Yes
2
No
Y
Question does not apply
X
No answer
30

Is there a bathroom for your use?

1
Yes
2
No
X
No answer
31

How do you obtain hot water?

1
Running hot water
2
Gas or electric copper
3
Boiling kettles
4
Other method, namely
X
No answer
Other
PLEASE MAKE ARANGEMENTS FOR THE MOTHER TO BRING HER BABY TO BE WEIGHED EITHER AT THE INFANT WELFARE CENTRE OR WHEREVER ELSE SCALES MAY BE AVAILABLE.
32 a

Present weight (without clothes) ... lbs. ... ozs.

Pounds
Ounces in pound
32 b

Present standing height ... ft. ... ins.

Feet
Inches in foot
HEALTH VISITOR'S COMMENTS.
(Health Visitors should not ask these questions, but should fill them in from their own knowledge or observation.)
33

Does this family live in-

1
A whole house?
2
Part of a house?
3
A flat?
4
Furnished rooms?
5
Other, namely
Other
34

Who owns the dwelling?

1
Occupier
2
Council
3
Charitable Trust
4
Private Landlord
5
Other, namely
Other
35

Is there a yard or garden attached to this dwelling in which the baby may be left in its pram?

1
Yes
2
No
36

Please comment freely on the state of the dwelling, its repair, dampness, light and ventilation

Generic text
37

Please comment freely on the bodily care of the baby. Are his clothes clean and in good repair?

Generic text
38 a

Please give your assessment of (a) the state of the dwelling, and (b) the bodily care of the baby. State of the dwelling

(Please ring the appropriate code numbers.)

1
Good
2
Fair
3
Poor
38 b

Please give your assessment of (a) the state of the dwelling, and (b) the bodily care of the baby. Bodily care of the baby

(Please ring the appropriate code numbers.)

1
Good
2
Fair
3
Poor
39

How long did this interview take? ... minutes

How many
End

nshd_48

s_intro_i
STRICTLY CONFIDENTIAL
s_intro_ii
FOLLOW-UP SURVEY
s_intro_iii
ROYAL COLLEGE OF OBSTETRICIANS AND GYNAECOLOGISTS POPULATION INVESTIGATION COMMITTEE
s_intro_iv
INSTITUTE OF CHILD HEALTH
i
Mother's Name
Generic text
ii
Address
Generic text
iii
If she has moved what is her present address?
Generic text
iv
In what M. and C.W. Authority is it?
Generic text
s_intro_v
IF SHE HAS MOVED TO ANOTHER M. AND C.W. AUTHORITY RETURN THIS FORM AT ONCE TO WHOEVER HAS BEEN DELEGATED BY YOUR MEDICAL OFFICER OF HEALTH TO RECEIVE IT.
s_intro_vi
Approach to the Mother.
s_intro_vii
Remind her that she was visited soon after her baby was born in March, 1946. We now want to find out what progress her baby has made. By giving as many details as she can, she will be helping us to plan better health services. All information she gives will, of course, be treated as ABSOLUTELY CONFIDENTIAL.
s_intro_viii
How to fill in this Form.
s_intro_ix
1. This inquiry refers throughout to THE BABY BORN IN MARCH, 1946.
s_intro_x
2. Before you interview the mother read through the questionnaire and answer as many questions as possible from your records and those of the Infant Welfare Centre. Check with the mother, when you interview her, all the answers you have obtained from the records.
s_intro_xi
3. The questions are printed in heavy type and the mother's answers in light type. Instructions to the interviewer are in italics.
s_intro_xii
4. The answers to the questions are shown by putting a ring with a soft pencil round the code number or letter opposite the mother's answer. If the answer does not fit any alternative write it below the question itself. If a mother refuses or is unable to answer any question put a ring round "X " or "XX" for "No answer."
s_intro_xiii
5. Please follow the order of the questions as set out in the questionnaire and keep as close to the phrasing as you can. When any question does not apply to a particular mother or baby ring the code number" Y" or ·" YY" for "does not apply". Do not strike through a question or leave it blank. EVERY QUESTION SHOULD BE ANSWERED. Before leaving the mother please check through the questionnaire to see that this has been done.
s_intro_xiv
6. Some of the questions on illness are in tabular form. Deal with each illness in turn and record the answer to each question by putting a ring round the appropriate code number in the column referring to the illness with which you are dealing.
s_intro_xv
7. The comments on borne conditions at the end of this questionnaire should be filled in from your own knowledge and observation of the household. Do NOT ask the mother these questions.
s_intro_xvi
8. If a baby has died please try .to .obtain all the details yo~ can about his health and development up to the date of death. It is just as essential to obtain information about a baby who has died as about one who is alive. However, use your judgment in leaving out any question that might cause embarrassment.
s_intro_xvii
9. If the mother refuses to be interviewed try to find out her reasons and write them in the space provided. Then fill in as much of the questionnaire as you can from the records, and RETURN THE FORM WITH THE OTHERS YOU HAVE COMPLETED.
s_intro_xviii
10. When you have completed your interviews, hand the questionnaires to whoever has been delegated by your Medical Officer of Health to receive them.
s_intro_xix
QUESTIONNAIRE
s_intro_xx
(Ring with a soft pencil the code number opposite the mother's answer.)
1
If mother not interviewed because she refused, was ill, etc., give reasons
Generic text

