INFANTah'^YOUNG 
 CHILD WELFARE 
 
 HAROLD SCURFIELD 
 
 M.D. 
 
haU QloUege of Agriculture 
 
 Kt O^acnell UntnetBity 
 
 Slihtarg 
 
The original of tliis book is in 
 tine Cornell University Library. 
 
 There are no known copyright restrictions in 
 the United States on the use of the text. 
 
 http://www.archive.org/details/cu31924003500877 
 
Infant and 
 Young Child Welfare 
 
 BY 
 
 HAROLD SGURFIELD 
 
 M.D.Ed., D.P.H.Camb, 
 
 Medical Officer of Health of Sheffield ; Professor of Poblic 
 Health io the University of Sheffield 
 
 GASSELL AND COMPANY, LTD 
 London, New York, Toronto and Melbourne 
 
First Published igig 
 
PREFACE 
 
 Child welfare is no longer a subject that interests 
 only doctors and social workers. It is a living issue 
 to-day. On all sides our attention is called to the 
 needs of the baby and the mother. Recent legis- 
 lation has forced the subject on local authorities. 
 There is a deep and widespread determination 
 among all classes of society that in future the 
 children shall be better cared for than they have 
 been in the past. 
 
 In one sense the problem is simple; it all 
 depends on good mothering. In another sense it 
 is complex because, in trying to remove the hin- 
 drances to good motherhood, we are up against 
 every social problem. One thing is certain. No 
 one will contest the importance of the problem, or 
 the fact that upon our solution of it depends the 
 future of the British Commonwealth. 
 
 The aim of this book is to give a bird's-eye 
 view of the whole question of child welfare, and 
 it is hoped that it may prove to be of interest to 
 the general reader as well as to members of local 
 authorities, midwives, maternity, district, and 
 other nurses, health visitors, members of Volun- 
 
Preface 
 
 lary Aid Detachments, and all those who realise 
 
 the supreme importance to the country of healthy 
 
 children. 
 
 To Sir Hall Caine and Messrs. Hodder and 
 
 Stoughton I tender thanks for permission to quote 
 
 from "The Queen's Gift Book " the stanzas which 
 
 appear on p. i. 
 
 H.S. 
 
 VI 
 
Contents 
 
 PAGB 
 
 naught — In Sheffield compared with Bradford — In 
 Dublin — Among English and Irish Mothers in Liver- 
 pool — Italian Ideals of Motherhood — ^The Society of 
 Friends and Family Life . . ... 38 
 
 CHAPTER IV 
 The Training of the Mother 
 
 Training of Future Mothers — Lack of Domestic Servants 
 — Training of Existing Mothers — ^Scheme of Instruc- 
 tion in Domestic Subjects for Girls of School Age — 
 Scheme of Instruction up to Eighteen Years of Age . 61 
 
 CHAPTER V 
 Child Poverty 
 
 Children of Widows and Disabled Bread-winners — 
 Children of Large Families — Children of Neglectful 
 Parents — Illegitimate Children 69 
 
 CHAPTER VI 
 An Efficient Medical Service 
 
 Infant Hygiene and the Medical Curriculum — The Family 
 Doctor — A Dental Service — Out-patient Departments 
 — Medical Treatment for all Children — ^^Claims of the 
 Wives and Children of the Insured . . .80 
 
 CHAPTER VII 
 
 Management of the Baby 
 
 Breaat-feeding — Risks of Bottle-feeding — Alleged Inability 
 of Many Women to Nurse their Children — Influence 
 of the Monthly Nurse — Ignorance of Mothers as to 
 Breast-feeding — Number of Feeds— 'Cow's Milk — Dried 
 Milk — Food after Weaning — Fresh Air — Sleep — Posture 
 
 viii 
 
Contents 
 
 PAGE 
 
 — Exercise— Clothing — ^Cleanliness — Old Wives' Fables 
 — Ophthalmia Neonatorum — Infectious Disease — Town 
 Life 88 
 
 CHiAPTER VlII 
 Management of the Ex-Baby 
 
 Prolonged Lactation — Irregular Feeding — ilmproper Food 
 — iCare of the Teeth — ^Fresh Air — Rest and Sleep — 
 Rickets — Discharging Ears and Adenoids — Bad Teeth 
 — Blepharitis — Skin Afiections — Infectious Diseases — 
 Tuberculosis — Clothing — Death-rates of Children — 
 Education — Discipline — Character Training . . . 109 
 
 CHAPTER IX 
 Institutions to Help the Mother 
 
 Maternity and Child Welfare Centres — Health Visitors and 
 Women Sanitary Inspectors — Day Nurseries — What 
 some Mothers have to do — Day Nurseries without 
 Gardens — Factory Crfeohes — Residential Nurseries — 
 Mother-substitutes not wanted — Nursery Schools . . 130 
 
 Conclusion 
 
 Raising the Ideals of Motherhood — Beginning with the 
 Young — An Appeal to the Churches and the Teaching 
 Profession 149 
 
 APlPENDIX : Breast-feeding 152 
 
 INDEX 161 
 
// He ordered that the mother for the children of her 
 
 womb 
 Should dare her death by travail and fight till crack of 
 
 doom, 
 He ordained that by that impulse, still the purest and the 
 
 best, 
 She should gather alt that suffer in her pity to her breast. 
 
 Nurturing, nursing, guarding, giving strength with heart 
 and hand, 
 
 Paying toll in pangs to Nature which, no man may under- 
 stand. 
 
 Dauntless from the God who made her without fear to draw 
 her breath, 
 
 Saviour of the weak and helpless, first at birth and last at 
 death. 
 
 Since, the Lord creating Woman, she became a living 
 
 soul. 
 Hers has been the old Earth's burthen, age on age, from pole 
 
 to pole. 
 Hers the conflict, hers the conquest, hers the flag of life 
 
 unfurl' d. 
 Hers the sorrow, hers the suffering, hers the love that rules 
 
 the world. 
 
 Hall Caine, in " The Queen's Gift Book." 
 
INFANT AND YOUNG CHILD 
 WELFARE 
 
 INTRODUCTION 
 
 So-called Darwinism has been applied to the pro- 
 blem of infant mortality. One frequently meets 
 people who think that a high mortality and slum 
 conditions provide for the removal of the " surplus " 
 population and the " survival of the fittest." I 
 came across a good example of this a few years 
 ago in a book written by an African missionary. 
 The author, in drawing attention to the terribly 
 high rate of infant mortality among the primitive 
 tribes, uses these words : " The life of an African 
 child is a constant witness to the practical truth 
 of the Darwinian principle of the survival of the 
 fittest," and then goes on to say, " Perhaps if some 
 of the safeguards so elaborately gathered round 
 English children were removed we should see some 
 compensation for a higher death-rate in an improved 
 stamina and physique." The author in question 
 dedicates his book " To my mother, to whose 
 guidance I owe my inspiration, and to whose 
 watchful care I owe my physical equipment for 
 the work of the mission-field." On his own show- 
 
 3 
 
Infant and Young Child 
 
 ing, if his mother had indulged in a little judicious 
 neglect he would have been either conveniently 
 dead or " fitter " than ever. 
 
 Can the doctrine of the survival of the fittest 
 be applied to our method or want of method as 
 a community in the rearing of children ? Darwin 
 pointed out that every organic being naturally 
 increases at so high a rate that if there were no 
 destruction of life the earth would soon be covered 
 by the progeny of a single pair, and that as a result 
 there is a constant struggle for existence between 
 various races of animals. It thus came about that 
 those animals of a particular kind which possessed 
 sUght peculiarities that enabled them to cope 
 with their environment tended to survive and 
 propagate their species, and to hand down to their 
 descendants by heredity the advantageous pecu- 
 harities. As these peculiarities became more and 
 more marked, generation by generation, new types 
 of animals became evolved. This, briefly, was the 
 principle of the evolution of new types by natural 
 selection. The types which survived were not 
 necessarily the highest ; they were simply those 
 which were fittest to cope with the dangers of 
 their environment at the time being. 
 
 If Darwin's principle could be applied to life 
 under slum conditions, all that it would mean 
 would be that the survivors were the fittest to 
 live in slums ! 
 
 It may be that in a slum the babies fittest to 
 combat slum conditions survive, but we have to 
 bear in mind that very many of the fit babies 
 
 4 
 
Introduction 
 
 become maimed in the process. If the sole object 
 of life were to endure slum conditions, the doctrine 
 might have some weight, but does it follow that 
 the baby best able to stand slum conditions is 
 going to be the best man or woman to hand on the 
 torch of civilisation ? 
 
 Akin to the doctrine of the usefulness of slums 
 in providing for the survival of the fittest is the 
 theory that it is a rhistake to attempt to control 
 the infection of tuberculosis, and that by so doing 
 we are tending to rear a race of weaklings. This 
 theory occasionally receives support from mem- 
 bers of the medical profession, who apparently 
 regard the tubercle bacillus as a useful means of 
 keeping up the tone of the disease-fighting cells 
 of our bodies. Athletes, however, as well as 
 scholars die from tuberculosis, and it must be 
 repeated that there is no evidence that the persons 
 who put up the best fight against the tubercle 
 bacillus are the " fittest " for carrying on the 
 work of the world and the progress of humanity. 
 We are born tuberculisable, not tuberculous, and 
 if a man, succumbs to tuberculosis it is because he 
 has been exposed to big doses of infection or be- 
 cause his resistance to tuberculosis was slight. 
 It is quite as unreasonable to say that a strong 
 man who dies from tuberculosis must have been 
 a weakling as it is to say that the men who die 
 from typhoid fever or pneumonia were weaklings 
 because their powers of resistance to these diseases 
 were insufficient. The owner of a pedigree bull 
 does not consider the animal a weakUng because 
 
 5 
 
Infant and Young Child 
 
 he has to take steps to protect him from the in- 
 fection of tuberculosis. 
 
 It must be a good thing for each individual to 
 lead the kind of life that strengthens resistance 
 against tuberculosis, and surely it must be a bad 
 thing to expose oneself unnecessarily to the tuber- 
 culous infection. 
 
 Most readers of " The Science of Power " will 
 probably agree with Benjamin Kidd that the doc- 
 trine of the survival of the fittest has no message 
 for students of social evolution. 
 
 Darwin recorded what happened when Nature 
 was left to herself, and his theory no doubt pro- 
 vided a satisfactory explanation of the evolution 
 of the animal world and the gradually acquired 
 dominance of primitive man over the brute 
 creation. 
 
 Kidd shows how the survival of the fittest has 
 tended to the gradual perfecting in the individual 
 of every quality contributing to his own efficiency 
 in pursuit of self-interest. He further shows that 
 the Darwinian theory has been used to justify 
 the German doctrine that might is right, the ap- 
 phcation of force to the solution of industrial 
 problems, the ruthless race for wealth, and pro- 
 posals for the scientific breeding of humanity. The 
 last-named is a revival of the views advanced in 
 Plato's "Republic." Family life is ignored. Men 
 and women are selected for breeding purposes, 
 and great care is to be taken of the offspring of 
 these selected types. " But the children of the 
 more depraved, and such others as are in any 
 
 6 
 
Introduction 
 
 way imperfect, they will hide in some secret and 
 obscure place, as is proper," or " expose it as a 
 creature for which no provision is made." Some 
 sanitarians seem to flirt with this idea of breeding 
 from selected types. Even if it were feasible, 
 what is to be done with the offspring of the un- 
 selected types ? Are they to be got rid of, as in 
 Plato's Republic ? Again, when we come to pro- 
 vide thus artificially for the survival of the fittest, 
 who are the fit ? The brainy persons with poor 
 bodies, or the brawny persons with poor brains ? 
 The former would include Calvin, Richeheu, William 
 of Orange, Chatham, Robert Louis Stevenson, 
 Chopin, Darwin, and a host of other makers of 
 history. Weakly babies often grow up to be 
 strong men and women, and one wonders how 
 many useful citizens the Spartan Council of Elders 
 ordered to be thrown down the cavern of Mount 
 Taygetus. Nelson was a weakly child, who might 
 have been condemned at birth by a Spartan Council 
 of Elders, and would certainly have been killed 
 by slum conditions. I do not think, however, 
 that many people can seriously believe in slums 
 as improvers of the race. Fewer still will regard 
 schemes for the scientific breeding of humanity as 
 practical politics. Men and women are not going 
 to have their mating regulated by a eugenic priest- 
 hood, and the most we can do is to endeavour 
 to prevent the marriages of such as syphihtics, 
 epileptics, alcoholics, mental defectives, and per- 
 sons suffering from an infectious stage of tubercu- 
 losis. The aim of scientific breeding would be to 
 
 7 
 
Infant and Young Child 
 
 produce a few supermen, the trend of social evolu- 
 tion is to give every child a chance and to raise 
 the average. We might use the simile of a com- 
 petition between teams of harriers. We want a 
 good average, and not a team composed of a few 
 brilliant runners and a " hopeless tail." 
 
 It has for long been the ethical code of Medicine 
 to use all its powers to prolong human hfe, how- 
 ever maimed, and Preventive Medicine must square 
 its efforts with that code. 
 
 Kidd's writings have helped us to reahse the 
 deadening effect of an exaggerated belief in the 
 doctrine of heredity, and will inspire us to take 
 up with renewed vigour the question of improving 
 the environment. 
 
 One of the most interesting chapters in " The 
 Science of Power " is that on " Social Heredity," 
 in which it is shown that many of the character- 
 istics of animals which have hitherto been regarded 
 as hereditary habits or instincts are not really 
 due to inborn heredity at all, but are acquired 
 after birth as part of the social inheritance which 
 the adults of the species impose by example and 
 training on the young of each generation. 
 
 The War has brought us down to the reaUties 
 of life, and we reaUse as we never did before that 
 the health and education of the children are the 
 chief things that matter. Failure to care for the 
 young life is not only folly in a nation but an 
 offence against humanity. We want healthy babies 
 born of healthy mothers in healthy homes. After 
 they are born, the parents must have sufficient 
 
Introduction 
 
 means to maintain them, and the aid when neces- 
 sary of an eihcient medical service. 
 
