CHAPTER VIII.

INFANT MORTALITY.

"A revolution in the economic incidence of the burden of child-bearing would leave the way open to the play of the best instincts of mankind. To the vast majority of women and especially to those of fine type, the rearing of children would be the most attractive occupation, if it offered economic advantages equal to those, say, of school teaching or service in the Post Office. At present it is ignored as an occupation, unremunerated, and in no way honoured by the State. Once the production of healthy, moral, and intelligent citizens is revered as a social service and made the subject of deliberate praise and encouragement on the part of the Government, it will, we may be sure, attract the best and most patriotic of the citizens."-SIDNEY WEBB in the Times, October 16th, 1906.

IN

NFANTS are children under twelve months of age, and the infant mortality rate is the proportion which the deaths of such infants bears to every thousand births. An ordinary death rate is the proportion which the total deaths of a community bears to a 1,000 of the population. We say, for instance, that the death rate of London in 1906 was 15 per 1,000, by which we mean that in every 1,000 people living in London 15 died during

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1906. In some towns this figure rises to about 25, in others and in rural districts it may fall to 10 per 1,000 people living in the district. But it is clear that a more accurate way of recording the death rate of infants is not per 1,000 persons living but per 1,000 born in the same year. In some places this figure is as low as 80 per 1,000 births, which means, of course, that for every 1,000 children born in the year 80 die before they are twelve months old. In other places it is found that this infant mortality rate is high, say 160, or even 200 or 250 per 1,000. A low rate, other things being equal, indicates a healthy community, a high rate the reverse.

There are three chief reasons why a high infant mortality rate is a matter of grave importance. First, a high mortality rate indicates a heavy loss of young lives by death. In 1905 there was, for instance, a loss to the nation of 120,000 infants dying under one year of age in England and Wales alone. This loss is being repeated year after year and is not growing less. So that in view of the marked decline in the birth rate which is taking place the loss becomes very grave. We are burning the candle at both ends. Fewer children are born and yet there is the sacrifice continually going on. Secondly, the circumstances and diseases which kill 120,000 infants every year, maim and injure the children who survive. Some only survive a few months, but others linger on and even grow up to adult age. Nevertheless, it cannot be doubted that many of them are as brands plucked from the burning, and bear the mark of death upon them. It is idle to wonder at physical degeneration if the majority of the nation's infants have before they grow up to pass under such unfavourable

influences as are able to kill 150 in every 1,000. A high infant mortality must therefore be taken, as Sir John Simon said, to denote a prevalence of those causes and conditions which, in the long run, bring about a degeneration of race.* Thirdly, a high infant mortality indicates the existence of evil conditions in the mothers and in the home-life of the people. It is an index of social evil. Poverty is not alone responsible, for in many poor communities the infant mortality is low. Housing conditions and external surroundings generally do not alone cause it, for under some of the worst external conditions in the world the evil is absent. There must be something else more intimately connected with social life, and more personal, than these things, which we must now consider. And to discover the true cause we must first learn the true state of the problem.

Characteristics of Infant Mortality.

When we come to look more carefully into the death of infants we shall find some interesting facts. The general death-rate and the special death rates for most diseases are year by year declining, while the infant mortality is stationary, in some places slightly falling, in others rising. This is shown in the table on the following page.

The first fact to get hold of, then, is that infants are not sharing in the general improvement and decline in sickness and death rates which has occurred at other ages. Nor is this only the case in England.

* Dr. Kerr has shown that school children who were born in years of high infant mortality have a poor physique. (Report of medical officer of L.C.C. Education Committee, 1905, pp. 8-11).

It is even worse in Germany, Austria, Spain and Russia, where the infant mortality is higher than in this country. Whereas in Scotland and Ireland, in Australia and New Zealand, and in Norway and Sweden, the case is very different. There the mortality among infants is low and is declining along with the other death rates.

Another fact which soon emerges in response to a little study of the matter is this, namely, that infant mortality is greatest in the first few weeks of the first year. When we think of 150 infants out of every 1,000 born dying before they are twelve months old, we must not think that the deaths fall more or less equally and uniformly throughout the first twelve months. As a matter of fact one fifth of the total loss of life in infancy occurs in the first week of life, one third of the deaths occur in the first month, and about half in the first three months.† Farr expressed this by saying that the

* For a five year period only, as compared with the ten year periods.

↑ Sixty-Eighth Annual Report of Reg. General, 1905, p. cxviii.

infant mortality in England was 570 per 1,000 births under one month, and 91 under eleven months, whereas in a town, such as Liverpool, it was 672 for infants under one month and 280 for infants under eleven months. The point of importance is that the burden of mortality falls most heavily upon the first weeks of life. Further, as I have elsewhere shown, this is increasingly so*; for while the death rate of infants aged three to twelve months is decreasing, the death rate among infants under three months of age is increasing. It should also be remembered that the death rate of illegitimate infants is nearly twice as high as that of legitimate infants.

Again, another fact to consider is that infant mortality is higher in towns than in rural districts, and higher in manufacturing than in agricultural districts. For instance, the West Riding, Lancashire and Staffordshire are high mortality districts, whereas Wiltshire, Dorset and Westmoreland are low mortality districts. Infant mortality in fact is largely a curse of the towns, and occurs in them in excess of the rural districts mostly in the late months of the first year of life. It also occurs more in the central, poor, and densely crowded areas of towns than in the better districts. The high infant mortality rates in London are in Shoreditch, Southwark, Bermondsey, Bethnal Green, Poplar, and Finsbury; the low ones are in the comfortable and airy districts of Hampstead, Marylebone, Lewisham, and Stoke Newington. In 1905 urban infant mortality was thirty per cent. in excess of rural; they are almost the same in the first week of life, but in the later months of the year the urban is fifty per cent. in excess of the *Infant Mortality (Methuen), pp. 12-14.