DETAILS OF CHILD BORN IN MARCH, 1946.

2
Is the baby born in March 3-9, 1946, living at home, with relatives, or adopted, or has he died?
1
Living at home
2
With relatives
3
Adopted
4
Ill in hospital
5
Living elsewhere, namely
6
Dead
X
No information
Generic text
3 a
Age at death ... months.
Age in months
Y
Question does not apply
X
No answer
If this baby has died, please fill in the following:-
3 b
Cause of death
Generic text
If this baby has died, please fill in the following:-
4
What is this baby's sex?
1
Male
2
Female
5
What was this baby's weight at birth? ... lbs. ... ozs.
Pounds
Ounces in pound

DEVELOPMENT.

6 a
How many months old was baby when he Sat up alone? ... months
Age in months
XX
No answer
6 b
How many months old was baby when he Stood alone? ... months
Age in months
XX
No answer
6 c
How many months old was baby when he Walked several steps without support? ... months
Age in months
XX
No answer
6 d
How many months old was baby when he Cut his first tooth? ... months
Age in months
XX
No answer
6 e
How many months old was baby when he Said more than "mum" "dad" or "nan"? ... months
Age in months
XX
No answer
7
Are you now using napkins for this baby?
1
Yes
2
No
X
No answer
7 a
Does he wear them by day only, by night only, or all the time?
1
Day only
2
Night only
3
All the time
Y
Question does not apply
X
No answer
(If " Yes.")
8
Has this baby any DEVELOPMENTAL (CONGENITAL) ABNORMALITY, DEFECT or MALFORMATION?
1
Yes
2
No
X
No answer
8 a
What type of abnormality has he?
Generic text
(If " Yes.")

DOMESTIC ACCIDENTS.

9

Has this baby ever had an accident in which he was BURNT or SCALDED, BROKE A BONE, or was BADLY CUT or BRUISED?

-

1 - Yes

2 - No

X - No answer
BURNS or SCALDS
BROKEN BONES
BAD CUTS or BRUISES
9 a(i)
How many months old was baby when he had the accident? BURNS or SCALDS Age ... months
Age in months
YY
Q doesn't apply
XX
No answer
(If " Yes.")
9 a(ii)
How many months old was baby when he had the accident? BROKEN BONES Age ... months
Age in months
YY
Q doesn't apply
XX
No answer
(If " Yes.")
9 a(iii)
How many months old was baby when he had the accident? BAD CUTS or BRUISES Age ... months
Age in months
YY
Q doesn't apply
XX
No answer
(If " Yes.")
9 b(i)
Where or by whom was he treated? BURNS or SCALDS
0
Not treated
1
Hospital In-Patient
2
Hospital Out-Patient
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Q doesn't apply
X
No answer
(If " Yes.")
9 b(ii)
Where or by whom was he treated? BROKEN BONES
0
Not treated
1
Hospital In-Patient
2
Hospital Out-Patient
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Q doesn't apply
X
No answer
(If " Yes.")
9 b(iii)
Where or by whom was he treated? BAD CUTS or BRUISES
0
Not treated
1
Hospital In-Patient
2
Hospital Out-Patient
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Q doesn't apply
X
No answer
(If " Yes.")
9 c(i)
What part was hurt? BURNS or SCALDS
1
Head or neck
2
Trunk
3
Arm or hand
4
Leg or foot
Y
Q doesn't apply
X
No answer
(If " Yes.")
9 c(ii)
What part was hurt? BROKEN BONES
1
Head or neck
2
Trunk
3
Arm or hand
4
Leg or foot
Y
Q doesn't apply
X
No answer
(If " Yes.")
9 c(iii)
What part was hurt? BAD CUTS or BRUISES
1
Head or neck
2
Trunk
3
Arm or hand
4
Leg or foot
Y
Q doesn't apply
X
No answer
(If " Yes.")
9 d(i)
How did the accident(s) occur? Burns or scalds
Generic text
(If " Yes.")
9 d(ii)
How did the accident(s) occur? Broken bones
Generic text
(If " Yes.")
9 d(iii)
How did the accident(s) occur? Bad cuts or bruises
Generic text
(If " Yes.")