 We look back rather vaguely to a merry England 
 some time in the past, and no doubt we have 
 suffered from urbanisation and the introduction of 
 factory and modern industrial conditions, but still 
 a study of the old church registers does not leave 
 one attogether laudator temporis acti as regards 
 child life. 
 
 If every child has a chance, and every family 
 a real home, we shall have built up a merrier 
 England than ever existed before. 
 
CHAPTER I 
 
 Healthy Parents 
 
 The infant science of Eugenics has not much bear- 
 ing as yet on the problem of child welfare, and 
 schemes for the " scientific breeding " of humanity 
 are not within the region of practical politics. We 
 cannot select the sires and dams, as in breeding 
 racehorses. It is said, however, that every infant 
 has a right to be " well born," but up to the pre- 
 sent that only means that an infant has a moral 
 right to be born in a reasonable environment and 
 of parents free from certain diseases or defects 
 which may be communicated to it before or imme- 
 diately after birth. 
 
 Five of these diseases or defects about which 
 there is general agreement are mental deficiency, 
 epilepsy, alcoholism, venereal disease, and tubercu- 
 losis. 
 
 Let us consider these subjects in turn. 
 
 Mental deficiency. — The law ought not to 
 allow mental defectives to marry or to have chil- 
 dren. The Mental Deficiency Act of 1913 does 
 something in this matter, but does not go far 
 enough. The Act does not directly prohibit the 
 marriage of " defectives," but it has some effect 
 in the promotion of this desirable object indirectly 
 by providing for the permanent care of the 
 
Healthy Parents 
 
 " defectives " in institutions under certain circum- 
 stances. The cases which, in the opinion of the 
 Education Authority, require to be sent to an 
 institution or placed under supervision are to be 
 reported to the Local Authority, with whom it 
 rests to take the necessary action. Two recent 
 cases which have been brought to my notice will 
 illustrate what may happen. A clergyman re- 
 ported that he had been asked to marry two per- 
 sons whom he knew to be mentally defective. 
 Inquiries were at once set on foot. The girl was 
 found not only to be mentally defective, but also 
 to be suffering from venereal disease. The mar- 
 riage was prevented by her being sent to an in- 
 stitution. In the second case, a clergyman re- 
 fused to marry two " defectives," and they were 
 married by licence before a registrar, the girl 
 being pregnant at the time. The girl in this case 
 was seventeen years old, and the man, who had 
 been rejected from the Army on account of his 
 mental deficiency, twenty-three years of age. 
 Special provision is made in the Act for sending 
 to an institution a defective who is in receipt of 
 poor relief at the time of giving birth to an illegiti- 
 mate child or when pregnant with such a child. 
 
 For dealing with this question efficiently the 
 law requires to be strengthened, but in addition 
 to this far more institutions for the accommodation 
 of mental defectives are needed. The provision of 
 these very necessary institutions is one of the 
 many matters which have been postponed by 
 the War. 
 
Infant and Young Child 
 
 The prevention of the marriage of mental 
 defectives would deal with the most unpleasant 
 phase of this problem, but it would not deal with 
 the whole problem. Our knowledge on this sub- 
 ject is insufi&cient, and in the majority of cases 
 we are unable to trace mental deficiency in the 
 children to any known parental or hereditary cause. 
 
 Epileptics. — Epilepsy ought to be regarded as 
 an absolute bar to marriage^ both in the interests 
 of the children that may be born affected with the 
 disease, and in the interests of the healthy partner 
 of the union. At the present time the risks are 
 very insuf&cieatly understood, and it is quite 
 common for persons who have suffered from 
 epileptic fits to marry. 
 
 Alcoholism. — The abuse of alcohol is the 
 principal cause of child neglect and the source of 
 widespread misery in families, but in addition to 
 this the children of excessive drinkers are liable 
 to be weakly at birth or to develop weakness of 
 mind or body in later Hfe. Unfortunately, the 
 tendency frequently does not show itself tiU after 
 marriage, so that preventive measures are not 
 easy. Parents of marriageable children can no 
 doubt do something by warning and advice. Every- 
 thing should be done to encourage temperance. 
 Possibly the Temperance cause has been injured 
 in the past by the intemperate language of some 
 of its advocates. A man who likes a glass of beer 
 with his dinner is not exactly a criminal, and if 
 our people only drank at meal times we should 
 be a sober nation. It is the abuse of alcohol, not 
 
 12 
 
Healthy Parents 
 
 its use, tfiat does the harm, but it must be admitted 
 that many people have the most erroneous ideas as 
 to what ig meant by moderation. The approximate 
 safe limit has been laid down as one ounce of 
 alcohol per day for a man doing a reasonable day's 
 work, and this amount would be contained in less 
 than a pint of beer. In any case, for a healthy 
 person alcohol is a luxury and not a necessity, 
 so that it often comes to be a question as to whether 
 " father's beer " makes the rest of the family go 
 short of necessaries. 
 
 The common saying that you cannot make 
 people sober by Act of Parliament has been to a 
 large extent disproved. Lord D'Abernon, the 
 Chairman of the Liquor Control Board, has shown 
 that the curtailment of facilities for drinking has 
 had a most marked effect. Not only has there 
 been a huge reduction in convictions for drunken- 
 ness, attempted suicides, and cases of delirium 
 tremens, but the statistics derived from certificates 
 of death show a remarkable decline in the deaths 
 caused by alcoholism. Thus in England and 
 Wales in 1913 there were 1,831 deaths from alcohol- 
 ism, in 1917 only 580 ; in 1913 there were 1,226 
 infants suffocated by overlsdng, in 1917 only 
 704 ; and in 1913 there were 3,880 deaths certified 
 from cirrhosis of the liver, in 1917 only 2,283. An 
 important point about these statistics is that they 
 come from an independent source. They are com- 
 piled by the Registrar-General from information 
 supplied by all the doctors and coroners in the 
 country, so that the gibe that statistics can be 
 
 13 
 
Infant and Young Child 
 
 manipulated to prove anything does not apply 
 in this case. It is to be hoped, for the sake of 
 the race, that we shall never return to pre- War 
 faciUties for drinking. Education, however, must 
 always be the most powerful factor in promoting 
 temperance. The education of a great part of 
 the children of the country has hitherto ended 
 at 13, the age when the education of the children 
 of the middle classes begins in earnest. When 
 education has been levelled up by the raising of 
 the school age to 15 and the continuation of half- 
 time education to 18, the rising generation will 
 want more intellectual recreation than at present, 
 and the amusement of standing at a bar drinking 
 will become less popular. One would like to see 
 the " stand-up " drinking bars replaced as far 
 as possible by places where, to quote Lord D'Aber- 
 non, " facihties for obtaining attractive, weU- 
 cooked food and refreshment in pleasant surround- 
 ings " are provided. 
 
 Venereal diseases. — If the War has had the 
 effect of reducing the damage done to child wel- 
 fare and family Hfe by the abuse of alcohol, the 
 opposite must be said as to the ravages of the 
 venereal diseases. The danger from this source 
 is very great, and needs to be appreciated by every 
 member of the community. The National Council 
 for Combating Venereal Diseases is doing a great 
 work in making the danger known. The two 
 diseases which we have to fight are gonorrhoea and 
 syphilis, and both have disastrous effects on child 
 life. 
 
 14 
 
Healthy Parents 
 
 Gonorrhcea, if not treated promptly and effi- 
 ciently, is liable to become chronic and cause in- 
 flammation of the bladder and kidney, stricture 
 of the urethra, and inflammation of the generative 
 organs, leading to sterility in the male. If the 
 man marries without proper treatment and before 
 he is cured, he may infect his wife years after he 
 contracted the disease himself, with the most 
 terrible results. The disease in the woman may 
 lead to all sorts of complications. A large pro- 
 portion of the operations which have to be per- 
 formed in women's hospitals are the result of 
 neglected gonorrhoea, and it is one of the com- 
 monest causes of sterility in women. Not only 
 does gonorrhcea prevent the birth of children : it 
 is also responsible for one of the commonest causes 
 of bhndness. If the mother suffers from a gonor- 
 rhoeal discharge at the time of childbirth the 
 baby's eyes may become infected, and severe in- 
 flammation, known as gonorrhceal ophthalmia or 
 ophthalmia of the newly born, may be set up. 
 It is estimated that more than one-third of the 
 inmates of institutions for the bhnd are admitted 
 there from this cause. 
 
 Syphilis is stiU more appalUng in its effects 
 than gonorrhoea if not properly treated, but, for- 
 tunately, great advances in the treatment of this 
 disease have been made of recent yea^s. Prompt 
 treatment is the great thing. A paiiiless sore or 
 ulcer at the point of infection is the first sign of 
 the disease, and then is the time for getting treat- 
 ment. Time is often lost by the patient consulting 
 
 15 
 
Infant and Young Child 
 
 a quack. There is no excuse for this now, as 
 clinics have been established all over the country 
 where the best modern treatment for venereal 
 diseases is given without charge and under con- 
 ditions of secrecy. Two cases of treatment by 
 quacks have been recently brought to my notice 
 In one case the man had been under treatment 
 for months and was in a shocking condition when 
 induced by a friend to come to the clinic, and as 
 the result of the delay his cure has been rendered 
 problematical or at best delayed for years. In 
 the other case the patient had been under treat- 
 ment by a quack for eight months, and had con- 
 sumed eighty bottles of medicine for the purpose 
 of curing a venereal disease which had no 
 existence ! 
 
 Treatment of these diseases by quacks is now 
 forbidden by law, but it still goes on, and is diffi- 
 cult to stop, for the victims, not unnaturally, are 
 unwilling to face the publicity of giving evidence 
 in a prosecution. 
 
 If the disease is not properly treated, the first 
 sore is followed by the second stage, with ulcers 
 in the mouth and throat and elsewhere, skin 
 eruptions, loss of hair, etc. This is followed by 
 the third stage, which may attack any organ of 
 the body, eating away the palate or bones and 
 causing large ulcers of the skin. The blood-vessels 
 may be affected, causing aneurysm and parly 
 apoplexy. The nervous system may be affected, 
 leading to the diseases known as locomotor ataxy 
 and general paralysis of the insane. If a man 
 
 i6 
 
Healthy Parents 
 
 marries before he is cured he may give the disease, 
 with possibly these sequelae, to his wife. 
 
 But that is not all. The most terrible thing 
 about the disease, from the point of view of this 
 book, is the effect on the children if the man or 
 woman who has had syphilis marries before being 
 thoroughly cured. 
 
 The usual history is for the wife to have one 
 miscarriage after another and then one diseased 
 child after another. Many thousands of children 
 die before they are born owing to parental syphilis, 
 many thousands more die in the first year of life, 
 or survive to become bhnd, deaf, or paralysed, .or 
 to grow up mentally defective. In the interests 
 of childhood and family life it behoves us to do 
 all we can to stamp out venereal diseases. What 
 can we do ? On two points all are agreed. Firstly, 
 that every person who becomes infected with 
 syphilis or gonorrhoea should at once get the special 
 treatment required and continue the treatment as 
 long as his doctor says it is necessary. Secondly, 
 that the man who marries before the medical 
 expert who has treated him has pronounced that 
 he is no longer infectious and may safely marry 
 is a criminal of the worst kind. This is not a case 
 for taking risks and gambling with the health of 
 the prospective wife or the children that may be. 
 
 As to other points, there is not the same general 
 agreement. A great controversy rages as to whether 
 the prevention of the disease shotfld be tackled 
 simply by a moral and educational campaign, or 
 whether it is justifiable to reduce the risk of 
 c 17 
 
Infant and Young Child 
 
 infection by the distribution to those who insist 
 upon being immoral of prophylactic outfits. Ex- 
 perience in the Army has shown that there the 
 use of prophylactic outfits has greatly reduced the 
 prevalence of venereal diseases. Those who oppose 
 the issue of outfits do so on the grounds that it 
 is a form of State regulation of vice, that it is 
 wrong to try to make immorality safe, and that 
 the fear of contracting venereal diseases is a valu- 
 able stimulus to morality. There would be more 
 force in the argument that the punishment fits the 
 crime if the punishment were limited to the criminal, 
 and if it were not for the fact that a very large 
 percentage of the sufferers from these diseases are 
 women and children who have acquired them 
 innocently from the wrongdoers. Some think there 
 is not much to be said in favour of a morahty which 
 is simply dependent on the fear of consequences ; 
 but on the other hand the fear of punishment is a 
 recognised part of our civil code. Some who oppose 
 the issue of outfits are in favour of the estabUsh- 
 ment of preventive-treatment centres, where, by 
 means of antiseptic ablutions, the risk of contract- 
 ing venereal disease may be diminished for those 
 who have exposed themselves to the risk of in- 
 fection. 
 
 However much opinions may differ with regard 
 to preventive methods, all are agreed that moral 
 and educational propaganda work is of the highest 
 importance. If we could abolish prostitution and 
 promiscuous sexual intercourse, venereal diseases 
 would rapidly disappear. In the first place, the 
 
 i8 
 
Healthy Parents 
 
 medical profession must state with no uncertain 
 voice that continence is consistent with perfect 
 health, and that no one who abstains from sexual 
 intercourse will suffer in health in the slightest 
 degree by so doing. We also need a higher ideal 
 of parenthood and family life. Every Jewish 
 father gives counsel to his son at puberty and 
 before marriage on sexual matters. The Jewish 
 mother does the same by her daughter. With us, 
 on the other hand, a boy is often dependent on 
 older youths for information on sexual matters, 
 and the sound rule, maxima debetur puero reverentia, 
 is not always observed by the man of the world. 
 The first step in immoraHty may be taken by a 
 youth from the desire to be thought manly, or 
 from curiosity, or from a lurking fear that he 
 may be unable to perform the sexual function, 
 or as the result of bad advice from an elder that 
 the desire for sexual intercomrse is natural and 
 that it is better for his health to indulge the desire. 
 If the boy got information from his father at the 
 right time he would be forewarned and forearmed. 
 The Gentile parent should emulate the Jewish 
 parent in this matter. 
 
