The Elements of Child-protection

by Sigmund Engel

In many countries, especially France, Germany, and England, Infant’s Milk Depots (Gouttes de Lait) have been founded, at which the poor can obtain infant’s milk gratuitously or very cheaply. The deficit is made up by individual contributions, by public grants-in-aid, or by the profit on milk sold to the well-to-do. Of late years a few English municipalities have begun to administer such Infant’s Milk Depots themselves. Such Infant’s Milk Depots appear to do more harm than good. By providing milk gratuitously or very cheaply they give a premium to those mothers who feed their children artificially, and this leads many who would otherwise suckle their children to bring them up by hand. Vainly in France are prizes offered to mothers, and especially to unmarried mothers, to induce them to suckle their own children, when simultaneously institutions are founded to reward mothers who bring up their children by hand. Infant’s Milk Depots must be under continuous medical supervision, such supervision to include the mothers and children attending the depot, since in default of this there is no guarantee that the mothers would use the milk properly in the nourishment of their infants. Of late it has been found necessary, especially in France, to associate with the administration of the Infant’s Milk Depots the continuous medical supervision of the infants, medical advice to the mothers, control of the use of the milk, and advice to the mothers to suckle their own children. The French Infant’s Milk Depots are now associated with the giving of advice to mothers (consultation de nourrissons), so that the mothers can be properly instructed regarding all matters bearing on infant-feeding. Several times a week mothers’ classes are held, at which all possible stress is laid on the need for women to suckle their own children, this theoretical advice being re-enforced by the giving of prizes. If natural feeding is rejected or is impossible, advice is given as to suitable artificial feeding. Domiciliary visits are made to see that this advice is properly followed. Thus the Infant’s Milk Depots tend more and more to develop into centres for the general care of infancy; their original aim will pass more and more into the background as advice to mothers becomes associated with children’s clinics (such as we find already in many university towns), or with hospitals for infants, schools for midwives, and lying-in hospitals. Such a development may be expected in the near future.

Infant’s Milk Depots, advice to mothers, and all the institutions and measures forming part of the campaign to lower infant mortality, must invariably have the general aim of promoting the public welfare, and must never assume the form of Poor-Relief, otherwise many who need their services will fail to avail themselves of these, for, as is well known, a great many people are frightened away from any institution connected with the system of Poor-Relief. It is sufficiently proved that those Infant’s Milk Depots in which the milk is given in accordance with individual medical prescriptions, which are subjected to medical supervision, which are associated with the giving of advice to mothers, which give milk free or at a low price only to those whose infants are kept under regular observation, promote breast-feeding by the mothers, and effect a notable diminution in infant mortality.

Other Methods of Artificial Feeding.—Nothing more need be said here of the other methods of artificial feeding—that is, of those in which no cow’s milk is used—beyond this, that they are in opposition to the essential principles of hygiene, and that they are of less than no value. Everyone who has the interest of society at heart should do all in his power to secure the complete discontinuance of such methods.

Institutional Care of Infants.—The institutional care of infants, if it is to be carried out in accordance with hygienic principles, is too costly. Hence it is applicable only in the case of weakly and sickly infants, and is out of the question for the permanent care of healthy infants. With regard to the institutional care of healthy infants, it is asserted that, even in the most modern and best-managed foundling hospitals and hospitals for infants, epidemic diseases—such as pneumonia, contagious ophthalmia, and intestinal catarrh—inevitably appear, and in such circumstances are extremely difficult to treat with success. It is, however, necessary to consider the following facts. Unquestionably, the institutional care of infants was formerly far from satisfactory. Certain diseases, the seeds of which have been sown in the institution, only develop in full severity after the child has been boarded out. This depends upon: (a) the primary lack of resisting power of the infants, which is the disastrous sequel of the unfavourable conditions of life to which they were exposed before entering the institution; (b) the lack of proper individualisation (for example, the continuous lying in bed, bad air, lack of sufficient cleanliness)—the so-called “hospitalism” or “hospital-marasmus” is referable to these influences; (c) a failure to meet the demands of hospital hygiene, so that the origination and the development of the infectious diseases are facilitated; (d) artificial feeding, by which the working of these evil influences is powerfully reinforced. But all these errors are avoidable. Nothing more is requisite for their avoidance than strict observance of the rules of modern hospital hygiene, with individualisation in all departments, and especially in the matter of diet, which should whenever possible be carried out through the instrumentality of wet-nurses. Since wet-nurses of the best quality are difficult to obtain in sufficient numbers, it is best that the hospital for infants should be associated with a lying-in hospital.

