In the ‘Transactions of the Obstetrical Society for 1870’ there is a valuable and interesting report, throwing much light on the condition and treatment of the children of the poor in England. The following is the substance of this report, the information contained in which was collected by various members of the society:—It was found that amongst the poorer populations of villages 30 to 90 per cent. are attended by midwives, and that this custom prevails to an almost equal extent in the large provincial and manufacturing towns. Thus in Glasgow, 75 per cent., in Coventry, 90 per cent.; and in Leeds and Sheffield, equally large numbers of the population employ the services of these women. In Edinburgh the midwife is rarely called on; neither is she in the West End of London; but in the East End 30 to 50 per cent. of the accouchements are undertaken by women.
Except in Glasgow, Sheffield, and London, the women are asserted to be totally ignorant and incompetent to meet any difficulty that might arise. In country districts the pernicious custom of giving an aperient to a newly born babe was very general, but less prevalent in London and the large towns. Amongst the married poor, suckling was found to be the rule; and it seemed to be pretty conclusively proved that it is often unreasonably prolonged for eighteen months or even two years, as a preventive to renewed pregnancy. It was found, however, that illegitimate children were rarely suckled, but almost always fed on artificial food. Amongst the married poor also it appears universal to give the children artificial food as well as the breast, and this from a very early and tender age. Further, it was found that the food was generally unsuited to the child both in quantity and quality. It consisted chiefly of bread soaked in water and milk, and sweetened, of arrow-root, sago and corn flour, and such like objectionable substances.
In one case the mother admitted to giving her infant (who was a few months old only) a diet similar to that she herself partook of, viz.—cheese, bread, meat, salt fish, heavy pastry, vegetables and beer. Amongst the upper classes it was ascertained that there is an increasing tendency amongst mothers to discontinue lactation, and to employ instead the services of a wet nurse; and where this was not done, it was found that the food partaken of by the babe was much more judiciously chosen than is the case amongst the poorer women. Mr Curquiven and others observed that a large number of women in London do not suckle their offspring, because of a deficient secretion of milk. It is satisfactory to find that both in the manufacturing and agricultural districts, the children of the poor are so constantly in the open air; but equally unsatisfactory to learn that at night they sleep in ill-ventilated and over crowded dormitories. The infant is encouraged to sleep to the utmost, and should it fail in securing renewed slumber (its waking being attributed to a desire for food), is very often dosed with gin, syrup of poppies, and paregoric. Another plan adopted for keeping infants quiet, consisted in letting them remain in the cradles and allowing them to suck the nipple attached to the empty feeding bottle, long after the food had been consumed; a practice that gives rise to infantile dyspepsia.
As regards cleanliness, it was learnt that poor people’s children are tolerably well attended to in this respect, or rather that the baby generally comes in for a larger share of ablution than the elder ones, who are sometimes much neglected in the matter of soap and water. The clothing of the little ones was much too scanty, and this was the case no matter what the season of the year. A prevalent practice, except in the agricultural villages, was that of giving the children cordials, spirits, and medicines.
A still worse custom was found to be the systematic administration of opiates. At Long Sutton, in Lincolnshire, which has a population of 6000, one chemist alone sold 251⁄2 gallons yearly of Godfrey’s cordial (a mixture principally consisting of treacle and opium), whilst 61⁄2 pints were got rid of weekly by another chemist in the same town. This administration of anodynes was mostly confined to illegitimate infants, and factory children placed out to nurse. A habit not unusual was that of an intentional deferring sending for a doctor when the child was first seized with illness, medical advice being only sought when in many cases it could be of no avail. Desertion by fathers and mothers of their children, especially of illegitimate ones, as well as concealment of birth and infanticide, were found to be much more general in London and the larger cities than in the country.
The causes of the high rate of infant mortality prevailing amongst the poor, seem very clearly indicated in the above abstract. For instance, the deaths of nearly half the children under one year of age are referable to diarrhœa, convulsions, atrophy, mesenteric
disease, and allied disorders; all of which maladies are caused by the grossly erroneous and unsuitable diet upon which the children are fed. In the article “Infants’ Food,” we have already pointed out that the proper and only safe aliment for an infant up to the age of eight or nine months is the maternal milk, and failing this, the pure and unadulterated milk of the cow; and we have furthermore shown that the admission into the dietary of infants even above nine months old, of farinaceous foods, should be regulated with great caution. Yet we learn from the above report, that in the early days of the infants’ existence, amongst the poor the breast milk is in most cases supplemented by large quantities of these very farinaceous matters, which we have shown to be so prejudicial and dangerous. That the deaths from these causes are clearly preventable, in a large measure, if not wholly, is proved by the very much less extent in which they occur amongst the higher classes, who use much greater judgment in the selection of their children’s food. Another important factor in the high infant death-rate is the extensive use of narcotics, a practice there is no doubt which yearly carries off a large number of infants, by poisoning, more or less prolonged. Inadequate clothing is likewise another source of mortality amongst the very young, whose tender frames easily succumb to inclement weather, and the sudden changes of temperature occurring in our variable climate. Hence we shall have no difficulty in understanding why pneumonia, bronchitis, &c., should be so prevalent among poor children. The habits of overcrowding and bad ventilation which prevail amongst the poor must also be fertile sources of disease amongst their offspring—the more immediate effect of such violations of sanitary principles resulting in bronchitis. That the extensive recourse by the poor to uneducated and unskilful midwives, also adds to infant mortality, seems indisputable.
In the report already alluded to, beyond reference to the fact that infanticide was rare, we find no mention made as to the number of violent deaths occurring amongst infants. It appears that about a sixteenth of the mortality amongst infants under one year old is due to violence, mostly accidental, the great majority of such deaths being caused by the mother lying upon and smothering her babe. These misadventures are said to occur mostly on Saturday nights, and raise the question as to whether a large proportion of such deaths are not due to the drunkenness of the mothers, who retire to rest in a state of alcoholic stupor.[358]
[358] Blythe.
The inference, we think, to be drawn from the above statements is, that the preponderating mortality prevailing amongst the children of the poor is due to ignorance and poverty, and not to intentional neglect or want of parental affection. Bearing in mind that poor women much more frequently suckle their babes than rich ones, it might perhaps be argued that this was evidence of greater maternal solicitude, and that, therefore, the poor mother exhibits more natural affection than the lady who consigns her offspring to the arms of the wet-nurse; but, possibly, were the circumstances of the two inverted, the lady might be found giving her infant the breast, whilst the humbler wife might call in the services of the wet-nurse; neither of them perhaps reflecting that, in choosing the latter alternative, they were depriving another little human unit of the maternal sustenance, and exposing it to the dangers of vicarious nurture and supervision. What these dangers are that beset the children of the poor when removed from their mother, the revelations of baby-farming and the appalling statistics of illegitimate infant mortality serve very forcibly to illustrate. For every 311 legitimate children of all classes 500 illegitimate out of every 1000 die each year under one month old, this large increase being due to cruel neglect and substitution of bad, insufficient, and improper food for the maternal milk. That in their own homes they are exposed to the serious hardships arising from errors in diet has already been shown, but in their own homes they die at little more than half this rate; hence the deduction is unavoidable that half of these poor little waifs perish because they are deprived of the care and solicitude of the mother.