INFECTIOUS DISEASES.

10 i
Has this baby ever had WHOOPING COUGH, GERMAN MEASLES, MEASLES or SCARLET FEVER? WHOOPING COUGH
1
Yes
2
No
X
No answer
10 ii
Has this baby ever had WHOOPING COUGH, GERMAN MEASLES, MEASLES or SCARLET FEVER? GERMAN MEASLES
1
Yes
2
No
X
No answer
10 iii
Has this baby ever had WHOOPING COUGH, GERMAN MEASLES, MEASLES or SCARLET FEVER? MEASLES
1
Yes
2
No
X
No answer
10 iv
Has this baby ever had WHOOPING COUGH, GERMAN MEASLES, MEASLES or SCARLET FEVER? SCARLET FEVER
1
Yes
2
No
X
No answer
10 a(i)
How many months old was baby when it started? WHOOPING COUGH Age ... months
Age in months
YY
Q doesn't apply
XX
No answer
(If " Yes.")
10 a(ii)
How many months old was baby when it started? GERMAN MEASLES Age ... months
Age in months
YY
Q doesn't apply
XX
No answer
(If " Yes.")
10 a(iii)
How many months old was baby when it started? MEASLES Age ... months
Age in months
YY
Q doesn't apply
XX
No answer
(If " Yes.")
10 a(iv)
How many months old was baby when it started? SCARLET FEVER Age ... months
Age in months
YY
Q doesn't apply
XX
No answer
(If " Yes.")
10 b(i)
Where or by whom was he treated? WHOOPING COUGH
0
Not treated
1
Hosp. I-P
2
Hospital O-P
3
Nurs. Home
4
Private Dr.
5
Chemist
6
Other
Y
Q does'nt apply
X
No answer
(If " Yes.")
10 b(ii)
Where or by whom was he treated? GERMAN MEASLES
0
Not treated
1
Hosp. I-P
2
Hospital O-P
3
Nurs. Home
4
Private Dr.
5
Chemist
6
Other
Y
Q does'nt apply
X
No answer
(If " Yes.")
10 b(iii)
Where or by whom was he treated? MEASLES
0
Not treated
1
Hosp. I-P
2
Hospital O-P
3
Nurs. Home
4
Private Dr.
5
Chemist
6
Other
Y
Q does'nt apply
X
No answer
(If " Yes.")
10 b(iv)
Where or by whom was he treated? SCARLET FEVER
0
Not treated
1
Hosp. I-P
2
Hospital O-P
3
Nurs. Home
4
Private Dr.
5
Chemist
6
Other
Y
Q does'nt apply
X
No answer
(If " Yes.")
11 i
Has this baby ever had CHICKEN POX, MUMPS, or DIPHTHERIA? CHICKEN POX
1
Yes
2
No
X
No answer
11 ii
Has this baby ever had CHICKEN POX, MUMPS, or DIPHTHERIA? MUMPS
1
Yes
2
No
X
No answer
11 iii
Has this baby ever had CHICKEN POX, MUMPS, or DIPHTHERIA? DIPHTHERIA
1
Yes
2
No
X
No answer
11 a(i)
How many months old was baby when it started? CHICKEN POX Age ... months
Age in months
YY
Q doesn't apply
XX
No answer
(If " Yes.")
11 a(ii)
How many months old was baby when it started? MUMPS Age ... months
Age in months
YY
Q doesn't apply
XX
No answer
(If " Yes.")
11 a(iii)
How many months old was baby when it started? DIPHTHERIA Age ... months
Age in months
YY
Q doesn't apply
XX
No answer
(If " Yes.")
11 b(i)
Where or by whom was he treated? CHICKEN POX
0
Not treated
1
Hospital In-Patient
2
Hospital Out-Patient
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Q doesn't apply
X
No answer
(If " Yes.")
11 b(ii)
Where or by whom was he treated? MUMPS
0
Not treated
1
Hospital In-Patient
2
Hospital Out-Patient
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Q doesn't apply
X
No answer
(If " Yes.")
11 b(iii)
Where or by whom was he treated? DIPHTHERIA
0
Not treated
1
Hospital In-Patient
2
Hospital Out-Patient
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Q doesn't apply
X
No answer
(If " Yes.")

