(1) Poor physique of the mother or inheritable disease in one or other parent, causing premature births with weakened constitutions and congenital defects in the children.
(2) Ignorance of mothers in appropriate infant care and low standard of home life; bad feeding and insanitary conditions are accountable for the greater number of child deaths.
We find the infantile death rate is much higher in urban communities than it is in rural England. It is well to give a table to show this—
| Annual Rates per 1000 living | Annual Rates per 1000 births | |||
|---|---|---|---|---|
| Birth Rate. | Death Rate. | Diarrhœa and Enteritis (under two years). | Infant Mortality Rate. | |
| England and Wales | 23.8 | 13.7 | 20.4 | 105 |
| 97 great towns (including London) | 25.0 | 15.0 | 26.1 | 114 |
| 145 smaller towns | 23.9 | 13.1 | 19.8 | 104 |
| England and Wales less the 242 towns | 22.2 | 12.4 | 12.6 | 93 |
| London | 24.3 | 14.4 | 27.6 | 104 |
Consider the reason for this difference in the death rates—114 deaths per 1000 in the great towns, 104 in the smaller towns, and 93 in the country districts. Does not this prove that children are killed by the conditions into which they are born. It is obvious that urbanisation, with all that it means of unhealthy living, with factory work and the employment of women, exerts a profound effect on the lives and health of little children.
A portion of infant and child mortality represents, I well know, the removal from life of diseased children who ought never to have been born, and would not have been born under different sexual conditions, for this, above all, is a question of instructed motherhood. I am not forgetting this side of the problem. But these children, doomed to death from the time they are conceived, represent a fraction only of our infant mortality. The vast majority of babies are born healthy; it is we who kill them. Though the fact of the falling birth rate is being shouted aloud with an ever-increasing fear and insistence, the plain, simple fact is neglected; it is absurd to go on having more babies if we can’t first care enough to keep alive the babies that we have. There are still too many births for our civilisation to look after; we are still unfit to be trusted with a rising birth rate.[4]
Let us consider now how our neglect acts on the children who fight through the first years of infancy. I can take a few facts only chosen almost at hazard from the mass of similar evidence in the Educational Report. In London, out of 294,000 children medically examined, 101,000 or nearly half, were found to be in need of treatment. In England and Wales 391,352 children of school age were medically attended. A summary of the returns shows a wide prevalence of verminous uncleanness, the percentage being 18.1 per cent. for the heads and 11.8 per cent. for the bodies of the children. Again the figures show unclean conditions to be most prevalent in the towns, in some instances the percentage rising as high as thirty unclean children out of each hundred children examined. I ask you to think what this implies.
The nutrition of the children is equally bad, the different counties varying in percentage between five and twenty. Stockton-on-Tees has the unenviable distinction of standing the highest—thirty out of each hundred of its children showing signs of malnutrition. The same Report shows the fatal prevalence among the children of rickets, eye disease, discharging ears, and diseases of the throat and nose.[5] The proportion of defective teeth is higher than any malady and often exceeds seventy and eighty per cent. of the school entrants.
We should note that insufficient or unsuitable food is the chief cause of malnutrition and illness in children, and investigations seem to show that wrong feeding is the more prevalent. Thus Dr. Gould, writing of the children he examined in Bolton, says, “it is obvious that defective nutrition is due to dietetic ignorance on the parents’ part or to parental neglect.” Dr. Macdonald of Northampton, reporting on 448 cases examined in 1914, corroborates this view, stating in the course of his report of adenoidal children, “Many are suffering, not from insufficiency of food (that, I think, far from common in Northampton), but from bad food and badly prepared food.” Again, Dr. Orr of Shrewsbury writes, “The subject of unsuitable food is a very important one. The women of the working classes often show a surprising ignorance of the proper methods of cooking for family requirements, a want of knowledge of the value and suitability of food stuffs, and too often a general incompetence respecting household management.”[6] I may add as corroboration an instance from my own knowledge; one that would be comic, if it were not so piteous. A party of poor workings girls were invited to a meal; they were asked what they would like to have to eat. They answered, “Bread and pickles,” and added, “Pickles are so sustaining!”
Who can doubt the greatness of the evil that is going on? I could add many more facts at least equally impressive with the few that I have given, all witnessing to weakness in the constitution of our children, to disease and dirt, and every other painful result of ignorance and neglect. And does not all this speak of unfit motherhood; of women ill-trained as women and incapacitated for their supreme duty? There is failure somewhere. We have to find out where that failure is.