 We are not, however, going to abolish immorality 
 and venereal diseases by cold reason. Benjamin 
 Kidd, in " The Science of Power," points out a 
 more excellent way. We must act on the emotions 
 of the ideal in the young. Kidd asserts that the 
 average man is not prevented from becoming a 
 swindler or a thief by the fact that honesty is the 
 best poUcy, but by the fact that hfe would not 
 
 19 
 
Infant and Young Child 
 
 be worth living for him if he lost his self-esteem 
 according to the code in which he had been brought 
 up ; and that nations will not give up war " because 
 it doesn't pay," but only when the barbarism of 
 war is felt to be a disgrace by the conscience of 
 humanity. Similarly, we shall not abolish prosti- 
 tution and immorality because they don't pay, 
 but only when the ideals of motherhood and family 
 life have been raised. These ideals have undoubt- 
 edly been lowered during the industrial revolution 
 and urbanisation of the nineteenth century. Per- 
 haps the twentieth century wiU rediscover the 
 mother. The Jews have always scored by the 
 fact that a reverence for motherhood, family Mfe, 
 and education is a definite part of their religion. 
 One feels also that the Protestant rehgions may 
 have lost much incidentally by discarding the 
 Madonna. The low infant mortaUty in the poor 
 country districts of Ireland and the better mother- 
 ing of children in the slums of our large cities by 
 Italians, Spaniards, and Poles than by the native 
 women are illustrations. If to sensible instruction 
 of the young in sexual matters there could be 
 added a higher ideal of the sanctity of motherhood, 
 would not the tragedy of the condemnation of a 
 potential mother to the degraded Ufe of a prostitute 
 be brought into more startUng reUef ? 
 
 Tuberculosis. — ^Tuberculosis is in a different 
 position from syphilis because it may be said with 
 truth that a baby born infected with tuberculosis 
 is so rare as to be a freak. In the case eveir of 
 cows, which go on bearing calves while markedly 
 
Healthy Parents 
 
 tuberculous, the birth of a calf actua,Uy infected 
 is a very rare event, and is only possible when the 
 womb is tuberculous or the disease is so advanced 
 that tubercle bacilli are circulating in the blood. 
 Under these latter circumstances the human mother 
 would not give birth to a living child. Although 
 infection before birth is almost impossible, in- 
 fection after birth is, on the other hand, very easy 
 and very common if one of the parents has tuber- 
 culosis of the lungs and expectorates living tubercle 
 bacilli. What we have to guard against, there- 
 fore, is infection after birth. We cannot lay down 
 any rule as regards the mysterious predisposition 
 to tuberculosis. There is no means of testing the 
 predisposition except by seeing how easily the 
 individual catches the disease. This is being wise 
 after the event. The predisposition may run in 
 families, and may be acquired from environment. 
 The liability to or immunity from tuberculosis is, 
 therefore, for most of us an unknown quantity, 
 unless we can say that we have been exposed to 
 massive doses of infection without effect. 
 
 Post-mortem examinations show that most 
 people experience slight infections with tubercle 
 and overcome them, as a rule, without the presence 
 of the disease being suspected during life. When 
 marriage is in question we can only consider 
 recognisable attacks of the disease which have 
 reached a certain stage. For instance, an occa- 
 sional attack of pleurisy in an otherwise reason- 
 ably robust person, or a tubercular hip-joint or 
 knee cured in childhood, could not be considered 
 
 21 
 
Infant and Young Child 
 
 bars to matrimony. On the other hand, very 
 few persons who reach the stage of open tubercu- 
 losis of the lung with an expectoration containing 
 tubercle baciUi ever lose the tubercle bacilli from 
 their sputum, and medical opinion would be agreed 
 that such persons ought not to marry. As with 
 venereal diseases, so with tuberculosis, there is no 
 excuse for ignorance. There are free tuberculosis 
 dispensaries aU over the country, and any person 
 affected with this disease can obtain a rehable 
 expert opinion as to whether he or she is justified 
 in marr5dng. 
 
 In the large majority of cases the danger to the 
 children arises from one or the other of the parents 
 becoming tuberculous after marriage. In such 
 cases the danger can be greatly lessened if the 
 tuberculous parent is able to carry out the instruc- 
 tions which he wiU receive from the Tuberculosis 
 Dispensary or during his residence at a sanatorium 
 as to occupjdng a separate bedroom, adopting an 
 open-air regime, and being careful about the 
 destruction of his infectious expectoration. 
 
 We have to recognise, however, that we have 
 only touched the fringe of this vast problem as 
 yet. Sanatoria have failed because we have not 
 adequately supported the family of the consump- 
 tive, and because we have only just begun to 
 reahse that the labour of the consumptive cannot 
 compete with healthy labour and must always 
 be subsidised. The recognition of these two facts 
 has led to the estabhshment of Papworth Colony, 
 in Cambridgeshire The problem is a national 
 
Healthy Parents 
 
 one : trades which pay a heavy toll to tubercu- 
 losis are carried on for the country as a whole, 
 and not only for the benefit of the district where 
 they are established. The State should there- 
 fore establish colonies similar to that at Pap- 
 worth, with model factories and workshops, to 
 which consumptives and their families can be 
 sent by local authorities, and in which, owing to 
 the attractive conditions, they will be glad to 
 stay as long as the interests of their health re- 
 quire. The subsidisation of the labour of con- 
 sumptives must be regarded as the payment made 
 by the community to guard itself from infection, 
 and the adequate maintenance of the children 
 of consumptives ought soon to show its effect 
 in the lessened prevalence of the disease. At pre- 
 sent the children of a consumptive breadwinner 
 are generally exposed to a double risk : they have 
 the infection in the home, and they are not suffi- 
 ciently fed to enable them to resist it. 
 
 Certificate of fitness for marriage. — As re- 
 gards the general question, I believe it is usual 
 in France for the parents of the prospective bride 
 and bridegroom to make careful inquiries with 
 regard to the health record of the parties to the 
 proposed alliance. Medical certificates before mar- 
 riage have been advocated, but a single examina- 
 tion by a strange doctor might prove illusory. A 
 syphilitic, for example, might be examined at a 
 time when he was free from symptoms and passed 
 as safe when he was not safe ; or, again, the examinee 
 might fail to mention that he had suffered from 
 
 23 
 
Infant and Young Child 
 
 epileptic fits. A reliable certificate could only be 
 given by an examiner who knew the health record 
 and from whom nothing was concealed. The value 
 of the certific9,te would therefore largely depend 
 on the truthfulness of the examinee, just as in 
 the case of an examination for life insurance. A 
 nice point would arise as to how far the man would 
 be in honour bound to mention the fact that he 
 had suffered from syphilis, even if the doctor who 
 treated him was satisfied that he could safely 
 marry. 
 
 Of course, in order to secure healthy parents 
 we really ought to begin with (heir parents, but 
 we have to take the prospective parents of the 
 present day as we find them, and do our best to 
 limit the effect of influences such as have been 
 mentioned. In the course of time, as social con- 
 ditions and the PubUc Health Service in the broadest 
 sense improve, ijew generations of parents will 
 grow up better fitted than those of the present day 
 to hand on the torch of civilisation. 
 
 54 
 
CHAPTER II 
 Healthy Homes 
 
 The home is not merely the roof or shelter under 
 which the members of a family eat or sleep. It 
 should be a happy centre of life where every mem- 
 ber of the family can read, work, play, or rest in 
 comfort, and it has so important a bearing upon 
 the welfare of the infant and the young child that, 
 although it forms the subject of one of the books 
 in this series,* I must devote to it a short 
 chapter. 
 
 Owing to the stoppage of building operations 
 during the War there is a great scarcity of houses 
 and much overcrowding. Many of the existing 
 houses are unsatisfactory, and thousands of houses 
 of a higher standard are needed. The minimum 
 requirements of the healthy home may be 
 summarised as follows : — 
 
 1. Every room in the house should be well 
 
 Ughted and properly ventilated. 
 
 2. There should be sufficient sleeping accom- 
 
 modation for each member of the family 
 without overcrowding and with due regard 
 to decency. 
 
 * " Housing and Public Health," by John Robertson, C.M.G., 
 O.B.E., M.D. 1919. 
 
 25 
 
Infant and Young Child 
 
 3. The living-room, which may also be the 
 
 kitchen, must be sufficiently large to 
 allow children and adults to sit and read 
 in comfort. 
 
 4. There should be a bathroom with hot and 
 
 cold water, and a sink with hot and cold 
 water inside the house; also facihties 
 for washing and drying clothes. 
 
 5. It is also necessary for the healthy home 
 
 to have a cool place for food storage, 
 with direct ventilation from the outside 
 air. 
 
 6. There should be a water-closet for the use 
 
 of each family and a movable receptacle 
 for house refuse. 
 
 In addition to this, every house should have 
 at its door a satisfactory open space in which 
 children can play without having to cross main 
 roads. 
 
 To any ordinary person glancing at these re- 
 quirements they would seem the absolute minimum, 
 though there might possibly be a difference of 
 opinion as to whether a bath is an amenity or a 
 necessity. Yet, if we consider these requirements 
 in detail, we shall find that in some of our big 
 industrial centres, as well as in many rural dis- 
 tricts of England^ ■'there are parents trsdng to 
 bring up healthy families in houses which are very 
 far from fulfilling these demands. 
 
 Women architects. — ^Architects and builders 
 are, of course, in one sense of the word the " build- 
 
 26 
 
Healthy Homes 
 
 ing experts " when it is a question of site, eleva- 
 tion, and actual planning of a house, but there 
 is no doubt that the real " housing expert " is 
 the woman who has to run the house. She is 
 the person who really knows what is wanted to 
 make a house convenient and fit to Uve in. So 
 far, she has not been sufficiently considered by 
 the builders. Why should we not have women 
 architects ? The two objections one used to hear 
 before the War were that women were not good 
 at going up ladders, and could not use strong 
 enough language to the builder's foreman. The 
 nimbleness of the women window-cleaners has 
 disproved the former statement, and perhaps the 
 latter was a Hbel. 
 
 Cleaning, cooking, scrubbing, and keeping home 
 and children clean and respectable are very pleas- 
 ant jobs in their way, but there are limits to a 
 woman's strength, and there are only twenty-four 
 hours in the day. It is not sufficiently reaUsed 
 what a very hard Ufe the woman has who brings 
 up a large family in a big town on small means, 
 and there is no need for housework to be made 
 unnecessary drudgery. 
 
 The hot-water supply. — It is, for instance, 
 practically impossible to keep a house and family 
 clean and healthy, especially in a big city, without 
 a proper hot-water supply. This point was very 
 strongly insisted upon in paragraph 13 of the 
 first interim report by the Women's Housing Sub- 
 Committee of the Ministry of Reconstruction Ad- 
 visory Council. I quote it in its entirety : 
 
 27 
 
Infant and Young Child 
 
 " It cannot be too strongly emphasised that a 
 regular and efficient water supply is a sine qua non 
 from the point of view both of personal cleanliness 
 and of labour saving. The extra time, trouble, and 
 expense involved when water must be heated in kettles 
 and carried to the bath, washtub,, or sink is a serious 
 addition to the housewife's burden. A great part of 
 the everyday work of the house, as well as the laundry 
 work, is doubled by the lack of a proper supply of 
 hot water. The extra strain on the woman's strength, 
 coupled with the waste of time, leaves her without 
 either the opportunity or energy to attend to other 
 household tasks or to secure any form of recreation 
 for herself." 
 
 Many people do not realise that there are still 
 tens of thousands of homes in this country with- 
 out a hot-water supply, and many groups of houses 
 where the only water supply is a standpipe in the 
 yard. The additional work for the mother in- 
 volved in the case of houses where a convenient 
 water supply does not exist and where there is 
 a big family to cater for can only be realised by 
 those who understand what it means for one 
 woman to undertake the entire care of a house and 
 family. 
 
 Surely, when we are considering the well-being 
 and health of the children, it is important to see 
 that the mother should have some little leisure 
 in which to read and keep abreast of the times. 
 If she has not, she will soon find that the fchildren, 
 as they grow up, will cease to consult her or con- 
 sider her opinion, and " mother" gradually becomes 
 
 28 
 
Healthy Homes 
 
 for them the household drudge, the provider of 
 the food, and in some cases (and who can wonder 
 at it ?) the ready fault-finder and scolder of the 
 young people who come heedlessly rushing into 
 the house from school or workshop, so engrossed 
 with their friends or arrangements for amusements 
 that they scarcely notice the weary, hard-worked 
 woman who is the " home-maker " for them, 
 except to grumble at her if the meals are late or 
 the house untidy. 
 
 The larder. — One thing very often neglected by 
 the builders of small houses is the provision of any 
 sort of decent larder. There are countless homes in 
 this country where the only place for the storage of 
 food is either the cellar stairhead — very often quite 
 a warm place — or a small stone table in part of 
 a small, dark coal cellar, which is unprotected 
 from dust and reaUy not possible to use ; and the 
 housewife with the very best intentions cannot 
 store such things as milk and meat in hot weather 
 without the milk going sour or the meat becoming 
 maggoty. 
 
 Indeed, when one considers the difficulties and 
 inconveniences which have to be faced by the 
 ordinary town mother, one is not surprised at the 
 high infantile death-rate, but is rather amazed at 
 what goodwill has accomphshed in the face of 
 apparently insurmountable difficulties. 
 