IMMUNISATION.

12
Has this baby been immunised against DIPHTHERIA?
1
Yes
2
No
X
No answer
12 a
How old was he when immunised (i.e., had his first injection)? ... months
Age in months
YY
Question does not apply
XX
No answer
(If " Yes.")
12 b
Why hasn't he been immunised?
Generic text
(If " No.")

MISCELLANEOUS ILLNESSES.

13 a
At what age did this baby have his first cold? ... months
Age in months
XX
No answer
13 b
How many colds has he had during the three months, December 1, 1947 to March 1, 1948? ... colds
How many
X
No answer
13 c
Does he have them in Winter or Summer or both?
1
Winter
2
Summer
3
Both
Y
Question does not apply
X
No answer
13 d
Does anybody else in the family have frequent colds or catarrh. If so, who?
1
Mother
2
Other children
Other person, namely
X
No answer
Other
14
Has this baby ever had a LOWER RESPIRATORY INFECTION, i.e., bronchitis, broncho pneumonia or pheumonia?
1
Yes
2
No
X
No answer
14 a
How many months old was baby when he first had a lower respiratory infection? ... months
Age in months
YY
Question does not apply
XX
No answer
(If " Yes.")
14 b
How many times has he had a lower respiratory infection? ... times
How many
Y
Question does not apply
X
No answer
(If " Yes.")
14 c
Where or by whom was he treated?
0
Not treated
1
Hospital In-Patient
2
Hospital Out-Patient
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Question does not apply
X
No answer
(If " Yes.")
15 i
Has this baby ever had FITS or CONVULSIONS or DIARRHOEA (i.e., the passage of liquid stools)? FITS OR CONVULSIONS
1
Yes
2
No
X
No answer
15 ii
Has this baby ever had FITS or CONVULSIONS or DIARRHOEA (i.e., the passage of liquid stools)? DIARRHOEA
1
Yes
2
No
X
No answer
15 a(i)
How many months old was baby at the first attack? FITS OR CONVULSIONS Age ... months
Age in months
YY
Question does not apply
XX
No answer
(If " Yes.")
15 a(ii)
How many months old was baby at the first attack? DIARRHOEA Age ... months
Age in months
YY
Question does not apply
XX
No answer
(If " Yes.")
15 b(i)
How many attacks has he had in all? FITS OR CONVULSIONS No. of attacks ... fits
How many
Y
Question does not apply
X
No answer
(If " Yes.")
15 b(ii)
How many attacks has he had in all? DIARRHOEA No. of attacks ... attacks
How many
Y
Question does not apply
X
No answer
(If " Yes.")
15 c(i)
Where or by whom was he treated? FITS OR CONVULSIONS
0
Not treated
1
Hospital In-Patient
2
Hospital Out-Patient
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Question does not apply
X
No answer
(If " Yes.")
15 c(ii)
Where or by whom was he treated? DIARRHOEA
0
Not treated
1
Hospital In-Patient
2
Hospital Out-Patient
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Question does not apply
X
No answer
(If " Yes.")

FEEDING.

16 a
At what age was the baby completely weaned from the breast? ... months
Age in months
OO
At birth
YY
Not yet weaned
XX
No answer
16 b
At what age was he completely weaned from the bottle? ... months
Age in months
OO
Never bottle fed
YY
Not yet weaned
XX
No answer

INFANT WELFARE.

17
Have you ever taken the baby to an Infant Welfare Centre?
1
Yes
2
No
X
No answer
17 a
How many weeks old was he when you first took him to the L.W.C.? ... weeks
Age in weeks
YY
Question does not apply
XX
No answer
(If " Yes.")
17 b
How many times did you take him in the first year? ... times
How many
YY
Question does not apply
XX
No answer
(If " Yes.")
17 c
How many times did you take him in the second year? ... times
How many
YY
Question does not apply
XX
No answer
(If " Yes.")

