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of Lords has taken seriously in hand the question of its own reconstruction. It has, through a strong and representative Committee, put forward a scheme of reform at once simple and coherent, drastic and conservative, which looks to the future without breaking with
It is, I submit, the clear duty of all who regard politics seriously, who think less of party than of the Commonweal, to give to that scheme a respectful, if critical, consideration.
J. A. R. MARRIOTT.
THE WASTE OF INFANT LIFE
The primitive instinct of self-preservation taught men to avoid such things as were shown by experience to be detrimental to the race, or to the individual. In this category disease and death will evidently hold a foremost place; they are, as it were, malevolent forces of Nature, sent out by her to attack the human race. The progress made by civilised nations during the last hundred years is due almost entirely, either directly or indirectly, to the control which has been gained over the forces of Nature. This was obtained by first of all investigating the force; the next step was to find the means for its control.
In the Middle Ages, if an epidemic broke out in any part, the inhabitants all fled. It was looked upon as a judgment of Providence, and cause and remedy were unknown and unsought for. This is no longer the case. We have been able in many instances to discover the cause and to control it. The first sign of any epidemic is not the signal for a general flight, but for active measures being taken to prevent its spread ; whilst suitable care and treatment are arranged for those already attacked. Owing to increased knowledge, plague, that terrible scourge of the Middle Ages, has been stamped out of England; and the same is now true of hydrophobia. The measures to be adopted for the prevention of tuberculosis form one of the topics of the day; and everyone knows that great efforts are being made to discover means for the cure and prevention of
The nation is awakening to the possibility of the control of disease; it is realised that whilst it is good to cure, it is better to prevent. There are many troubles which a little knowledge and care may prevent, but which much knowledge may be unable to cure.
Although the chief causes of mortality among adults are occupying the attention of many of the thoughtful men and women of the day, the same cannot be said of the causes of mortality among infants. Most people, perhaps rather naturally, feel more chagrined at the death of some young man or woman in the prime of life than at the death of a baby.
It is rightly considered that the life of an adult, especially of a young adult, is of value to the community, and that every effort should be made to preserve it; the death of a baby is the cause of very little concern to anyone outside its immediate relations. But it must not be forgotten that every baby is a potential adult, and as such of value to the State.
The highest death-rate is, of course, among old people from sixty-five years of age upwards; but with that exception the mortality rate among infants is very greatly in excess of that at any other age. The birth-rate for England and Wales is decreasing annually, as is also the death-rate ; and a decreasing death-rate will naturally tend to raise the rate of increase of the population. The rate of increase is, however, declining, in spite of the fact that the average length of life has increased during the past years.
Table I. gives the Registrar-General's statistics for the last thirty years :
If the rate of increase continues to decline a time will come when there will no longer be any increase, and the next phase will show a death-rate which is in excess of the birth-rate. This means gradual depopulation. This is a state of affairs which prevails, as is well known, in France at the present time. The French are making every effort to alter the condition, but the causes concerned are very difficult to detect, and therefore to control. Not until the French were faced with actual depopulation were active steps taken.
The steady tendency towards depopulation shown in Table I. makes it advisable that we should learn betimes from our neighbours the causes of this condition and the measures which may be adopted for its counteraction.
II.-THE WASTE OF INFANT LIFE IN ENGLAND (a) Infantile Mortality : Its Extent, and the Causes of Death The causes of a decreasing birth-rate are bound up with some of the most complex problems of domestic life. The present social conditions in England render it difficult to hope for much improveLent in the way of an increased birth-rate; possibly in years to
VOL. LXV - No. 383
come satisfactory means may be adopted, but it is not proposed to deal with the matter in this article.
Given that it is a difficult, if not impossible, matter to hope for an increased number of births in the near future, it becomes of the greatest importance to preserve all the children that are born, in order, as far as possible, to discount the present decreasing birth-rate. The rate of infant mortality in England is terribly high, and calls for very serious attention. The question is by no means a new one to those whose work is in any way connected with the public health ; much has been written about the possible causes, and many lists of statistics have been published. As yet, however, even the more intelligent public is scarcely awakening to the existence of the problem, and has certainly not realised its gravity.
Under the heading of infantile mortality is comprised the number of deaths from all causes of children under one year of
recorded in the proportion of deaths to 1000 births. An analysis of the figures for the past few years (see Table II.), which are very representative of the condition for some time past, will show the main causes of death.
Proportion of Deaths to 1000 Births among Children under One
Year of Age
It is evidently most important at the present time to discover some means of prevention of those diseases which show the highest mortality. To do this we must know at any rate some of the causes at work. The highest figures occur under wasting diseases and diarrhoea. The former heading includes prematurity, marasmus, debility, atrophy, congenital defects, injuries at birth, and starvation -a somewhat varied assortment, involving a large number of factors. The next highest figures are those of diarrhoea. It is generally acknowledged that the cause of diarrhea is some form of incorrect alimentation. There are, however, in addition several concomitant factors, which may with advantage be considered here.
(6) The Causes of Diarrhoea. A glance at the Registrar-General's report, together with other public health statistics, shows that the highest mortality from Carrhea takes place in the summer, chiefly in the third quarter of the year—that is, during the hottest weather. It also depends on
— :he prevailing meteorological conditions for the particular year, being less in cold, rainy summers than in hot, dry ones. The onset and duration of the epidemic appear to be mainly dependent upon he mean average temperature; a short spell of very hot weather in the early part of the year does not cause any noticeable increase in diarrhoea, but a prolonged period of warm weather gives rise to the cset of the epidemic after a variable number of days, depending upon the degree of heat. The mortality is generally rather more than Tce as great in the urban as in the rural districts. Its victims are mery largely quite young babies, from one to about five or six months. The rate of infant mortality has only been correctly estimated for about the past thirty years, and the returns under the heading of Fasting diseases are probably still somewhat inaccurate. During - is period the average total mortality and the deaths from various anses have not undergone any very marked diminution, and this in spite of improved hygienic conditions and with a constantly decreasing Cith-rate.
À consideration of the food of a child of under nine months of age shows that the meteorological and other factors are really secondary - the main question of improper feeding. Up to that age a child would be fed exclusively on milk, or, at any rate, up to the age of six Baths. The milk, unfortunately, in very many cases is not mother's -2, but cow's milk. A pure germ-free cow's milk may be said to e an impossibility ; even with all precautions a sample taken Crectly after milking shows several thousand microbes of many varie*33 in each drop of milk. These multiply, slowly in winter and rapidly in summer. The transit of the milk from the farm to the home Serapies a good many hours, during which time the microbes continue to multiply. The milk undergoes various manipulations, and fresh Sparces of contamination are added at each step. By the time ordinary god milk reaches the infant it frequently contains several million Jerobes per drop, and also a large number of the products of metaWism of the microbes--i.e. those substances formed by the living microbes during their growth. Some of these may be injurious, if ist absolutely toxic to the child. This is all accentuated in hot Trather by the increased rapidity of multiplication. In hot, dry Feather dust is prevalent, and dust swarms with microbes. Flies 2e prevalent, and are well known as disease-carriers. The milk is atten kept for many hours, and is no longer even moderately fresh aten it is given to the child. Most frequently no attempt is made to