 Ventilation. — It is important for the healthy 
 home that it should have as much sunlight and 
 fresh air as possible, and that the windows should 
 open freely. If the windows are double sashed, 
 
 29 
 
Infant and Young Child 
 
 the two portions should be equal, so that half the 
 window space is openable at one time, and if the 
 casement window is adopted it is not sufficient 
 that only one-third of the window space is made 
 openable, as is frequently the case. No house can 
 be considered healthy which cannot be flushed with 
 fresh air in a few minutes. One would like to see 
 all curtains and lace frills around windows abol- 
 ished. They lessen the amount of fresh air and 
 sunlight available, and the air, when it does pene- 
 trate fold after fold of stuffy lace or material, is 
 dusty and musty, and has lost much of its original 
 freshness. Of course, in the case of some of the 
 windows some screening is necessary for privacy, 
 but that is no justification for blocking up all the 
 windows for the sake of uniformity. In some 
 towns, in addition to the ordinary supply of bhnds 
 and curtains, it is fashionable to have an abomina- 
 tion known as a sham blind which permanently 
 cuts off a third or a quarter of our not too plentiful 
 sunlight. An undressed window seems to be con- 
 sidered indecent ! Venetian blinds may be all 
 right for the clear, clean air of Venice, but they 
 are dust and dirt traps in an industrial town. 
 Here, again, much of the Mghting effect of the 
 window is lost because the housewife lets the blind 
 half or two-thirds way down the upper sash, accord- 
 ing to the custom of the town. 
 
 Aspect of the kitchen. — The kitchen or living- 
 room is the place where the mother and younger 
 ones of a family spend most of their time. It 
 seems a pity that this room is not always given 
 
 30 
 
Healthy Homes 
 
 the best aspect and position in the house. The 
 parlour is often little used except on state occa- 
 sions and perhaps on Sundays, but nevertheless is 
 generally considered a necessity by the poorest 
 family, and may be given the sunny aspect. We 
 are too much tied up by conventions. If a street 
 runs east and west and the northern houses have 
 Hving-rooms with a southern aspect, for the sake 
 of symmetry the buildejr gives the hving-rooms 
 of the southern houses a northern aspect. Why 
 shotddn't he reverse the plan for the southern 
 houses, so as to give all the living-rooms a southern 
 aspect ? Again, why should a house have a back ? 
 Why not two fronts ? A back was necessary >yhen 
 you had an offensive privy midden as a convenience, 
 but a dustbin can be hidden anjTvhere without 
 spoiling either of the fronts. It has been sug- 
 gested that living-room and parlour should form 
 one large room which could be divided at need by 
 folding doors, so that, as a rule, the warmth and 
 comfort of the kitchen can penetrate the parloiur, 
 and the kitchen in return be lighted and brightened 
 by the parlour windows. Whether this suggestion 
 be approved or not, the kitchen-hving-room in the 
 typically healthy home should be the largest, 
 best-Ughted, and pleasantest room in the house, 
 where everyone in the family can, after the day's 
 work is done, sit, read, rest, or play in warmth 
 and comfort. 
 
 Not too many doors. — Warmth and comfort 
 can never be obtained in a room which has four 
 or five doors in it or into which the house-door 
 
 31 
 
Infant and Young Child 
 
 opens direct. It is quite usual in Sheffield houses 
 for the outside door to open direct into the living- 
 room. A small living-room often has four doors 
 opening into it — a door leading to the street, a 
 door leading upstairs, a door leading to the coal 
 cellar, and a door leading to the scuUery, which 
 may in turn have an outside door leading into the 
 yard. In such a room there is not much comfort 
 or pleasure for anyone sitting in front of the fire, 
 and there is practically no wall space for a dresser 
 or other necessary article of kitchen furniture. 
 The writer has had his meals for the last two years 
 in a kitchen with a door opening direct into fhe 
 yard and three other doors leading to the sctil- 
 lery, cellar and front door respectively, and he 
 now thoroughly understands the discomfort caused 
 by a superfluity of doors in a room, and also the 
 need for the outside door to open into a lobby 
 or passage or, at any rate, into the scullery, and 
 not directly into the kitchen. 
 
 Another debatable point is as to whether there 
 is any necessity for a,ny small house to have two 
 house-doors. The front house-door is rarely used, 
 and only increases draught, dust, and discomfort. 
 I once stayed at the seaside in one of a row of 
 very pleasant two-storeyed houses, each of >vhich 
 had only one door. On one side of the house were 
 windows only, looking on to the street ; on the 
 other side was the door, leading through a little 
 garden to another street. 
 
 The sink. — Opinions vary as to whether there 
 should be a sink in the kitchen-living-room. It 
 
 32 
 
Healthy Homes 
 
 is certainly much more comfortable and less labour 
 for the housewife to wash up after meals in a warm 
 kitchen than to have to carry the things through 
 to a cold scullery and bring them back to the 
 kitchen dresser. If the sink is in the living-room 
 it will always be kept clean. Crede experto. 
 
 Carpets. — Floors completely covered with car- 
 pets are dirty, dusty, and unhealthy. Linoleum 
 is much better, and small rugs, which can easily 
 be taken out and beaten, can be added in the case 
 of bedrooms if thought necessary. Stair-carpets 
 are a great source of dust and labour. The air in 
 the staircase will be much purer and much labour 
 will be saved if the treads are covered with linoleum 
 with rubber nosing. 
 
 Bath and bathroom. — One often hears dis- 
 cussions as to whether a bath should be provided 
 in the ordinary cottage home. Many stories are 
 told about the bath being used for storing coal, 
 etc., but it is not generally understood that many 
 of the modern workmen's houses with baths have 
 no bathroom. There is no privacy for the would- 
 be bather. The bath is more often than not in 
 the scullery — a place which is in constant use in 
 a family of any size, where, for example, all the 
 washing-up is done after meals — and in many houses 
 the back door opens direct into the scullery where 
 the bath is fixed. Again, many of the baths which 
 have been installed have no hot-water supply ; 
 others have even no waste-pipe and require not 
 only to be filled from a kettle, but also to be emptied 
 by means of a ladle or a siphon arrangement. 
 
 D 33 
 
Infant and Young Child 
 
 Should we often take a bath if we had to ladle out 
 the water afterwards ? And yet a bath and a 
 bathroom may be considered almost a necessity of 
 life. If anyone doubts it, let him do some reaUy 
 dirty work, such as putting in and stacking a load 
 or two of coal in the coalhouse, and then try to 
 get clean in the water contained in the ordinary 
 hand-basin. Then let him consider what must 
 be the life of the wife of a coahniner or chimney- 
 sweep who has no bathroom and no hot-water 
 supply laid on in her house. It is very hard to 
 keep clean, and especially hard to keep children 
 clean, in a big smoky city, but it is ten times 
 harder to do this without a bath and proper washing 
 accommodation. 
 
 It is a good plan to have the hot-water cylinder 
 placed in a room other than the kitchen, so that 
 it may heat an otherwise unwarmed part of the 
 house instead of overheating the kitchen. A good 
 place for it is the bathroom. 
 
 Facilities for drying. — In our climate great dis- 
 comfort is caused if there is no arrangement for 
 dr57ing clothes, especially in the case of a large 
 family. A rack, worked by pulleys, should be 
 fixed to the kitchen ceiling for this purpose. 
 
 Self-contained cottages or flats. — With re- 
 gard to the preference most people have for self- 
 contained cottages rather than the flat system, 
 I do not see how a fiat, unless it be on the 
 ground floor or have a yard on its own level, can 
 be a healthy home for babies and little children. 
 The mother cannot be always helping very small 
 
 34 
 
Healthy Homes 
 
 children up and down stairs. I have always 
 thought the want of fresh air and sunlight from 
 this cause had something to do with the prevalence 
 of rickets in Glasgow. The epoch-making dis- 
 covery that a baby can be put outside in its pram 
 instead of being wheeled about is of no use to 
 the mother unless she can overlook the baby in 
 the yard while she is at work in the Uving-room. 
 
 It is perhaps Utapian to wish that every home 
 might have a garden of its own, however small. 
 There is no doubt that such an ideal, if realised, 
 would go far to make our homes more healthy. 
 
 One might almost say that a garden is more 
 necessary than a parlour, serving, as it does, in 
 turn as a nursery, drjdng-room, workshop, play- 
 ground, and open-air dining-room. 
 
 If the minimum requirements of the healthy 
 home summarised at the beginning of this chapter, 
 are fulfilled and the Sanitary Authority removes 
 the refuse regularly and scavenges the streets 
 efficiently, it rests with the housewife to see that 
 the house becomes a healthy home by keeping it 
 clean and by opening the windows to let in fresh 
 air. It must never be forgotten that it is the 
 woman who makes the home. Given an untidy 
 dirty housewife, the most modern and best-fitted 
 house in the world would be nothing but an un- 
 healthy honie, while on the other hand some badly 
 constructed, poorly ventilated, inconvenient back- 
 to-back houses have been made happy, healthy 
 homes by the devoted work of women. 
 
 Landlord and tenant. — There is another point 
 
 35 
 
Infant and Young Child 
 
 of importance. Bad tenants make bad land- 
 lords, and bad landlords make bad tenants. The 
 sacrifices of the War will have been in vain if 
 we have not got a step farther towards realising 
 the essential brotherhood of man. We want a 
 better co-operation between employer and em- 
 ployed, but for the sake of getting better homes 
 we undoubtedly want a better feeMng between 
 landlord and tenant. Miss Octavia Hill has shown 
 what can be done by a more friendly system of 
 rent collection by women who take an interest 
 in the welfare of the tenants and make i1^ their 
 business to help them when a difficulty arises, 
 and at the same time see that necessary repairs 
 have prompt attention. A visit to the Walworth 
 estate of the Ecclesiastical Commissioners will con- 
 vince anyone of the value of this system. It may 
 be necessary, also, in the case of incorrigible tenants, 
 to adopt the suggestion of Mr. John Mann, junior, , 
 secretary of the Glasgow Workmen's DwelHngs 
 Company (who is a warm advocate of Miss Hill's 
 system), and leave them to be housed by the Local 
 Authority in the simplest accommodation possible, 
 with the aim of getting them drilled into better 
 ways by strict supervision. 
 
 It is not possible to lay down rules for the housing 
 of all families, but it may be asserted without fear 
 of contradiction that the breadwinner should be 
 ready to spend as much as he can possibly afford 
 of his earnings (we know that this is not the case 
 at present) on his house rent, and that a home is 
 healthier and easier to manage, and to keep respect- 
 
 36 
 
Healthy Homes 
 
 able and clean, the farther it is from great works 
 and from the smoke and grime of the centres of 
 industrial life ; and, further, that every home 
 worthy of the name should contain the maximum 
 of labour-saving appliances that can be devised 
 for the help of the housewife, so that she may have 
 time to be a real home-maker and friend to her own 
 family. 
 
 We have many reasons to be dissatisfied with 
 the present housing conditions. The final report 
 of the Women's Housing Sub-Committee of the 
 Ministry of Reconstruction Advisory Council should 
 be carefully studied by all architects and members 
 of Housing Committees. 
 
 37 
 
CHAPTER III 
 
 The Mother 
 
 For the solution of this problem of child welfare 
 we must look to the mother. We need to educate 
 and train the mothers in housecraft, and to put 
 at their disposal all the knowledge we possess about 
 infants and children. We need to give them all 
 faciUties for doing their work, but, above all, we 
 need the raw material, women inspired by the 
 altruistic, self-sacrificing ideals of motherhood, 
 shining examples of which are to be found in every 
 modern slum among women of all races and all creeds. 
 Ideals of motherhood. — Everyone who goes 
 deeply into this question comes to the same con- 
 clusion, and decides that " the mother's the thing." 
 Let me quote from Mr. John Burns, when, as 
 President of the Local Government Board, he 
 delivered his memorable address to the National 
 Conference on Infantile MortaUty in 1906 : 
 
 " First, concentrate on the mother. What the 
 mother is, the children are. The stream is no purer 
 than its source. Let us glorify, dignify, and purify 
 motherhood by every means in our power. Let us 
 see to the nursing child in every way ; nourish the 
 mother, you feed the child. In every aspect of this 
 subject let us have good mothering ; that is at the 
 bottom of happy, healthy children. . . . Milk depots 
 
 38 
 
The Mother 
 
 are good, but not good enough if they supersede or 
 discourage breast-feeding. Crdches may be all very 
 well here and there. Personally, I am against them, 
 because I beheve that crSches stimulate the growth 
 and increase of married women's labour." 
 
 Sir George Newman, in his book on " Infant 
 Mortality," published in 1906, after discussing the 
 causes of infant mortality, proceeds as follows : 
 
 " This book will have been written in vain if it 
 does not lay the emphasis of this problem upon the 
 vital importance to the nation of its motherhood. 
 Wherever we turn, and to whatever issue, in this 
 question of infant mortahty,' we are faced with one 
 all-pervading primary need — the need of a high stand- 
 ard of physical motherhood. Infant mortality in the 
 early weeks of Hfe is evidently due in large measure 
 to the physical conditions of the mother, leading to 
 prematurity and debility of the infant ; and in the 
 later months of the first year infant mortahty appears 
 to be due to unsatisfactory feeding of the infant. But 
 from either point of view it becomes clear that the 
 problem of infant mortahty is not one of sanitation 
 alone, or housing, or indeed of poverty as such, but 
 is mainly a question of motherhood. No doubt external 
 conditions, as those named, are influencing maternity, 
 but they are, in the main, affecting the mother, and 
 not the child. They exert their influence upon the 
 infant indirectly through the mother. Improved sani- 
 tation, better housing, cheap and good food, domestic 
 education, a healthy hfe of body and mind — these are 
 the conditions which lead to efficient motherhood from 
 the point of view of child-bearing. They exert but 
 an indirect effect on the child itself, who depends for 
 
 39 
 
Infant and Young Child 
 
 its life in the first twelve months, not upon the State 
 or the municipality, nor yet upon this or that system 
 of creche or milk-feeding, but upon the health, the 
 intelligence, the devotion and maternal instinct of 
 the mother. And if we would solve the great problem 
 of infant mortality, it would appear that we must 
 first obtain a higher standard of physical motherhood. 
 " Without a moment's hesitation, I place this need 
 as the first requirement. Other things, as we have 
 seen, are important, but this is the chief thing. And, 
 therefore, in the consideration of any measures for 
 reducing the infant mortality, we must first attempt 
 to solve the problem through the mother." 
 