BABY'S SLEEPING ARRANGEMENTS.

s_babyssleepingarrangements_i
(Health Visitors please check these answers if possible.)
18
Does he sleep in a room by himself or in a room with others?
1
By himself
2
With others
X
No answer
18 a
How many others sleep in his room? ... children (under 15) ... adults (15 and over)
How many
How many 2
Y
Question does not apply
X
No answer
(If " with others ")
18 b
Does he sleep in his own cot or with others?
1
Own cot
2
With others
Y
Question does not apply
X
No answer
(If " with others ")

USE OF NURSERIES.

19
Does this baby go (or has he ever gone) to a day or other nursery?
0
No
1
Yes, Municipal or voluntary day nursery
2
Yes, Municipal or voluntary residential nursery
3
Yes, factory day nursery
4
Yes, other, namely
X
No answer
Other
19 a
How many months old was he when you first took him? ... months
Age in months
YY
Question does not apply
XX
No answer
(If baby is going or has gone to a day or other nursery)
19 b
Why did you take him?
1
Mother working
2
Mother ill
3
When Mother confined
4
Other reasons, namely
Y
Question does not apply
X
No answer
Other
(If baby is going or has gone to a day or other nursery)
19 c
Is he still being taken?
1
Yes
2
No
Y
Question does not apply
X
No answer
(If baby is going or has gone to a day or other nursery)
19 d
Would you have liked him to go to a nursery?
1
Yes
2
No
Y
Question does not apply
X
No answer
(If baby not sent to nursery)
19 e
Why didn't he go to one?
1
None available
2
Mother not eligible
3
Baby ill
4
Other, namely
Y
Question does not apply
X
No answer
Other
(If baby not sent to nursery)
(If mother would have liked him to go to a nursery)

THE MOTHER.

20
Are you helped with the housework?
1
Yes, all the time
2
Yes, regularly part-time
3
Yes, occasionally
4
No
X
No answer
21
Are you working now? (i.e. doing paid work inside or outside the home.)
1
Yes
2
No
X
No answer
21 a
What is your occupation?
Generic text
(If " Yes.")
21 b
Is it whole-time or part-time?
1
Whole-time
2
Part-time
Y
Question does not apply
X
No answer
(If " Yes.")
21 c
Who looks after the children when you are at work?
1
Relations or friends
2
Day Nursery
3
Residential Nursery
4
Mother works at home
5
Paid help at home
6
Other, namely
Y
Question does not apply
X
No answer
Other
(If " Yes.")
22
Did you have a post-natal examination by a doctor after your child was born in March, 1946?
1
Yes
2
No
X
No answer
22 a
How many weeks after the birth of your baby were you examined? ... weeks
How many
Y
Question does not apply
X
No answer
(If " Yes.")
22 b
Why did you not have a post-natal examination?
Generic text
(If mother not examined)
23

Have you suffered, since the birth of your baby in 1946, from BREAST ABSCESS, BACKACHE, BLADDER TROUBLE, VAGINAL DISCHARGE, PROLAPSE (fallen womb), or PILES?

