482 



NATURE 



[December 30, 1915 



MOTHERCRAFT AND INFANT WELFARE. 



NATIONAL existence is to a large extent 

 dependent upon the quantitative value of 

 the population, and diminution of population is 

 the downward path which, if continued, must 

 eventually lead to national extinction. The popu- 

 lation of any country is the resultant of the 

 balance between births and deaths and between 

 emigration and immigration. In the British Isles, 

 while emigration is a material factor in reducing 

 population, the principal influence securing its 

 continuous increase is the excess of births over 

 deaths. 



Unfortunately for the nation, a persistent and 

 serious fall in the birth-rate in the United 

 Kingdom has been in progress for many years, 

 from 307 per 1000 of population in 1887 to 24*0 

 in 1913, and to 23'3 in the June quarter of this 

 year. What this means is better seen from the 

 actual number of births ; in England and Wales 

 alone for the last September quarter the births 

 were 28,000 fewer than in the corresponding 

 quarter of 1913 ! Fortunately, the natural increase 

 of population during the same period has almost 

 been maintained by a striking diminution in the 

 death-rate. It is of interest that decline in the 

 birth-rate is by no means confined to the United 

 Kingdom, but has occurred in many countries on 

 the Continent, the principal factor causing it here 

 and elsewhere being a diminution in the size of 

 the family, chiefly, apparently, in consequence of 

 intentional restriction of child-bearing. 1 



W^e cannot anticipate any increase in the birth- 

 rate at present, but rather a further decrease, for 

 the toll exacted by the present war on the flower 

 of the nation's manhood, the fathers and prospec- 

 tive fathers of her children, is sadly heavy. 

 ^ It is of the utmost importance, therefore, that 

 eVery means should be employed which may tend 

 to maintain the effective fertility of the nation to 

 the utmost practicable extent. If it be impractic- 

 able to increase the number of births, it is prac- 

 ticable to reduce still further the number of deaths 

 of infants and children. As a matter of fact, 

 infant mortality 2 has undergone a striking decline 

 since the beginning of the century — from about 

 158 in 1900 to 105 in 1914. But, even so, the 

 possibilities of saving child-life are by no means 

 exhausted. If the chief causes of mortality during 

 infancy and the first five years of life be ex- 

 amined, it will be found that one-fifth of the deaths 

 in infancy and nearly one-third of the deaths in 

 childhood are due to measles, diarrhoea and 

 enteritis, whooping-cough, and tuberculosis. 

 Bronchitis and pneumonia account for about one- 

 fifth of the remaining deaths, and conditions 

 operating at and before birth (premature birth, 

 injury at birth, etc.) for another fifth. Measles 

 and whooping-cough in themselves are not mortal 

 diseases, the deaths arising mainly from exposure, 

 ineflficient nursing, and unhygienic conditions, and 



1 See "Report on Maternal Mortality in connection with Child-bearing 



and lU Relation to Infant Mortality " (Rep. of the Med. Officer of the 



^°c. Gov. Board) for many of the data and details mentioned in this article. 



Infant mortality "is the number of deaths of infants during the first 



year of life per looo bJTths. 



NO. 2409, VOL. 96] 



much may be done to reduce the mortality from 

 these and the other diseases mentioned by im- 

 proved care of the sick. It is evil conditions 

 of environment, and not poverty only, which 

 kill children and damage survivors; this is 

 well shown by the variation of the death- 

 rate among children in different parts of the 

 community. In 1911-13 the infant mortality in 

 Wigan was 165, in Nelson 87, and the death- 

 rate at ages one to five in the same localities was 

 119 and 58 respectively. The children of miners, 

 a relatively prosperous portion of the community, 

 die at the rate of 166, of doctors at the rate of 40 ! 



Unfortunately, during the last year the infant 

 and child death-rates have shown an alarming 

 tendency to rise, and during the first half of the 

 present year the mortality from measles has 

 doubled. It can hardly be doubted that this is 

 largely due to the increased employment of women 

 and consequent neglect of the home, and to the 

 diversion of the activity of health visitors, district 

 nurses, and others, who hitherto have done 

 splendid work in helping to look after the children 

 of the poor, into other channels more closely con- 

 nected with the war. 



With the view of reducing the mortality from 

 measles, the Local Government Board has just 

 issued an order making measles and German 

 measles notifiable throughout England and Wales, 

 and enabling local authorities to undertake 

 measures for the care of patients suffering from 

 these diseases. 



A national campaign to promote the welfare of 

 mothers and infants has also been inaugurated, 

 and meetings were held at the Guildhall on 

 October 25 and 26. 



Municipal enterprises In the form of ante-natal 

 clinics and maternity homes, infants' departments 

 and milk depots, feeding of expectant and 

 nursing mothers, pre-school and post-school 

 clinics, etc., should be encouraged in every way; 

 what may be done In this direction is well shown 

 by the example of Bradford, which has estab- 

 lished departments in all these branches. ^ 



Another factor which both lowers the birth-rate 

 and tends to increase infant mortality Is maternal 

 mortality in connection with child-bearing, for 

 obviously the mothers who thus lose their lives, 

 had they lived, would in many instances have 

 borne other children, while the infant is more 

 likely to survive when cared for by its mother. 

 In the four years 1911-14 the number of deaths 

 of mothers assigned to complications of preg- 

 nancy and childbirth in England and Wales was 

 i4)045) corresponding to a rate of 4*0 per 1000 

 births. The mortality among mothers due to 

 child-bearing varies in different parts of the 

 country. It is highest in Wales and Westmor- 

 land, and may there, perhaps, be ascribable to 

 deficiency of skilled assistance In childbirth; it is 

 also very high in textile areas, where female 

 labour is largely employed. But the question is 

 a complicated one, for we find that the mortality 



'See "Maternity and Child W-lfare." By E. J. Smith. (P. S. King 

 and Co.) Price is. net. 