 Anyone who studies descriptions of the social 
 conditions in our towns and the history of child 
 labour during the nineteenth century cannot be 
 surprised at the lowering of the ideals of mother- 
 hood and family hfe. Rather will he wonder that 
 anything is left of those ideals. Sir George New- 
 man, in the book already quoted, gives a mass of 
 evidence as to the disastrous consequences to 
 child-life of the conditions in our towns, and con- 
 cludes his chapter on " Domestic and Social Con- 
 ditions " with the following words : 
 
 " It is clear that it is not external environment which 
 only, or in fact mainly, affects the problem under con- 
 sideration. During the last half-century external en- 
 vironment has enormously improved, and the advance 
 has never been greater than in the last twenty-five 
 years.* Yet infant mortality remains as grave a 
 problem as ever. And we shall not, perhaps, be far 
 
 * " Report of Interdepartmental Committee on Physical Dete- 
 rioration," vol. i., pp. 14-15. 
 
 40 
 
The Mother 
 
 from the mark if, in judging of the evil effects of bad 
 housing and of poor social conditions, we give chief 
 place to the ' laziness, want of thrift, ignorance of 
 household management, and particularly of the choice 
 and preparation of food, filth, indifference to parental 
 obligation, and drunkenness ' which ' largely infect 
 adults of both sexes, and press with terrible severity upon 
 their children.' * ' The people perish,' it has been 
 truly said, ' for lack of knowledge.' " 
 
 The follovping quotation from Sir George New- 
 man's next chapter gives us a gleam of hope : 
 
 " The incidence of a high infant mortality upon poor 
 districts is, as we have seen, almost a universal experi- 
 ence wherever the conditions exist. The overcrowded 
 and poverty-stricken districts of London, the dense 
 populations on the banks of the Tjme, or in the huge 
 manufacturing towns of the North, Glasgow, Dundee, 
 Dublin, the teeming tenements of New York or Chicago 
 — they all tell the same story with one remarkable 
 exception, namely, that where by race or custom it is 
 the practice to feed infants by the breast, the infant- 
 mortality rate drops, even though the environment 
 be highly insanitary. There is the instance of the low 
 infant death-rates obtaining among Jews, Italians, 
 Scotch, and Irish, when these races continue, even under 
 adverse circumstances, to feed their infants by the 
 breast." 
 
 There can be no doubt whatever that the pre- 
 servation of the ideals of motherhood which create 
 the determination to breast-feed the baby is the 
 
 ♦"Report of Interdepartmental Committee on Physical Dete- 
 rioration," vol. i., p. 15. 
 
 41 
 
Infant and Young Child 
 
 one most important factor in keeping down mor- 
 tality during the first year of life. Sir George 
 Newman gives conclusive evidence to show that 
 the countries where the practice is observed show 
 the lowest infant-mortality rates, that times of 
 trade depression which cause the women to stop 
 at home and tend and suckle their infants lower 
 the infant mortahty, and that it is the universal 
 experience of Medical Of&cers of Health that the 
 death-rate among bottle-fed babies is many times 
 greater than among breast-fed babies. 
 
 Mr. G. R. Sims, in his book " The Black Stain," 
 shows that the mothering of the children in poor 
 districts of our great cities is carried out more 
 successfully by Jews, ItaUans, and other aUens 
 than by the native population. It may be that 
 the aliens in these cases are not always habitual, 
 dwellers in towns. The Italians are, I beUeve, 
 often peasants from the country districts of Italy, 
 so it may be assumed that social heredity, to use 
 Benjamin Kidd's phrase, has not had time to kill 
 the national traditions of motherhood. 
 
 Motherhood as affected by race and religion. 
 — Sir George Newman quotes from some evi- 
 dence collected by Dr. Farr about fifty years 
 ago which goes to show that in Scotland, Norway, 
 and Sweden, where breast-feeding was the rule, 
 the infant mortahty was much lower than in 
 Austria, France, and Russia, where this practice 
 was neglected. England is compared unfavour- 
 ably with Scotland in this respect. 
 
 It may be said at once that there is no evidence 
 42 
 
The Mother 
 
 that the women of one race have any advantage 
 over the women of another in the ability to bear 
 and suckle healthy children. Celt, Slav, Latin, 
 Teuton, and Semite all start fair in this respect. 
 The difference that exists must be ascribed not 
 to inborn heredity but to social heredity and the 
 customs of the race. It is to be expected, there- 
 fore, that social conditions and the influence of 
 religion will play a powerful part. 
 
 The Jews. — Let us consider first the case of 
 the Jews. Mr. Sims, in " The Black Stain," says : 
 
 " The instinct of family life and the deeply religious 
 view of motherhood ensure the Jewish children, even 
 in the most crowded slum, the affectionate regard of 
 both parents. 
 
 "It is the contrast between the condition of the 
 Christian children and the Jewish children inhabiting 
 the same area and Uving under the same housing con- 
 ditions that should, if nothing else will, bring this 
 problem of the disregard of the value of child life home 
 to the Christian conscience. 
 
 " It is a terrible reflection that if the population of 
 this country were not chiefly a Christian population, 
 the Society which now protects little children from ill- 
 treatment and cruel neglect, and has its hands full 
 aU the year round and in every part of the kingdom, 
 would have very little to do." 
 
 The sanctity of motherhood and family Mfe is 
 part of the Jews' reUgion. The fact that wine is 
 used weekly in the ceremony of consecrating the 
 Sabbath seems to have the effect of making the 
 abuse of wine unMkely. There is little drinking 
 
 43 
 
Infant and Young Child 
 
 among Jewish women, especially before and after 
 confinement. If necessary, the father and rest of 
 the family will go short so that the nursing mother 
 shall not want for sustenance. The expectant 
 mother takes great care of herself, and the nurse 
 is usually in the house some time before the con- 
 finement. The education of the children is a first 
 thought and almost part of the rehgion. The 
 standard of morals among Jewesses is high. The 
 Jew father has a heart-to-heart talk on sexual 
 matters with his boy at puberty and before mar- 
 riage ; the Jew mother does the same by her 
 girl. The Jewish population in Sheffield is small, 
 about 2,500, but what experience we have con- 
 firms these statements. Drink is the usual cause 
 of overlying, and there has been no case of over- 
 ling in a Jewish family — ^in Sheffield, at any rate 
 — during the last twenty years. The only case 
 approaching child neglect I have come across was 
 the family of a widower, and was due to the woman 
 in charge of the children not looking after them 
 properly and faihng to keep the house clean. Jew- 
 ish children are seldom brought to the Day Nursery. 
 One of the few exceptions was the family of a Jew 
 whose wife was ill, and the children only came for 
 a short time. In another case some children, 
 obviously Jewish in appearance, used to be brought, 
 but they were the illegitimate children of a Gentile 
 mother by a Jewish father. Jewesses seldom give 
 birth to illegitimate children, but the standard of 
 morals is not so high for the men. Considering the 
 small Jew population in Sheffield, the number of 
 
 44 
 
The Mother 
 
 Jewish boys and girls attending secondary schools 
 is remarkable. Jews do not allow their cMldren to 
 be street traders. During the last ten years there 
 have been on the average over 500 licensed street 
 traders in Sheiiield. Only once has a Jewish boy 
 been licensed, viz. in 1909 ; in this case the father, 
 a tailor in New York, was unable to send home 
 enough money to maintain his wife and family in 
 Sheffield. A few years ago, when the son of 
 a Jewish tailor became Senior Wrangler, it was 
 not a matter of wonderment to the Jewish com- 
 munity. The father, though in humble circum- 
 stances, was a cultured scholar. 
 
 Many towns are able to confirm our experience 
 in Shef&eld. Dr. W. Hall, of Leeds, has produced 
 convincing evidence of the superior physique of 
 the Jewish children attending the Leeds elementary 
 schools as compared with the Gentile children, 
 and of the very great care taken by the Jews with 
 regard to the dietary of their children. In an 
 address delivered at a Health Congress in Leeds 
 in 1909 he said : 
 
 " I have placed in your hands statistics which 
 show that the children attending our poor district 
 Jewish schools are superior in height, weight, and bony 
 development to the children attending our good dis- 
 trict Gentile schools — ^nay, even to the children attend- 
 ing the day schools of Ripon. I believe this to be 
 due to the nature of the food supplied. 
 
 " A child suffering from rickets and scurvy may be 
 cured by the administration of cod-Uver oil and fruit 
 juice, but prevention is better than cure, and I beheve 
 
 45 
 
Infant and Young Child 
 
 that the Jews prevent their children suffering from 
 rickets and scurvy by the free administration of oil, 
 fresh fish, and vegetables, and that our Gentile children 
 suffer much from the want of such fresh food. 
 
 " Further, the poor Jewish matron, when pregnant, 
 is guarded against alcohol, prolonged outdoor or in- 
 door labour, and from insufficient food. It has not 
 been customary to pay much regard to these things 
 amongst our Gentile poor. Again, 90 per cent, of 
 poor Jewish mothers breast-feed their infants ; 80 per 
 cent, of poor Gentile mothers do not. The Jewish 
 child, then, starts hfe with a double advantage, pre- 
 natal as well as post-natal." 
 
 All reports agree that Jewesses breast-feed their 
 children and are not prevented from doing so by 
 having to go out to work. 
 
 Dr. Niven, of Manchester, in a Report on Infant 
 Mortality, dated April, 1907, seeking to explain, 
 why the Cheetham district of Manchester during 
 the decade 1894-1903 had an average infant- 
 mortality rate of 115 per 1,000 births as compared 
 with 184 for the whole city, said : 
 
 " There is an extensive poor and crowded quarter 
 in this district, which comes close to the centre of the 
 city. This quarter is inhabited by Jews. It is the 
 custom among these Jews for married women to stay 
 at home. The mother is thus protected before and 
 after childbirth. There is also practically no drunken- 
 ness, and these poor people are in consequence com- 
 paratively well-nourished. They are not very clean. 
 It is probable, therefore, that the advantage which 
 they have secured is due to the care which the mothers 
 
 46 
 
The Mother 
 
 bestow on their offspring, and to their being able to 
 give the breast." 
 
 The following paragraphs are taken from the 
 Annual Report for 1907 of Dr. Hope, the Medical 
 Oificer of Health for Liverpool : 
 
 " It is desirable to add a few words in reference 
 to the Jewish community, and for the purpose of 
 illustration to take fifty poor — some very poor — Jewish 
 families, taken corisecutively. The family earnings 
 averaged from los. to 30s. per week. The points which 
 stand out are, first, that in every instance the children 
 are well looked after, all suitably clad, and not one 
 ragged or barefooted child seen. The beds were clean, 
 and always a cot provided for the baby beside the 
 mother's bed. Domestic dirtiness is uncommon, but 
 even where it existed all the mothers seemed to realise 
 their duty and responsibility to their children, and 
 to act upon it. Thriftiness and sobriety were universal ; 
 no drunkenness at all. A noticeable feature which 
 always impresses the visitor is the attention given 
 by the mothers to the children's food. In no single 
 instance was the mid-day meal wanting ; moreover, 
 it is usually good and wholesome, and prepared in a 
 way which the children relish. It must be remembered 
 that some of these families were in receipt of relief 
 from the Jewish Board of Guardians, but others, 
 of course, are fairly comfortably off for that 
 class. 
 
 " With regard to the numbers of children born, 
 the average number in the family is not large. The 
 maximum was ten, and that only in one family ; the 
 average is five, but the figures as to the numbers who 
 have died compare very favourably indeed with those 
 
 47 
 
Infant and Young Child 
 
 of the Gentile races in the same social scale. In the 
 fifty families, the total number of infants born was 
 233, and the number of deaths which have taken 
 place amongst the whole number and at various ages 
 and by no means all in infancy, was 29 — figures which 
 speak very favourably." 
 
 Mr. Parr, the Director of the National Society 
 for the Prevention of Cruelty to Children, states 
 that in his experience of nearly twenty years, 
 " proceedings against Jews for neglect or cruelty 
 have been very rare." 
 
 Can it be doubted that the religion, traditions, 
 and social heredity of the Jews make for good 
 motherhood, a low infant-mortaUty rate, and the 
 general welfare of children ? It may be that their 
 religious traditions have been stimulated by supreme 
 necessity in providing for the preservation of their 
 race during centuries of persecution. 
 
 The Irish. — As long as our records go back, 
 Ireland has consistently had a much lower infant- 
 mortality rate than either Scotland or England. 
 Since 1890 the English rate, which was much 
 higher than the Scottish, has come nearer to the 
 Scottish, but both are still considerably higher 
 than the Irish. The infant-mortality rates in the 
 Irish country districts have been remarkable when 
 compared with the standards which we have 
 hitherto regarded as attainable. They are less 
 remarkable now owing to the recent improvement 
 in the EngHsh rates. 
 
 The following table gives a comparison between 
 EngUsh and Irish infant-mortality rates during 1916 : 
 
 48 
 
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Infant and Young Child 
 
 The appended lists show the English and Irish 
 counties with the lowest infant-mortality rates 
 during 1916 : 
 
 England and Wales 
 
 Radnorshire . . 53 
 
 Oxfordshire . . 55 
 
 Berkshire . . 58 
 
 Isle of Wight . 59 
 
 Somersetshire . . 60 
 
 Surrey . . .61 
 
 Southampton . . 63 
 
 Wiltshire. . . 63 
 
 West Sussex . . 63 
 
 Shropshire . . 64 
 
 Lincolnshire (parts of 
 
 HoUand) . . 64 
 
 Gloucestershire . 66 
 
 Northamptonshire . 66 
 
 In the Report on Ireland prepared for the 
 Carnegie Trust, Dr. E. Coey Bigger shows that 
 eight counties — Roscommon, Leitrim, Wicklow, 
 Mayo, Tipperary (N.R.), Cavan, Galway, and Long- 
 ford — had infant-mortahty rates below 60 per 
 1,000 births during 1915, and that in them 17. i 
 per cent, of the births of Ireland occurred. Of 
 these counties, Galway, Mayo, Leitrim, and Ros- 
 common, all in Connaught, are perhaps the poorest 
 counties in the country. 
 
