Riches and Poverty (1910)

by L. G. Chiozza Money

We have to consider not alone the woman who works in the factory, but also the woman who works in the home. A large proportion of the latter are necessitous and ignorant, lacking both the means to feed themselves and their children properly, and the training to apply the means if they had them. The case is one in which education and supply must go hand in hand, and both education and supply should be provided for nationally.

In the school the teaching of personal and domestic hygiene to scholars of both sexes should begin at an early age. In the case of girls, infant hygiene should be added in the higher standards. Girls should not leave school or continuation classes until they have been seriously trained in domestic duties. At present we herd them in classes of 60 or 80, and leave a teacher, herself often ignorant of the chief duties of womanhood, to impart to them a smattering of matters of secondary importance. Able to write badly, to cipher inaccurately, and to read a novelette, the girl goes forth from the school "educated," and more ignorant of essential things than the untutored savage.

If we would have these children technically trained in domestic economy and hygiene, acquainted with the dietetic value of simple foods, and sent out into the world fit to take their places in the national economy, we must make up our minds to increase our expenditure upon education. We must have more teachers and better trained teachers.

But, if we put our hands earnestly to this work tomorrow, many years would elapse before we could rear a new generation of mothers. What of the mothers who now lack education—of the vast number of girls who are now passing from school into the world they are so unfit to play a part in? Work upon the right lines has already been commenced at Preston, St Pancras, and other places. Let me outline the admirable scheme of Dr J. F. J. Sykes, the Medical Officer of Health for St Pancras.

St Pancras is a poor and crowded London Borough in which, as in many other such neighbourhoods, infants are dying at a younger and younger age from increased immaturity at birth, from diminished capacity to resist disease and from increased rearing "by hand." It is but necessary to take one walk through its mean streets to see that St Pancras is breeding a degenerate race. The Borough Council has awakened to the terrible evil which increasingly threatens them. They have a most capable medical officer and they have appointed women inspectors to act under his authority. These women inspectors perform the important function of following up the weekly official returns of births. There are about 130 births a week in St Pancras, and all of them cannot be visited by the present small staff, but an endeavour is made to visit every necessitous case. To all the mothers, whether visited or not, a card or leaflet of useful information is sent by post. Dr Sykes does not teach the mothers how to wean or artificially feed their children, but to suckle their babies and to avoid weaning them before their first teeth appear. To the many indigent mothers the women inspectors give advice as to regimen and diet and, where artificial feeding is absolutely necessary, how best to proceed. Endeavour is also made to reach and advise pregnant women. Throughout, the chief aim is to reduce hand-feeding to the smallest possible proportions.

In cases of poverty requiring temporary assistance, the women inspectors give cards of introduction to the Charity Organization Society, or to the Poor Law Guardians. Where health is deranged or there is a desire or necessity to wean, introduction to a doctor or a hospital is arranged for. Where the husband is out of work the case is notified to the Labour Bureau. In every case the hygienic, sanitary and domestic circumstances of the mother and infant are carefully inquired into and reported upon.

This practical work, now in operation in St Pancras, and with variations in some other places, is what is wanted everywhere if we are to rescue the poor children of the new generation. The appointment of sufficient Women Health Inspectors by local authorities must be made compulsory. In "Riches and Poverty," edition 1905, I wrote: "The Health Inspectors must of course be directed by a capable Medical Officer enjoying a permanent appointment. It is most important that Medical Officers of Health everywhere should have the same security of tenure which they have in London. At present they hold office as a rule at the goodwill of the local authority." Mr Burns's Housing Bill of 1909 has secured this important reform. In future every county will have its independent Medical Officer, unafraid of local influence.

Closely allied to the work of the Health Inspector is that of the medical man, and here is raised a point of the utmost importance. Above all, if we are in earnest about this matter of breed, the public medical service should be greatly enlarged as part of the machinery of a Ministry of Health, and the sale of soothing syrups and other "patent" medicines absolutely prohibited.[43] The Medical Officers of Health should be able to marshal a liberal service of trained medical skill in defence of the national well-being. Also at their command should be an ample supply of Health Visitors and trained and certificated nurses. The creatures, nearly always ignorant and frequently unclean, who now "assist" poor women in their time of trouble, are responsible for part of the infant mortality which swells our death returns. I shall never forget some of the "monthly nurses" I have met in the homes of the poor. One ancient dame I found swilling stout. She leered at me out of a beery eye and explained that she liked stout "because it made her feel as though she could sing." Needless to say, she strongly recommended the same joyful fluid to her patients.

The excellent Notification of Births Act of Lord Robert Cecil (1907) should be adopted (or its adoption enforced—the Local Government Board has power to enforce adoption) universally, in order that Health Visitors may do their work effectually.

Given a properly organized public medical service we could begin at the beginning, with the unborn child. The pregnant woman could obtain, free of charge and as a matter of course, advice upon her diet and conduct. Through such a service, it would be a simple matter to administer a Public Maternity Fund. It is probable that, of the 1,200,000 births per annum, as many as 300,000 are in necessitous families. We cannot afford to allow 300,000 children to be starved before and after birth every year.