The Crèche.—In the families of the poor, the elder children have in most cases to work for their living, so that even these are not continuously available for the care of the younger children. This applies especially to those families whose members work away from home, and in places to which the younger children cannot be taken. When a peasant with his wife and his elder children works in the fields, it is possible to take even quite little children to the place of work and to keep an eye on them there; but when a workman with his wife and his elder children works in a shop, a factory, or a workshop, to take the younger children there is impossible. But young children must on no account be left without supervision, for this exposes them to all kinds of dangers—to burns and scalds, falling out of window, &c. Moreover, an infant-in-arms cannot be entrusted to the care of the older children, if only for the reason that this is injurious to the latter alike in body and in mind. They have, for example, to drag the baby about with them wherever they go, are kept away from school, &c. To board out an infant is, in the first place, costly, and, in the second place, separates the infant completely from its parents. In many cases it is only by the fact that she keeps her child with her, and becomes attached to it, that an unmarried mother is restrained from adopting an immoral life. Thus there is need of a place to which the children may be sent, either permanently or only during the hours in which the family are at work. Institutions for this purpose actually came into existence only as a sequel of the development of the factory system. They are known as crèches, and provide for the care, not of infants merely, but of children up to the age of three. The need for and value of such institutions is obvious. It is a real service to parents of the poorer classes, if not far from their dwelling or from their place of work there exists an institution at which, either gratuitously or for a nominal payment, their little children can be properly cared for. Early in the day the mother takes her infant to the crèche, during the midday pause goes there if necessary to suckle the child, and fetches it home in the evening.

Illegitimate children are in many places refused admission to the crèches. This refusal merits our strongest disapproval. The reasons alleged for this course are of two different kinds. First, we are told that we must not encourage girls to be immoral; secondly, it is said that married mothers will hesitate to entrust their children to a crèche which also receives illegitimate children. The injustice of this practice is more and more generally understood, and the better course more commonly prevails. Of course, only such illegitimate children should be received at a crèche as are cared for by their own mothers during the hours of the day when they are not at the institution. Illegitimate children boarded out with foster-parents should not be admitted to a crèche, because foster-parents who send to a crèche the child entrusted to their care are not properly fulfilling the duty they have undertaken, and those who cannot look after the foster-child themselves should not receive one at all.

In most countries crèches are founded and maintained by private benevolence, and are merely supervised by the State. Only in a few countries—Hungary, for instance—has the State imposed upon the local authorities the duty of founding and maintaining such institutions; and the central authority has itself founded and maintained such institutions, and in these the matrons of the Public Homes for Children (Kinderbewahranstalten) receive their training.

To-day various defects exist in these crèches. Not infrequently the attendants lack the necessary experience in the care of children, medical supervision is often inadequate, the building is unsuitable, the infants are artificially fed, the crèche is often too far from factory, workshop, or home, so that artificial feeding or feeding by a wet-nurse is encouraged. Before long crèches will become national institutions. They will become more numerous; they will be used more readily; their faults will be corrected.

Particular mention must be made of factory crèches and family crèches. (a) Many factory owners construct crèches and feeding-rooms for the infants of women working in their factories, and arrange for such women to leave work at intervals to suckle their children. The employers do this, not so much from the goodness of their hearts, as with an eye to their own well-considered interest. The working time they lose amounts to very little, and they hope that their benevolent actions will secure the goodwill, and consequently the hearty co-operation, of their workpeople. (b) A recent development is the family crèche. Adequate maintenance and free house-room are guaranteed to a widow, in return for her undertaking to care during the day for a restricted number of infants (and in some cases, also, children of school age). Family crèches share to some extent the advantages of the family care of infants. Their great and obvious advantage lies in the fact that they facilitate decentralisation—that is, the crèche can be nearer to the homes of the infants’ parents. Their main defect lies in their failure, as a rule, to satisfy the demands of modern hygiene; a second disadvantage is that systematic occupation for the older children is usually difficult to arrange in the family crèche. For these reasons it is unlikely that they will ever become very general.

Proposed Reforms.—Proper training and discipline are requisite, not only for midwives, but also for medical practitioners. Proper training of mothers is also necessary. Most young mothers seek advice above all from midwives, and these latter often advise very badly. In the first place, there are many matters connected with the care of infancy about which midwives have no expert knowledge. Secondly, midwives often advise mothers not to suckle their children, but to bring them up by hand, because the case is sooner done with and the midwife has less to do when the mother does not suckle.