 Dr. Bigger regards a reduction of the infant- 
 mortahty rate to 50 in the country and 80 in the 
 towns as an easily attainable ideal for Ireland. 
 
 50 
 
 Ireland 
 
 
 Roscommon 
 
 35 
 
 Leitrim . 
 
 46 
 
 Mayo 
 
 51 
 
 Kerry 
 
 51 
 
 Galway . 
 
 53 
 
 Clare 
 
 55 
 
 Meath . 
 
 56 
 
 Monaghan 
 
 56 
 
 Cavan 
 
 59 
 
 Tipperary (N.E 
 
 ..) 60 
 
 Londonderry 
 
 61 
 
 Fermanagh 
 
 62 
 
 Shgo 
 
 64 
 
The Mother 
 
 A few sentences extracted from the Report furnish 
 a good part of the explanation of the low infant- 
 mortality rates in the Irish counties : 
 
 " The Irish mother is celebrated throughout the 
 world for the affection she has for her offspring " 
 
 (P- 45). 
 
 " The practice of breast-feeding is almost universal 
 among the poorer mothers in the country, and is still 
 very common in town " (p. 45). 
 
 " The figures (for illegitimate births) vary from 
 0.8 per cent, in Connaught to 4 per cent, in Ulster " 
 
 (P- 47)- 
 
 " Intemperance in Ireland is now much less common 
 than formerly, and although still all too prevalent 
 among men, it is rare among women, especially in the 
 country " (p. 44). 
 
 " In other countries one of the chief diseases of the 
 parents which has a considerable influence in causing 
 infant mortaUty is syphihs. This has already been 
 referred to as one of the causes of abortions, miscarriages, 
 prematurity, and marasmus in infants, and it has been 
 shown that, apart from DubUn and Belfast, the disease 
 is not common in Ireland. The deaths of infants 
 stated to be due to syphiUs amount to 0.7 per cent, of 
 the whole ; and though this figure is probably too 
 low, the number cannot be lirge. Syphilis is not ac- 
 countable for many of the deaths of infants in Ireland. 
 Gonorrhoea, while not causing the deaths of infants, 
 is often associated with sterihty in females. It is also 
 a most usual cause of a serious though non-fatal disease 
 of infants — ophthalmia neonatorum, which, if neglected, 
 causes bhndness. Ireland is, however, very free from 
 blindness caused by this disease " (pp. 43-44). 
 
 51 
 
Infant and Young Child 
 
 Syphilis, alcohol, and heavy work by the mother 
 in the later part of pregnancy are given as the 
 chief causes of deaths of infants ascribed to " pre- 
 maturity," etc., and the following figures, taken 
 from the Report, confirm what is said about the 
 temperance a,nd freedom from syphilis of Connaught 
 mothers : 
 
 Deaths of Infants from Prematurity 
 
 Leinster . . . 10.9 per 1,000 births 
 
 Ulster . . . 10.2 
 
 Munster . . • 5-2 „ „ 
 
 Connaught . . 2.0 „ „ 
 
 Deaths from Syphilis at All Ages 
 
 Leinster . . . 2.1 per 1,000 deaths 
 
 Ulster . . .1.4 „ 
 
 Munster . . . 0.38 „ „ 
 
 Connaught . . 0.12 „ „ 
 
 Dr. Bigger draws attention to the poverty in 
 the country districts, to the practice of midwifery 
 by untrained handy women, to the high percentage 
 of deaths with no doctor in attendance at the last 
 illness, and to the fact that famiUes are larger 
 than in England and Scotland. 
 
 It is an extremely noteworthy fact that in the 
 west of Ireland, where these low infant-mortality 
 rates prevail, rickets is, practically speaking, an 
 unknown disease. The Carnegie Report on Scottish 
 Mothers and Children records a similar association 
 of breast-feeding, low infant mortality-rates, and 
 
 52 
 
The Mother 
 
 absence of rickets, coupled with good teeth, among 
 the children of the Outer Hebrides, a large number 
 of whom live in the remarkable " black houses." 
 
 It would appear that the low infant-mortality 
 rates in Connaught are attributable to freedom 
 from alcohol and syphihs and the determination 
 of the Connaught mother to be a mother. The 
 country districts of Ireland have suffered in the 
 past from absentee landlords, but the babies 
 in them have not suffered from absentee 
 mothers. 
 
 Bradford compared with Connaught. — In a 
 lecture published in 1918 by the National Baby 
 Week Council, Dr. C. W. Saleeby gives a most in- 
 teresting comparison between Bradford and Con- 
 naught. Referring to the prosperity of Bradford 
 and the splendid and well-directed efforts of its 
 model Infant Welfare Department with an ex- 
 penditure of ;f20,ooo a year, he points out that, 
 in spite of this effort, the infant-mortality rate 
 in 1916 was 132, the birth-rate being only 13.2. 
 He then goes on to show that in Connaught, where 
 there were " poverty," " ignorance," and adverse 
 conditions as regards " medical and nursing re- 
 sources," " housing," and " public effort," and 
 the birth-rate is high, the infant-mortality rate 
 is only about 50, and that the infant-mortality 
 rate in Roscommon is " little more than one-fourth 
 of that of Bradford with its rare babies." " But 
 the Connaught babies have healthy mothers with 
 an extreme minimum of syphihs, who stay at 
 home and feed them as no science can feed them, 
 
 S3 
 
Infant and Young Child 
 
 and the babies live," while in Bradford 
 tically all the mothers go out to work." 
 
 prac- 
 
 Sheffield compared with Bradford.— The fol- 
 lowing comparison between Sheffield and Bradford 
 is of interest because in Sheffield, unhke Brad- 
 ford, the mothers of babies have not gone to work 
 in the factories to any appreciable extent during 
 the War : 
 
 Infant-Mortality Rate and Birth-Rate 
 Sheffield and in Bradford 
 
 IN 
 
 Year 
 
 Birth-rate 
 
 Infant-mortality rate 
 per 1,000 births 
 
 
 Sheffield Bradford 
 
 Sheffield 
 
 Bradford 
 
 1909 .. 
 
 29.8 . 
 
 . 18.8 
 
 .. 119 . 
 
 116 
 
 1910 . . 
 
 28.1 . 
 
 . 18.6 
 
 ■ • 127 . 
 
 127 
 
 1911 . . 
 
 27.7 . 
 
 . 19.0 
 
 . . ?4i • 
 
 138 
 
 1912 . . 
 
 27.7 . 
 
 • 194 
 
 . . X07 . 
 
 99 
 
 1913 . . 
 
 28.2 . 
 
 ■ 19-9 
 
 ,. 128 . 
 
 127 
 
 Average 5 yrs 
 
 
 
 
 
 1909-13 . . 
 
 2S.J . 
 
 . 19.1 
 
 . . 124 . 
 
 131 
 
 1914 . 
 
 27-3 ■ 
 
 • 197 
 
 . . 132 . 
 
 122 
 
 1915 : 
 
 25-5 • 
 
 • 17-5 
 
 •• 133 . 
 
 . 123 
 
 1916 . . 
 
 25-3 • 
 
 • 17-5 
 
 . . 109 . 
 
 . 119 
 
 19x7 . 
 
 21.7 . 
 
 . 13-2 
 
 . . 104 . 
 
 . 131 
 
 1918 . 
 
 20.7 . 
 
 . 13.2 
 
 . . 129 . 
 
 . 123 
 
 Average 5 yrs 
 
 
 
 
 
 1914-18 . 
 
 24.1 . 
 
 . t6.2 
 
 . . 121 . 
 
 . ^'4 
 
 It will be noticed that, comparing the quin- 
 quennium before the War with the quinquennium 
 of the War, the birth-jate in both towns has 
 
 54 
 
The Mother 
 
 declined, and that in Bradford the infant-mortality 
 rate has increased from 121 to 124, whereas in 
 Sheffield the rate has declined from 124 to 121. 
 The figures, as far as they go, tend to support the 
 contentions in Dr. Saleeby's comparison. 
 
 Infant mortality of Dublin.— Throughout Ire- 
 land the infant-mortality rate has always been 
 low compared with other countries, and even in the 
 towns, as, for example, Dublin, it has never been 
 so high as one would expect from the social and 
 sanitary conditions and the high general death- 
 rate. In the case of Dublin the Carnegie Report 
 points out that it is not an industrial city, and 
 that the mothers " are able to remain at home and 
 tend and nurse their children." 
 
 English and Irish mothers in Liverpool. — Dr. 
 Hope, giving evidence before a Committee of 
 Inquiry into the health of the city of Dublin, 
 attributed the lower infant mortality among the 
 Irish population in the slums of Liverpool as com- 
 pared with the English population to the fact 
 that the Irish mothers suckled their babies much 
 more commonly than the English. 
 
 Racial traditions of motherhood must be very 
 strong to survive exposure to conditions such as 
 are to be met with in the poorest parts of Liver- 
 pool and Dubhn, and one cannot help feeling that 
 religion and the inspiration of the Holy Mother 
 must play a part in producing this result. The 
 beautiful picture of a peasant mother in the frontis- 
 piece of the Irish Carnegie Report seems to be the 
 recognition by the Irish author of this train of 
 
 55 
 
Infant and Young Child 
 
 thought. It may seem a paradox that a Church 
 with a celibate clergy should have this effect, 
 but the mere fact that the clergy do not have 
 their imagination dulled by the everydayness of 
 family life may enable them to keep the ideals 
 on a higher plane for those to whom they have to 
 act as spiritual directors. 
 
 Italian ideals of motherhood. — If we turn to 
 the Itahans in this country, who also preserve 
 their ideals of motherhood so wonderfully, in spite 
 of adverse circumstances, in many of our large 
 cities, is it not conceivable that they have acquired 
 ineradicable impressions in their upbringing in the 
 country of the beautiful Madonnas ? We are not 
 going to raise the ideals of motherhood and family 
 life by science or pure reason alone, and the example 
 of the Jewish, Irish, and ItaUan mothers may point 
 the way to a more inspiring method of applying 
 our reUgious ideals. 
 
 The Society of Friends and family life.— This 
 is an example of a small religious community 
 which has succeeded in incorporating in its code 
 of ethics a very high standard of family Hfe. The 
 infant mortality among them is very low. 
 
 It may be said that the small size of the Society 
 (there are about 20,000 Quakers in the United 
 Kingdom), and the fact that there are few, if any, 
 Quakers living below the " poverty hne," make it 
 unfair to compare them with communities which 
 include many poor persons. It may, however, be 
 fair to compare them with the more well-to-do 
 portion of our population in certain particulars. 
 
 56 
 
The Mother 
 
 The Central Ofifice of the Society of Friends 
 keeps a record of the births and deaths of all mem- 
 bers of the Society. "When both parents are 
 Quakers their children become members of the 
 Society by birthright. It is possible, therefore, to 
 obtain the number of births and the number of 
 deaths under one year over a period of years. 
 During the eight years 1910-1917 there were re- 
 corded 1,024 births and 35 deaths under one year, 
 which is equivalent to an infant-mortaUty rate of 
 about 34 per 1,000 births. 
 
 The Secretary of the Society of Friends has 
 kindly supplied me with figures relating to twenty- 
 five years before 1910. During this period, 1885 
 to 1909, there were 3,959 births and 236 deaths 
 of children under one year, equivalent to an infant- 
 mortality rate of 60. If the period is divided into 
 three, we find that during 1885 to 1893 there were 
 1,539 births and 106 deaths under one year ; during 
 1894 to 1901, 1,211 births and 74 deaths under one 
 year ; during 1902 to 1909, 1,209 births and 56 
 deaths under one year. Thus, the infant mor- 
 taUty in the Society since 1885 has been as follows : 
 
 I885-I893 . 
 
 . 6g per 1,000 births 
 
 I894-I90I . • 
 
 . 61 „ „ ,, 
 
 I902-I909 . 
 
 . 46 .. » » 
 
 I9IO-I9I7 . 
 
 ' 34 " >> >> 
 
 I am indebted to a medical and other members 
 of the Society for further information which I believe 
 will be of interest. Quaker mothers almost in- 
 variably breast-feed their babies, not as the result 
 
 57 
 
Infant and Young Child 
 
 of any direct teaching on the subject, but because 
 they devote themselves to the home and social 
 service, and have an instinctive feeling that it is 
 their duty to their children. 
 
 Early marriage is commoner than among per- 
 sons of corresponding social status, because the 
 much simpler life Hved by the Quakers renders 
 early marriage possible. Definite talks on sex 
 questions are given by most parents to their chil- 
 dren, beginning at quite an early age, such as four 
 or five years, when questions begin to be asked. 
 Illegitimacy is practically unknown. Alcoholism 
 and venereal disease are very rare. 
 
 A chief factor in enabling this high moral 
 standard to be reached has been that for genera- 
 tions the boys and girls have been brought up as 
 equals. In the place of worship and in the home 
 there is no distinction, and the same moral standard 
 is expected of each sex when they grow up. Girls 
 and boys have equal education, and the girls of a 
 family are not brought up to wait on the boys. 
 The form of worship and the life expected of mem- 
 bers of the Society teach self-restraint. They 
 reaKse that there is an element of the divine in every 
 human creature, and that to defile it would be a 
 sin. A great point is made of talks at the schools 
 on social subjects. 
 
