ESSAY-REVIEWS 679 



provides an admirable introduction to the essential features of the whole problem. 

 It is a statesmanlike summary by one who has enjoyed unique opportunities and 

 has proved himself a master in organisation and administration. Dr. Hope con- 

 cludes : " a careful survey of the whole subject reveals many needs, some of which 

 may be, or are being, dealt with by local authorities, local philanthropy, or both. 

 It is, however, perfectly obvious that there remain some passing necessities for 

 which there is as yet no adequate provision nor prospect of making it." Among 

 the pressing necessities the following are enumerated : (i) The provision in 

 suitable localities, and under appropriate conditions, of maternity homes for the 

 benefit of outlying rural populations, (ii) The establishment of welfare centres 

 to meet the recognised needs of pre-maternity and infancy, with which may 

 be associated day nurseries. The need for provision for the better care of 

 illegitimate infants calls for careful consideration, (iii) Provision for the im- 

 provement and better equipment of the means of education in the various 

 branches of the science of public health, and for the encouragement of further 

 research into the circumstances adversely affecting Infancy and Motherhood. 



Dr. Hope supplies data and arguments, warnings and suggestions, and a 

 careful study of his recommendations will go far to initiate enterprises and 

 endeavours along sure lines. It is shown that had the annual wastage of male 

 infant life during the last fifty years been no greater than it is at the present 

 time, at least 500,000 more men would have been available to-day for the defence 

 of the country. No less than 90,000 of the infants born in England and Wales 

 annually do not survive the first year. It is interesting to find that the number 

 of survivors per 100,000 of the population is higher, both actually and relatively, 

 when the birth rates and infant mortality rates are both high, than when these 

 figures are low ; or in other words, under existing conditions it is the high birth 

 rate, notwithstanding its accompanying waste, rather than the low birth rate 

 and the greater saving associated with it, which dominates the increase of the 

 population. Dr. Hope shows that much of the infantile mortality is due to the 

 following factors : (i) The presence of some antenatal condition in the mother 

 which requires treatment ; (ii) the need for emergency medical assistance before, 

 during, and after confinement ; (iii) the presence of syphilis in the stillborn or 

 in the parents ; (iv) lack of skilled midwifery assistance ; (v) the need for 

 improvement and care in the feeding and hygienic management of infants. 



Many will be glad to note that Dr. Hope is a convinced supporter of judicious 

 co-operation between voluntary and official workers. The first volume contains 

 a series of charts and diagrams which graphically portray some of the most con- 

 spicuous facts and features of infant mortality rates, distribution, and relationship 

 to various areas. The co-ordination and relationship of special effort, voluntary 

 and official, in promoting the welfare of mothers and little children are strikingly 

 brought out by cleverly designed scheme- diagrams. A praiseworthy feature is 

 the very full and effectively arranged abstract of the main legislative enactments 

 in operation in England and Wales bearing on maternal and infant welfare and 

 particularly on the protection of child life. Of special value at the present time 

 are the condensed and skilfully arranged epitomes compiled from Reports fur- 

 nished by Medical Officers of Health of various Counties and Boroughs of 

 England and Wales. The information thus provided will be invaluable for 

 reference and should go far to stimulate local authorities to undertake com- 

 prehensive and practical schemes. 



Vol. II., prepared by Dr. Janet M. Campbell, contains much valuable material 

 relative to Midwives and their Practice and the service which is being accomplished 



