CHAPTER IX.

METHODS FOR THE PREVENTION OF INFANT

MORTALITY.

"First concentrate on the mother. What the mother is the children are. The stream is no purer than the source. Let us glorify, dignify, purify motherhood by every means in our power.

In every aspect of this subject let us have good mothering; that is at the bottom of happy. healthy children.”—THE RIGHT HON. JOHN BURNS, M.P. June 13th, 1906.

A COMPLEX problem, such as this, is no doubt

brought about, as we have said, by an ancestry of causes ; some of which have their origin far back in social or family life. Not one preventive method but many will therefore be necessary, if we are to wage effective warfare. Broadly, however, it may be said that the main lines of reform are to secure physical efficiency in the mother, an improvement in the nursing and management of infancy, and the better feeding of the child.

I.--Physical Efficiency of the Mother. One of the supreme assets and bulwarks of a nation is its motherhood. Wherever we turn, and to

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whatever issue, in this question of infant mortality, we are faced with one all pervading primary need -the need of a high standard of physical motherhood. The death of infants is not a problem of sanitation alone, or housing, or even of poverty as such, but it is mainly a question of motherhood. No doubt external conditions as those named are influencing maternity, but they are in the main affecting the mother rather than the child. They exert their influence upon the infant indirectly through the mother. The infant depends for its life not upon the state or the municipality, nor yet upon this or that system of crèche or artificial milk feeding, so much as upon the health, the intelligence, the devotion, and the maternal instinct of the mother. So that if we would solve this great national problem it would appear that we must first begin with the mother.

Now what are the forces and influences which result in a high standard of physical motherhood? We at once think of heredity, of up-bringing, of training, and of physical health, which in turn lead us to think of good housing (and still more of good homes), pure and nourishing food, freedom from hard work during child-bearing, a temperate life, healthy habits, and a wholesome mind.

These are not things to be bought in the market. They are the fruits of a liberal and commonsense education, and spring most naturally from seed sown in childhood. Nevertheless, much may be done in certain directions even after the girl has become a woman or the woman a mother. Let us name two of these directions :

(1). If possible, a woman should be relieved of hard work of any kind for some time before and after child-birth. The present Factory Act (S. 61),

requires that an occupier of a factory or workshop shall not knowingly" employ a woman within four weeks after child-birth. But this is not sufficiently drastic, and does not affect all women workers, and does not affect any before child-birth.

(2.) A child-bearing woman should be supplied with sufficient and nourishing food. This is perhaps one of the primary duties of the father of the child, but where that natural supply is not forthcoming assistance should be rendered from other sources. In Germany there are the insurance maternity funds. In France there exists a Society of Nursing Mothers, established in 1876, and recognised by the Government, which has for its object the protection and feeding of mothers before and after child-birth. It works by means of " refuges," relief bureaux, and dispensaries, and from 1877 to 1904 had sheltered nearly 10,000 future mothers, and watched over 39,000 children. Somewhat similar work is being done by Dr. Meile, in Ghent, in his admirable preventive work of twelve different services" of aid in the rearing of infants. Then there are Madame Coullett's restaurants in Paris for nursing mothers, where any mother suckling her infant may obtain two good meals daily, without charge and without any question whatever being asked. "They are mothers-they are hungry that is enough." Then in East London there is the Sick Room Helps Society, which provides personal help in the homes of poor Jewish women at the time of child-birth. Elsewhere in England one or two experiments in feeding suckling mothers have been tried, but reorganisation is necessary of the charitable agencies in England which have this sort of work for their object.

II. The Better Management of Infancy. There are two main points to be considered under this heading, namely, birth registration and the proper management and care of infancy.

By the Births and Deaths Registration Act of 1874 (S. 1), it was enacted that, in case of every child born alive, it shall be the duty of the parents, or, in their default, the occupier of the house in which the child was born, to give to the district registrar, within forty-two days of the birth, information and the necessary particulars for registration. Where this information has not been furnished within the specified period, the registrar may, by notice in writing, require the necessary information within not less than seven days and not more than three months. In practice it has been found that about half to two-thirds of the total births in England and Wales are registered within the six weeks' limit of the Act. In Scotland, by an Act of 1854, the period allowed for registration is twenty-one days, that is, three weeks in place of six weeks. The French Code. (Civil Art. 55) provides for registration within three days of birth.

When it is remembered that about one-third of the total deaths of infants take place in the first month of life, it will be evident that many births first come to the knowledge of the Sanitary Authority on the bills of mortality, which, of course, effectually precludes any preventive action whatever. The fact is that one of the most pressing legislative requirements in the whole range of public health law is a provision requiring the earlier registration of births. There should also be some system of registration of still-births. There is, at present, no record kept in England of children born dead.

In 1908 the Notification of Births Act 1907 comes into vogue. It is an adoptive Act only and requires notification of the birth to the medical officer of health within thirty-six hours of occurrence. Registration remains unaffected.

Then in the next place there is a great deal of lost ground to be made up as regards the management of infancy.. "Nothing seems to be wanting," wrote the Medical Officer of Burnley in 1905,

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but a department to teach the burgesses commonsense, and mothers how to feed a child till its teeth come and how to nurse it when it is poorly." It is to be feared that this candid remark is very near the truth of the matter. The enormous sacrifice of infant life every year to lung disease denotes harmful exposure of babies to unequable temperatures and to cold, yet, next to food, warmth is one of the main requirements of young children, and it is closely followed in importance by cleanliness. It is, after all, the elementary needs that a young child requires for its life, namely, food, warmth, fresh air, cleanliness, and sleep. Now to secure these things calls for carefulness, foresight and skill in infant management, and these are not birthright faculties, but require training and experience. We must therefore (a) educate young mothers in domestic hygiene, and (b) still more so the older girls in the elementary schools. (c) Leaflets of advice should be issued and (d Lady Sanitary Inspectors and Health Visitors appointed to give timely counsel.

Much benefit has been derived in the opinion of those well able to judge, in districts wellequipped in regard to Health Visitors. In the Longwood district of Huddersfield, in Finsbury, in Preston, in St. Pancras, and in many other places