 One of my correspondents writes : " The Society 
 certainly planned to give ail its children a good 
 education, and our schools have done splendid 
 work in the past, especially in the way they have 
 emphasised the need for educating our girls quite 
 
 S8 
 
The Mother 
 
 as well as our boys, even though they have not 
 quite managed to carry out the magnificent recom- 
 mendation of our founder, George Fox, that ' our 
 girls shall be taught all things civil and useful in 
 creation.' It is this equal ideal, I think, which 
 makes the relationship between brothers and sisters 
 among us curiously different from that in many 
 families, and I know it strikes many outsiders 
 very strongly. The girls of the Quaker family 
 are not sacrificed in order to send the boys to 
 college ! " 
 
 Parenthood is taken very seriously by the 
 Quakers, and a considerable portion of their book, 
 " Christian Discipline of the Society of Friends," 
 is devoted to advice to parents. The following 
 extract from Part II., " Christian Practice " (pp. 
 66 and 67), dealing with a matter which is very 
 important from the point of view of the education 
 of children for parenthood and the prevention of 
 immorality, illegitimacy, and venereal diseases, is 
 a good example : 
 
 " It is our earnest conviction that it is the duty, 
 as it is also the privilege, of parents to teach their 
 children the main facts concerning the formation and 
 functions of their own bodies, and concerning the 
 manner in which they have come into the world. This 
 can be done gradually in a simple and natural way, 
 'according to the growing intelligence of the child. 
 By answering the child's questionings, and by making 
 use of illustrations from nature, it should be possible 
 to prevent any morbid thoughts, and to impress upon 
 the child's mind the beauty, purity, and holiness of 
 
 59 
 
Infant and Young Child 
 
 life. The fullest confidence between parents and 
 children may well be encouraged in this matter. When 
 it is not dealt with in the way suggested, the informa- 
 tion which is naturally sought for by the inquiring 
 child will often be communicated by others in a manner 
 calculated to soil the mind and to work immeasurable 
 harm in the future. The responsibility for the wise 
 handling of this vital subject should be shared by both 
 parents." 
 
 If we were all Quakers the complex problem 
 of infant mortality and child welfare would be 
 easily solved. One does not, however, suggest 
 that as the way out. It is not the ideals of the 
 Churches that are at fault ; it is the failure to 
 incorporate those ideals in everyday conduct in 
 such a manner as to raise the regard for mother- 
 hood and the sanctity of family Ufe. Breatst- 
 feeding, for example, ought to be regarded as a 
 religious duty. It is not so regarded. Have the 
 Churches been too much concerned in what one 
 might call the theory of religion to give to these 
 all-impottant subjects the attention which they 
 deserve ? 
 
 60 
 
CHAPTER IV 
 The Training of the Mother 
 
 There is not much satisfaction to be got from doing 
 any job unless you know how, and a mother's job 
 is no exception to the rule. Efficient housewives 
 are more important than bricks and rnortar in the 
 making of healthy homes. In addition to knowing 
 about the feeding and rearing of children, the 
 mother needs to be an expert in housewifery, cook- 
 ing, laundry work, and needlework. In the days 
 of our great-great-grandmothers most of the popu- 
 lation Uved in the country, and girls learnt these 
 things from their mothers, those eighteenth-cen- 
 tury mothers whom Napoleon feared. Nowadays 
 most of us live in towns, and girls leave schocd 
 at 13 or 14 years of age to go into shops, work- 
 shops, and factories, and at the end of their day's 
 work are in no humour to learn housewifery ; and 
 if they were, the chances are that the town mother, 
 who has not been properly taught herself, would 
 not be in a position to teach them. 
 
 We have not yet learned how to Uve in towns. 
 
 Training of future mothers. — The change from 
 country Ufe to town Hfe makes it essential that 
 every girl's education should include a thorough 
 training in cooking, housework, laundry work, 
 needlework, and mothercraft. The mother's is a 
 
 61 
 
Infant and Young Child 
 
 skilled trade, and as urbanisation has abolished 
 the apprenticeship system we have to find a sub- 
 stitute. One imagines that the apprenticeship 
 system must have been kept up in the country 
 districts of Ireland, because of the low infant- 
 mortaUty rates in Leitrim, Mayo, Galway, and 
 Roscommon. Nowadays the town girl may, be- 
 fore leaving school, get a smattering of some of 
 the subjects enumerated, but after a few years' 
 work in an office, shop, or factory she soon for- 
 gets what she has learnt, and is probably little 
 quahfied to run a house when she is married. At 
 the present time the curriculum of elementary 
 education is too crowded and too short to get 
 the subjects in, and, in addition to this, there are 
 not enough domestic economy centres to give the 
 teaching. Also, if the estimates have to be cut 
 down, domestic economy is often the subject which 
 goes to the wall. When half-time education is 
 continued up to i8 years of age, it ought to be 
 possible for every girl to get a really good know- 
 ledge of domestic economy and to begin her mar- 
 ried hfe with the confident feehng that she knows 
 something about her job. Many of the hopeless 
 slatterns with neglected homes and families whom 
 we come across have developed from well-in- 
 tentioned girls who never learned how to manage 
 a house, and who, as the babies came and the 
 work increased, have simply let things sUde and 
 perhaps taken to drink at the finish. 
 
 Lack of domestic servants. — ^Another reason 
 will emphasise the need for thorough teaching in 
 
 63 
 
The Training of the Mother 
 
 housecraft and mothercraft. The number of male 
 workers has been greatly reduced by war casualties, 
 and in order that we may pay our way as a country 
 women will be required to do work of national 
 importance. The war will leave us with a paucity 
 of domestic servants,] and hence fewer women will 
 learn house management through domestic service. 
 Incidentally the middle-class woman will have to 
 become more efficient as a mother and a 
 housewife, to her own great gain. All this will 
 help to put scientific housewifery on a new 
 footing. 
 
 Training of existing mothers. — The instruc- 
 tion of the future mothers in domestic economy 
 and mothercraft is only one part of the problem ; 
 we have also to do what we can to improve the 
 efficiency of existing mothers, whose education in 
 these matters has been neglected. This can be 
 done by the institution of sewing and cookery 
 classes in connection with Maternity a,nd Child 
 Welfare Centres, Mothers' and Babies' Welcomes, 
 and Schools for Mothers. Sir George Newman's 
 Report for 1917 shows that 286 of such institutions 
 received grants from the Board of Education for 
 the year ended March 31st, 1918, representing an 
 increase over the number for 1915 of 129. The 
 most hopeful method would seem to be the holding 
 of classes for mothers by the Education Committee 
 at the schools which their daughters attend. The 
 grant of the Board of Education is available for 
 such classes. The mothers, as a rule, feel a great 
 interest in the cookery competitions and exhibitions 
 
 63 
 
Infant and Young Child 
 
 in which the scholars take part, and one would 
 suppose that this is the most hkely way of arousing 
 their interest and getting them to attend classes 
 themselves. 
 
 In the poorest parts of a large city one finds 
 whole streets and districts where the use of a 
 needle is almost unknown. One wonders what is 
 the effect on a mother whose knowledge of needle- 
 work and cooking is of the scantiest if her daughter 
 is turned out by the school an expert in these 
 matters. Does the mother learn from the daughter, 
 and is she stimulated to attend evening classes 
 on these subjects instituted for mothers by the 
 Education Committee, or does she look with scorn 
 on the acquirements of her daughter ? 
 
 Of course, what has been done up to now in 
 the way of training for motherhood has been 
 absurdly inadequate, and yet it seems impossible 
 to exaggerate the effects that would result from 
 a thorough training of the women of the nation in 
 mothercraft and housecraft. Certainly the solution 
 of the housing problem would be hastened thereby, 
 because well-trained women would not put up 
 with the primitive housing arrangements which 
 have hitherto been provided for them in so many 
 cases. Miss M. V. Palmer, author of " The Com- 
 monwealth Cookery Book," and organiser of domes- 
 tic subjects to the Birmingham Education Com- 
 mittee, who formerly occupied a similar position 
 at Sheffield, has kindly prepared for me the follow- 
 ing suggested schemes for helping existing mothers 
 and training school girls : 
 
 64 
 
The Training of the Mother 
 
 Suggestions for Helping Existing Mothers 
 
 Every evening school should include not only 
 Lectures on all domestic subjects, but also on Mother- 
 craft (or Maternity), in its curiiculmn. 
 
 Local Education Authorities should arrange after- 
 noon Lectures on — 
 
 Cookery : 
 
 Simple Household. 
 
 Invalid. 
 
 Meals for children. 
 Laundr3nvork. 
 Housecraft 
 
 (Special attention being paid to labour-saving 
 devices). 
 Needlework : 
 
 Dressmaking. Tailoring. Millinery. 
 Hygiene : 
 
 First Aid. Home Nursing, 
 Maternity. 
 
 It is important that these Lectures should be popu- 
 larised by first getting into touch with Women's Asso- 
 ciations, e.g. the Women's Co-operative Guilds, Mothers' 
 Meetings, Women's Institutes, etc. 
 
 Prizes might be given — even examinations have 
 been known to act as incentives. 
 
 Small Exhibitions, open to the pubUc, should be 
 held at the end of each course. 
 
 The Lectures should generally be given in some 
 accessible building, and one well known to the 
 general public, e.g. an Elementary School, Church 
 or Chapel Room, Women's Institute, Public 
 HaU. 
 
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Infant and Young Child 
 
 If possible, during the second and third terms, 
 two hours per week should be spent as follows : 
 
 2nd Term — Cookery (including the preparation ot 
 menus and of meals for families of various 
 sizes, invalid cookery, etc.). 
 
 ^rd Term — ^Needlework or simple dressmaking (in- 
 cluding design). 
 
 68 
 
CHAPTER V 
 Child Poverty 
 
 As regards child welfare, I believe that the money 
 question is of very great importance. No one 
 knows what the nation loses through child poverty. 
 
 Child poverty is a disgrace to any nation, and 
 is expensive ultimately by fiUing workhouses, hos- 
 pitals, reformatories, asylums, and prisons. 
 
 The victims of child poverty may, roughly, be 
 divided into five classes : 
 
 1. The children of widows and disabled bread- 
 
 winners. 
 
 2. The children of large families where both 
 
 parents are alive and the breadwinner 
 earns a wage insufficient to meet the needs 
 of the family. 
 
 3. The children of a man who earns a big 
 
 enough wage but persists in giving his 
 wife an insufficient sum every week to 
 keep house on. 
 
 4. The children of neglectful and drunken 
 
 parents. 
 
 5. Illegitimate children. 
 
 Children of widows and disabled bread- 
 winners. — ^The first of the five classes is no doubt 
 
 69 
 
Infant and Young Child 
 
 humanely dealt with by progressive Boards of 
 Guardians, but it is considered a disgrace by many 
 people to have to apply to the Guardians, and a 
 good deal of want is often endured before appHca- 
 tion is made. It is impossible for a working man 
 to make provision so that his wife and children 
 can " carry on " if he is cut off prematurely, or 
 permanently disabled. Let us take an example. 
 A woman well able to earn her own living marries 
 a man who is an exemplary husband, and they 
 have six children. The husband dies from pneu- 
 monia when the eldest child is twelve. But for 
 her children the mother could again earn her own 
 hving. She has done nothing to mtfit any dis- 
 grace. She ought to receive an honourable allow- 
 ance free from the taint of pauperism or charity, 
 to enable her to maintain a home for her children 
 until they are started in life. 
 
 This class of child poverty, one feels, could be 
 adequately dealt with by the adoption in this 
 90untry of what are known in America as " Mothers' 
 Pensions," or, a? their principal advocate. Judge 
 Neill, would prefer to have them called, " Child 
 Pensions." I beheve it was Judge Neill who pointed 
 out that there is ancient historic precedent for this 
 system, in that Moses was boarded out with his 
 own mother, and Pharaoh's daughter paid the 
 " mother's pension." Opinion in this country is 
 undoubtedly growing in favour of giving the 
 system a trial. 
 
 The children of large families. — Children of 
 the second class might also be dealt with by a 
 
 70 
 
Child Poverty 
 
 system of child pensions. When there are more 
 than four children in the family under school-leaving 
 age simultaneously, an adequate allowance for each 
 child exceeding the number of four would perhaps 
 meet such cases. It is mathematically impossible 
 for a man and his wife and six children below 14 
 to be adequately maintained on a labourer's wages. 
 Even with the greatest thrift the children must be 
 underfed, insufficiently clad, and improperly housed. 
 Yet there are many such families. If we, as a 
 nation, are in earnest in this crusade we shall see 
 to it that the children in a large family have proper 
 support. How can one fix a living wage which is 
 suitable alike for a single man, a single woman, a 
 man and his wif« and three children, and a man 
 and his wife and six or eight children ? The State 
 must come to the rescue and recognise that a 
 woman who is briiiging up a large fanuly well is 
 doing good work. The dignity of motherhood de- 
 mands that any assistance given by the State in 
 such cases be free from the taint of pauperism or 
 patronising charity. 
 
 Pre-natal influences count for something. The 
 advent of a new-comer in a normally prosperous 
 family is hailed with joy. Can it he so if the 
 parents have already all they can do to make both 
 ends meet, and know that one more mouth to fill 
 wiU mean their sinking below the poverty hne ? 
 Is it remarkable if the woman in such circumstances 
 has recourse to dangerous operations or to drugs 
 which may cost her her life ? We must aboUsh the 
 unwanted child and help the super-mother. 
 
 71 
 
Infant and Young Child 
 
 The principle of making allowance for the main- 
 tenance of children has been recognised in the 
 income-tax for some years, and since the outbreak 
 of war a system of war allowances varying accord- 
 ing to the size of the family has come into operation 
 on a huge scale, and those of us who have been 
 intimately in contact with its working are able 
 to say that it has been very little abused. In 
 very many cases homes have been improved, neces- 
 sary furniture has been obtained, and the children 
 have been better fed and clothed than ever before. 
 This was especially the case where the famihes 
 received the half wage of the man who had been 
 " called up," in addition to the Army allowance. 
 When the school-leaving age is stiU further raised, 
 and children continue their education as half- 
 timers to i8 years of age, there will be all the more 
 reason for assisting the large families. 
 
 I do not think that the cost of thus assisting 
 large families will be so very great. 
 
 At the 1911 census the population of Sheffield 
 was about 450,000, of whom 200,000 Uved in houses 
 of four rooms or less. The famihes which would 
 require assistance in the manner suggested would 
 be mostly included in the 200,000 hving in the 
 small houses. 
 
