"My own experience in the out-patient room entirely confirms the opinion that the nutrition of the mother has a very important bearing on the nutrition of the fœtus and that the statement that the percentage of unhealthy births among the poor is small is not justified by facts. We constantly see fully developed infants a day or two old brought by midwives or neighbours exceedingly badly nourished, blue and feeble, and who are clearly ill fitted, as the event indeed proves, to withstand the conditions of an external existence. There must be numbers of such born in this city that perish within a few weeks of their birth, and who fail to thrive for even a day. There is no question of syphilis; they are the children of poor mothers who have lived lives of hard wear and tear during pregnancy, are themselves badly nourished and weakly, and have felt the pinch of poverty, though often perhaps poverty of the secondary sort. I have a strong conviction also that the infants of the poorer and weaker mothers, even though they are born fairly well nourished, are difficult to rear, and easily waste even when under fairly favourable conditions in a home or hospital."
Evidence to the same effect was given to the Physical Deterioration Committee, but unfortunately ignored in their report. It seems to a layman a common-sense view that if, in the period when a woman has to eat to "feed two," she is badly nourished, and exposed to undue fatigue, the child must suffer. Nevertheless, the striking phrase of Dr Malins, "Nature intends all to have a fair start," may be fully accepted, and Professor Cunningham's words of hope require no modification. What we have to remember is that pre-natal as well as post-natal conditions must be improved if we wish to rehabilitate our stock. If we have not a renewed opportunity with each birth, at least we have it, save in quite exceptional cases, in the person of each pregnant woman. The weight of evidence goes to show that the influence of heredity upon disease has in the past been greatly exaggerated. The chief causes of deaths from debility, atrophy and premature birth are to be found in the evil environment and malnutrition of the mother during pregnancy. The unborn child fights hard for its life, but in a number of cases, sufficiently large seriously to affect the total population, it is born unfit. It either succumbs rapidly or lingers on to be a curse to itself and its kind.
These all-important facts once realized, an avenue of hope stretches out before us. 1,200,000 new births every year; 1,200,000 new units added to the national stock, and the possibility of ensuring that nearly the whole of them shall be born healthy. Here is Nature ever endeavouring to reform the race—ever offering us opportunity. Combine with knowledge of this opportunity knowledge of the means to take advantage of it. Combine with the determination to secure reform the application of national wealth to truly national ends and all things become possible.
Under what circumstances are the children of the new generation now born? It follows from our examination of incomes that a large proportion of our new births are of mothers who exist in conditions of extreme poverty. Fully one-fourth to one-third of the 1,200,000 are born to want and squalor. In England and Wales, at the census of 1901, of a population of 32,527,843, there were 12,983,109 persons belonging to families living in four rooms or less. In one room each lived families forming 507,763 people. In two rooms each lived families forming 2,158,644 people. In three rooms each lived families forming 3,186,640 people. In four rooms each lived families forming 7,130,062 people.
If the one-third of very poor could be gifted with all the virtues, if drink were abolished and every penny spent upon scientific principles, we have seen that they would still be unable to command a healthy existence. One-third of our hope of the future is thus mortgaged. One-third of the new-born go to feed the ranks of misery and to form, such of them as do not perish in infancy, the raw material of the social problems of those who are to follow us.
In England and Wales, in 1908, 940,000 children were born. In the same year 113,000 infants died under one year of age, or 120 per 1000 births. The conditions which exist in some of our towns can be gathered from the following figures:—
INFANT MORTALITY
(Rates per 1000 births in 1908)
| Towns with High Rates. | Towns with Low Rates. | ||
| Stalybridge | 206 | Reigate | 80 |
| Farnworth | 209 | Tunbridge Wells | 83 |
| Aberdare | 198 | Hornsey | 75 |
| Rhondda | 182 | Guildford | 71 |
| Burnley | 194 | Winchester | 88 |
| Batley | 186 | Watford | 88 |
| Longton | 199 | Ilford | 98 |
| Tunstall | 198 | Salisbury | 95 |
The towns with low rates cannot be said to possess ideal conditions, but merely to take them as a standard we see how considerable is the wastage of life which goes on in Lancashire and Yorkshire and Staffordshire and South Wales. In some of the poorer wards of our great towns one in three of the children born perish within twelve months. That is the case in some parts of Birmingham, where the Medical Officer of Health recently stated that "a reduction of 50 per cent. in the rate of infant mortality in Birmingham would mean the saving of 1500 lives per annum."
But death is only one of the symptoms we have to consider in this connexion, and death itself were preferable to the survival of a large proportion of the children of neighbourhoods where the rate of infantile mortality reaches one in every three or four births. Death is the extreme case. Those who do not die in infancy have physical degeneracy as their portion, and, in a world where virility and energy were never more needed by the labourer if he is to bargain successfully for a decent livelihood, enter the fierce lists of modern industry with enfeebled bodies. Docile units thus flood the casual labour market, or, totally unfitted for labour, swell the ranks of the "residuum."