October 25, 191 7] 



NATURE 



147 



of the mortality statistics bringfs out some startling 

 facts. Of the total deaths occurring in England 

 and Wales during the four years 1911-14, 282 

 f>er cent., or rtxore than one-quarter, occurred 

 during the first five years after birth ; the number 

 of deaths of persons sixty-five to seventy years of 

 age is less than of children one to five years of 

 age, and it is not until the age of seventy years and 

 upwards is reached that the mortality is greater 

 than that of infants up to one year of age. For 

 England and Wales the present infant mortality 

 [i.e. deaths of infants up to one year of age) per 

 1000 births is about no. This means that of the 

 800,000 infants born in a year some 100,000 never 

 live to see their first birthday. Further, probably 

 at least as many prospective children die before 

 birth, and half the number between one and five 

 years of age, so that out of 900,000 possible 

 children 250,000 have succumbed by the end of the 

 fifth year. What should we think of 250,000 

 casualties — all fatal — ^out of 900,000 in action? 

 And what of the uncounted wounded and disabled? 

 It may be said that, high as our present infant 

 mortality appears from such figures, it is, at any 

 rate, much less than formerly. Fortunately for the 

 nation, this is quite true; the infant mortality has 

 fallen from 165 in 1899 to no at the present time. 

 But, even so, there is still an appalling mortality 

 among infants and young children, and the pity 

 of it is that it is undoubtedly largely preventable. 

 The best proof of this statement is, perhaps, the 

 startling difference in child' mortality in different 

 districts. We find, for example, that during the 

 first year of life : 



In Burnley 172 die against 67 in Hornsey 



In Stoke-on-Trent 161 „ „ 70 in Ilford 

 In Wigan 1 59 ,, ., 78 in Bath 



If, instead of taking the death-rate of infants, 

 we take that of children up to five, the result is 

 the same : 



In Middlesbrough 251 die against 109 in Bournemouth 

 In St. Helens 242 „ „ no in Ealing 



In Oldham 223 „ „ 127 in Croydon 



But this is not all. So far these towns have 

 been considered as a whole, but the worse have 

 their good and bad parts. Thus, while the general 

 hild mortality up to five in Middlesbrough is 251 

 per 1000 births, for the Canon Ward it is 328, and 

 for the St. Hilda's Ward 369 ! If we survey the 

 country generally, it will be found that child 

 mortality is greatest in the large industrial towns 

 and mining centres, less in the smaller towns, and 

 least in the rural districts. Poverty is not the domi- 

 nant factor, for the highest child mortality occurs 

 in areas where, on the whole, wages are good, and 

 ^ r. Findlay, in a report to the Medical Research 

 Committee, notes that in times of famine and 

 ndustrial trouble the infantile death-rate usually 

 alls. He emphasises the importance of environ- 

 nent (housing, etc.) as a factor in causing the 

 wesent high infantile mortality. 

 Of the total deaths of children up to five years ! 

 NO. 2504, VOL. 100] 



of age 123 per cent, are due to measles and whoop- 

 ing cough, 19' 5 per cent, to bronchitis and pneu- 

 monia, 1 58 per cent, to diarrhoeal diseases, and 

 230 per cent, to "congenital debility." It is 

 fairly obvious that diarrhoeal diseases and congeni- 

 tal debility are largely dependent upon the con- 

 ditions under which the people live, and the same 

 holds good also for the other diseases mentioned. 

 We find, for example, that, as regards measles and 

 whooping cough — two diseases over which we have 

 the least control — 6 per 1000 die of these diseases 

 in Harrogate and Weymouth, against 41 in Shef- 

 field and Stalybridge. With facts of this kind 

 before us it is patent that a considerable saving 

 of child-life might, and ought to, be accomplished. 

 Of the factors conducing to child mortality, the 

 principal are ignorance and carelessness, intem- 

 perance, disease, and poverty, overcrowding, 

 vitiated atmosphere, impure milk supply, and 

 defective sanitation. 



The remedies are, for the most part, obvious ; 

 they comprise : (i) A better training for mother- 

 hood on the part of girls of all classes; (2) improved 

 care of the prospective mother and the provision 

 of well-trained midwives, health visitors, and 

 maternity and child-welfare centres ; (3) the clear- 

 ing out of slum areas ; (4) improved housing of the 

 masses, with a wider distribution of the popula- 

 tion and better sanitation ; and (5) an equitable 

 solution of the drink problem. A great deal can 

 be done by certain measures of care and super- 

 vision alone. Mr. Benjamin Broadbent, when Mayor 

 of Huddersfield in 1905, tried such an experi- 

 ment, with the result that of 112 babies born in 

 that year, 107 survived the first year, and ninety- 

 seven were surviving in 1915, ten years later, 

 whereas, according to the average rate of mortal- 

 ity, only eighty-four would have been alive in 



It ought to be appreciated by every right-think- 

 ing man and woman that the child is a national 

 asset of great price, and that the saving of child- 

 life is a duty, national as well as humanitarian. 

 The problem is a vast and complicated one and 

 worthy of the best efforts of the State, yet how- 

 little has hitherto been done to grapple wuth it on 

 anything' like a national scale. Mr. Hayes 

 Fisher has recently promised to introduce, and if 

 possible to pass by Christmas, a Maternity and 

 Infant Welfare Bill to deal with the problem. He 

 indicated, however, that delay might be caused 

 by sources of opposition much the same as have 

 apparently obstructed the formation of a Ministry 

 of Health. Let us see to it that Mr. Hayes 

 Fisher's hands are strengthened by the force of 

 public opinion. The call is urgent, and human 

 lives, so much needed by our country, are at 

 stake. 1 



R. T. H. 



1 For data bearing on thU subject, see " Report on Matem.il Mortality in 

 connection with Child-bearing and its Relation to Infant Mortality "; "Report 

 on Child Mortality at Ages 0-5 in England and Wales " (L.O.B. Reports, Cd. 

 8085 and 8496); "The Problem of Infant ani Child Mortality," by \. 

 Sheldon Wither:, Medical Officer of Health for Sidmouth ; " The Mortali- 

 ties of Birth, Infancy, and Childhood," by Drs. Brend, Findlay, and 

 Brownlee (Special Report Series, No. lo. Medical Research Committee;. 