-

1 - Yes

2 - No

X - No answer
BREAST ABSCESS
BACKACHE
BLADDER TROUBLE
VAGINAL DISCHARGE
PROLAPSE
PILES
23 a(i)
Where or by whom were you treated? BREAST ABSCESS
0
Not treated
1
Hospital In-Patient
2
Hospital O-P
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Q doesn't apply
X
No answer
(If " Yes.")
23 a(ii)
Where or by whom were you treated? BACKACHE
0
Not treated
1
Hospital In-Patient
2
Hospital O-P
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Q doesn't apply
X
No answer
(If " Yes.")
23 a(iii)
Where or by whom were you treated? BLADDER TROUBLE
0
Not treated
1
Hospital In-Patient
2
Hospital O-P
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Q doesn't apply
X
No answer
(If " Yes.")
23 a(iv)
Where or by whom were you treated? VAGINAL DISCHARGE
0
Not treated
1
Hospital In-Patient
2
Hospital O-P
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Q doesn't apply
X
No answer
(If " Yes.")
23 a(v)
Where or by whom were you treated? PROLAPSE
0
Not treated
1
Hospital In-Patient
2
Hospital O-P
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Q doesn't apply
X
No answer
(If " Yes.")
23 a(vi)
Where or by whom were you treated? PILES
0
Not treated
1
Hospital In-Patient
2
Hospital O-P
3
Nursing Home
4
Private Doctor
5
Chemist
6
Other
Y
Q doesn't apply
X
No answer
(If " Yes.")
23 b(i)
Are you still suffering from any of these? BREAST ABSCESS
1
Yes
2
No
Y
Q doesn't apply
X
No answer
(If " Yes.")
23 b(ii)
Are you still suffering from any of these? BACKACHE
1
Yes
2
No
Y
Q doesn't apply
X
No answer
(If " Yes.")
23 b(iii)
Are you still suffering from any of these? BLADDER TROUBLE
1
Yes
2
No
Y
Q doesn't apply
X
No answer
(If " Yes.")
23 b(iv)
Are you still suffering from any of these? VAGINAL DISCHARGE
1
Yes
2
No
Y
Q doesn't apply
X
No answer
(If " Yes.")
23 b(v)
Are you still suffering from any of these? PROLAPSE
1
Yes
2
No
Y
Q doesn't apply
X
No answer
(If " Yes.")
23 b(vi)
Are you still suffering from any of these? PILES
1
Yes
2
No
Y
Q doesn't apply
X
No answer
(If " Yes.")
24
Have you been fitted with a ring to keep your womb in place?
1
Yes
2
No
X
No answer
25
Have you had either an increased or a decreased loss of blood at your menstrual periods since the birth of your baby in 1946?
1
Increased
2
Decreased
3
Same as before
X
No answer
26
Have you been pregnant since your child was born in March, 1946?
1
Yes, once
2
Yes, twice
3
Yes, more than twice
4
No
X
No answer
26 a
How did the pregnancy end? (i.e. live birth, still birth, etc.)
Generic text
(If " Yes.")
26 b
At what date did the pregnancy end?
Generic date
(If " Yes.")

THE DWELLING AND HOUSEHOLD.

27 a-d

How many are there in your household (including the baby born in 1946 and any later births) who are-

-
How many
Less than 5 yrs. of age ... infants
5 yrs-14 yrs. 11 mths. of age ... children.
15 yrs. or older (including self, husband, older children, relations, lodgers and domestics) ... adults
Total in household
28 a
How many living rooms and bedrooms (including kitchen if used as a living room but excluding if other type of kitchen, scullery or bathroom) are occupied by you or the members of your household ... rooms
How many
29
Is there a kitchen for your use?
1
Yes
2
No
X
No answer
29 a
Is the kitchen shared with another household?
1
Yes
2
No
Y
Question does not apply
X
No answer
(If " Yes.")
29 b
Do you use the kitchen as a living room?
1
Yes
2
No
Y
Question does not apply
X
No answer
(If " Yes.")
30
Is there a bathroom for your use?
1
Yes
2
No
X
No answer
31
How do you obtain hot water?
1
Running hot water
2
Gas or electric copper
3
Boiling kettles
4
Other method, namely
X
No answer
Other
s_32a
PLEASE MAKE ARANGEMENTS FOR THE MOTHER TO BRING HER BABY TO BE WEIGHED EITHER AT THE INFANT WELFARE CENTRE OR WHEREVER ELSE SCALES MAY BE AVAILABLE.
32 a
Present weight (without clothes) ... lbs. ... ozs.
Pounds
Ounces in pound
32 b
Present standing height ... ft. ... ins.
Feet
Inches in foot

HEALTH VISITOR'S COMMENTS.

s_healthvisitorscomments_i
(Health Visitors should not ask these questions, but should fill them in from their own knowledge or observation.)
33
Does this family live in-
1
A whole house?
2
Part of a house?
3
A flat?
4
Furnished rooms?
5
Other, namely
Other
34
Who owns the dwelling?
1
Occupier
2
Council
3
Charitable Trust
4
Private Landlord
5
Other, namely
Other
35
Is there a yard or garden attached to this dwelling in which the baby may be left in its pram?
1
Yes
2
No
36
Please comment freely on the state of the dwelling, its repair, dampness, light and ventilation
Generic text
37
Please comment freely on the bodily care of the baby. Are his clothes clean and in good repair?
Generic text
38 a
Please give your assessment of (a) the state of the dwelling, and (b) the bodily care of the baby. State of the dwelling
1
Good
2
Fair
3
Poor
38 b
Please give your assessment of (a) the state of the dwelling, and (b) the bodily care of the baby. Bodily care of the baby
1
Good
2
Fair
3
Poor
39
How long did this interview take? ... minutes
How many