 It is possible to obtain from the census the 
 number of those families in which there were more 
 than four children under the age of 10 simultane- 
 ously at the time when the census was taken, and 
 also the number of such children. The total of 
 such children exceeding the limit of four per family 
 
 72 
 
Child Poverty 
 
 in Sheffield in 1911 was 835, and if an allowance of 
 5s. per week had been paid in respect of each of 
 them the total annual cost would have been £10,855, 
 A penny rate in Sheffield brings in nearly £9,000, 
 so that the cost for children under 10 would be 
 equivalent to a rate of about ijd. in the £, but 
 there would be some savings to put against this 
 in decreased out-relief, etc. One cannot obtain 
 from the census the same particulars for children 
 under the school-leaving age of 14, but the cost 
 would certainly be less than a 2d. rate. I only 
 mention the rates for the purpose of giving some 
 idea of the cost. Most people will agree that 
 assistance of this kind to both widows and large 
 families should be a national and not a local charge 
 
 I would further suggest that these child pen- 
 sions should be administered by the local health 
 authcffities, who already possess, through their 
 health visitors, much knowledge of the families and 
 would be able to ascertain if the pensions were being 
 rightly used. 
 
 The pa3anent of an adequate allowance for each 
 child boarded out with its own mother would not 
 exceed one-third of the cost of keeping such child 
 in a Poor Law institution, and the allowances in 
 such cases would be really preventives of poverty 
 and want, with all their direful results to the 
 physique of the children, instead of assistance from 
 the Poor Law after the breaking-up of the home 
 and the occurrence of destitution. I think that 
 the difference in cost between adequate and timely 
 allowances paid to the mothers and the necessarily 
 
 73 
 
Infant and Young Child 
 
 belated payments made by the Guardians in re- 
 spect of many such families would be balanced 
 by the lessened cost of institutions and the im- 
 proved health of the children, the latter of which 
 gains is not to be expressed in money value. 
 
 It need not unduly worry us that the cost of 
 child pensions wiU to a large extent fall on bachelors 
 and the childless. We are all working for social 
 evolution and the future, whether it be a Christian, 
 a Socialist, or a Jewish millennium to which we 
 look forward. We do not exactly want to punish 
 the conscientious objectors and shirkers who fail 
 to join up in the matrimonial army, but I know 
 of no reason why they should be left out in the 
 cold. 
 
 Children of neglectful parents. — ^The third class 
 of victims of child poverty are the children of 
 indifferent fathers who do not seem to realise their 
 responsibiUties and appear to be unconscious of 
 neglect till their attention is drawn to the matter 
 by an outsider. As the border-Mne between 
 parental indifference and parental neglect is ill- 
 defined it may be well to consider this and the 
 fourth class together. 
 
 It used to be quite a common practice before 
 the War for men earning big wages to " give the 
 wife a sovereign to keep house on " and spend 
 the rest on themselves, and some of the cases were 
 only brought to a head by war prices and the fact 
 that the consequently increased insufficiency of the 
 sovereign meant semi-starvation and neglect for 
 the wife and children. The War also brought to 
 
 74 
 
Child Poverty 
 
 light the widespread ignorance among wives of 
 the amount of their husbands' earnings, and even 
 of the places where they worked. At the outset 
 of the War many firms continued to pay half wages 
 to their employees who enlisted, and the comments 
 of the surprised wives when they received their 
 husband's half-wages for the first time were, to 
 put it mildly, sometimes forcible. 
 
 This question of the allocation of a reasonable 
 proportion of a man's earnings to the maintenance 
 of his family can be, and no doubt is being to 
 some extent, solved by the change in the standard 
 for the maintenance of children which is now 
 demanded by public Opinion. For example, when 
 the National Society for the Prevention of Cruelty 
 to Children began its work the standard it aimed 
 at was necessarily a low one. It was a pioneer 
 society supported by voluntary subscriptions, and 
 it had to feel its way and gain the confidence 
 of the" pubhc. Most of the work was done by 
 patient supervision and admonition. The cases 
 which were taken into Court were therefore, as a 
 rule, cases of gross neglect and actual physical 
 cruelty, and it was almost necessary to prove to 
 the magistrates that the children had actually 
 suffered in health. Now, thanks to the splendid 
 work of this Society, followed as it has been by 
 valuable legislation such as the Children Act, and 
 the establishment of Child Welfare Departments 
 and School Medical Inspection, the standard has 
 been raised, and it is not necessary to wait till the 
 children have suffered before taking action. It is 
 
 75 
 
Infant and Young Child 
 
 enough to prove to the magistrates that the children 
 of parents in receipt of a good income, even if 
 fairly well nourished, are verminous, clad in rags, 
 and have no proper bedding or bed-clothes, to 
 secure a conviction. The pleasant feature of this 
 raising of the standard is that it results from the 
 opinion of all classes. Most of the reports of 
 neglected children which we receive come from 
 neighbours who refuse to look on in silence when 
 children are not being fairly dealt by. 
 
 Of course, most cases of child neglect are due 
 to drink, and are very difficult to deal with. If 
 the man drinks, the wife often makes a brave show, 
 but if the woman drinks the husband has no chance, 
 because the wife, when he is away from home, 
 pawns the furniture and the children's clothes and 
 spends the proceeds on drink. 
 
 There is no very satisfactory penalty. A fine 
 only further impoverishes the children. A term 
 of imprisonment may put the children temporarily in 
 the care of the Guardians, but the trouble usually 
 begins again when the prisoner is released. An 
 order for committal to an Inebriates' Home can 
 only be obtained after three convictions or on 
 proof that the person convicted is a confirmed 
 drunkard. Sometimes the defendant agrees volun- 
 tarily to go to a Home in order to escape a term 
 of imprisonment, but there are not enough Homes 
 for the reception of such cases. Very frequently 
 the only satisfactory solution is the formal adoption 
 by the Board of Guardians of all the children till 
 they are i8 years of age. 
 
 76 
 
Child Poverty 
 
 More use might be made of the Children Act. 
 It may not be generally known that " any person 
 who in the opinion of the Justices is acting in the 
 interests of a child " which is being neglected may 
 get a warrant for its removal to a place of safety 
 and take proceedings against the person guilty of 
 neglect. Unnecessary delay and suffering to the 
 child are often caused by the erroneous impression 
 that the National Society for the Prevention of 
 Cruelty to Children is the only body which has 
 power to act. 
 
 In Sheffield the Maternity and Child Welfare 
 Department occasionally finds it extremely useful 
 to put the clauses of the Children Act in operation 
 in cases where notices and warnings are ignored. 
 A warrant is obtained for the removal of the children 
 to a place of safety, and proceedings are taken 
 against one or both parents for neglect. In some 
 cases the parents are put on probation, and an 
 order is made for the children to remain in the 
 Guardians' Homes till their own home is fit for 
 their reception. In other cases a term of imprison- 
 ment is inflicted, and the children at any rate 
 get a respite and live under decent conditions for 
 a time. It is remarkable how, in some cases — and 
 the records of the N.S.P.C.C. are quite convincing 
 on this point — the term of imprisonment has the 
 effect of " pulling up " the parent and ultimately 
 securing for the children a restoration of reasonable 
 home conditions. We find that the fact that the 
 woman inspector or school nurse occasionally has 
 to take part in proceedings against parents who 
 
 •71 
 
Infant and Youn^ Child 
 
 neglect and ill-treat their children in no way dis- 
 turbs her friendly relations with mothers who are 
 anxious to do their best for their children. 
 
 Illegitimate children. — The fifth class of vic- 
 tims of child poverty have a much worse time now 
 than they had in the Middle Ages. It is no credit 
 to Christianity that it should be so, or that the 
 death-rate among them should be twice what it is 
 among legitimate children. One need not labour 
 the point that the child is in no way responsible 
 for the stigma cast upon it, and that if properly 
 looked after it may grow up to do as useful work 
 as anybody else. If I were an illegitimate child 
 I should Mke to think I had as feUow-sufferers in 
 this respect the greatest genius the world has ever 
 known, Leonardo da Vinci, and the Renaissance 
 scholar, Erasmus. 
 
 The N.S.P.C.C. is at present promoting a Bill 
 which will greatly improve the chances of the, 
 illegitimate child, and which deserves general sup- 
 port. The Bill proposes to throw more responsi- 
 bility on the father and to give the mother a better 
 chance of dealing with her burden. Proceedings 
 for affiliation will be made easier, the magistrates 
 will have power to increase the allowance paid by 
 the father, and the illegitimate child wiU become 
 the ward of a court of summary j-urisdiction em- 
 powered to act on its behalf. If the Bill becomes 
 law a great advance will have been made in this 
 question. A recent Order of the Local Government 
 Board gives local authorities new powers to expend 
 money in the interests of the illegitimate child, 
 
 78 
 
Child Poverty 
 
 and further benefit may be expected from the 
 efforts of the recently established National Council 
 for the Unmarried Mother and her Child. Alto- 
 gether, there are signs of an awakening, and one 
 may hope that steps will be taken ere long to 
 remove this blot on our national reputation. 
 
 79 
 
CHAPTER VI 
 An Efficient Medical Service 
 
 The mother needs to be backed up by an efficient 
 Medical Service. 
 
 Infant hygiene and the medical curriculum. 
 
 — The first point to be insisted upon is that the 
 whole question of the management and feeding 
 of the infant requires to be given a proper place 
 in the medical curriculum. One realises that the 
 curriculum is overcrowded, but the importance of 
 the subject demands that it should have proper 
 attention and that less important subjects should 
 give way to it. Infant management is not 
 included in Medicine, Surgery, or Public Health. 
 It is, perhaps, supposed to be included in Mid- 
 wifery, but as a rule it receives scant attention. 
 The lecturer on Midwifery is primarily an obste- 
 trician, and as a rule is not an expert on the manage- 
 ment of infants. His concern is with the mother, 
 not with the baby. Sir A. R. Simpson, who for 
 so long occupied the Chair of Midwifery in the 
 University of Edinburgh, made a remarkable con- 
 fession in his introduction to the translation of 
 Budin's book on the nursling : " When I look back 
 on my own professional and professorial life," he 
 wrote, " no memory stings me with more sharp 
 regret than the thought of the too little heed I 
 
 80 
 
An Efficient Medical Service 
 
 have given to the needs of the neonate." It has 
 been the fashion for some years to talk about the 
 ignorance of mothers as one of the chief causes 
 of infant mortahty, but we have only just reahsed 
 that the medical profession knew very httle about 
 the matter, and that there was no one to teach the 
 mothers. 
 
 As the result of infant consultations and the 
 work of a few medical men and women who have 
 devoted special attention to the subject, we now 
 know that such an elementary matter as the manage- 
 ment of breast-feeding cannot be left to the instinct 
 of mothers, aided by the advice of a more or less 
 ignorant grandmother, monthly nurse, or midwife. 
 There has been no one to teach the monthly nurse 
 or midwife, so that it is not surprising that the 
 newly-born infant has been the victim of many 
 curious superstitions and traditions. Dr. Eric 
 Pritchard has made the valuable suggestion that at 
 each training school for midwives a special meniber 
 of the medical staff should be told off to instruct 
 the pupils in infant management. For this pur- 
 pose it would, of course, be necessary to make new 
 appointments of men or women of special ex- 
 perience. The staff of a hospital for women are 
 appointed on account of their skill as obstetricians 
 or gynaecologists, and it is very necessary in the 
 interest of the babies that there should be one 
 naember of the staff who has special knowledge of 
 infant management. There can be no doubt that 
 great advances have been made in our knowledge 
 of this subject in the last ten or fifteen years, and 
 G 8i 
 
Infant and Young Child 
 
 that there would now be found medical men and 
 women capable of doing excellent work in such 
 appointments. 
 
 It is also advisable that there should be an 
 ophthalmic surgeon on the staff, although his ser- 
 vices might not be required very frequently. 
 
 In January, 1913, the Society of Medical Officers 
 of Health unanimously passed the following resolu- 
 tion : 
 
 " Thati with a view to the reduction of infant 
 mortality, the Council of the Society be asked to con- 
 sider the best method of securing that the subject of 
 infant management be given a more important place 
 in the medical curriculum." 
 
 Inquiries made early in 1914, by the National 
 Association for the Prevention of Infant Mortahty, 
 of all the medical schools and children's hospitals 
 where teaching is given, throughout the United 
 Kingdom, ehcited the fact that the subjects of 
 infant hygiene and management receive very Uttle 
 attention in the medical currictilum. The Execu- 
 tive Committee of the Association thereupon made 
 the following recommendations : 
 
 " (i) That degree- and licence-conferring bodies 
 should require from each candidate for the final examina- 
 tion in Medicine a certificate of having attended a course 
 of clinical instruction on infant hygiene, to include 
 lectures or demonstrations on the management of 
 infants, and the prophylaxis and treatment of infantile 
 diseases. 
 
 " Such a course should include instruction in the 
 82 
 
An EflScient Medical Service 
 
 part flayed by the State in infant hygiene, with special 
 reference to the duties and functions of the medical 
 practitioner, the midwife, the hospital and local sani- 
 tary authorities, and the health visitors. 
 
 " (2) That the certificate required from candidates 
 in Midwifery for the final examination should include 
 evidence that they have received instruction in ante- 
 natal pathology and hygiene, and in the management 
 of infants during labour, the puerperium, and the period 
 of lactation." 
 
 In the meantime the newly qualified medical 
 practitioner has a great advantage over his pre- 
 decessors in the fact that he can attend one of 
 the many Infant Clinics that are now in existence. 
 
 If he intends to go into general practice he 
 will be well adAdsed to follow up his residential 
 hospital appointments by a few years spent as 
 Assistant Medical Officer in several of the special 
 services which have rederrtly sprung up. He will 
 be in a much stronger position to undertake general 
 practice if he has, for example, done six months' 
 work at an Infant Clinic and a like period at a 
 Venereal Diseases Clinic and a Tuberculosis Dis- 
 pensary and as a School Medical Officer. He wiU 
 thus have acquired information about child manage- 
 ment and children's diseases which will be invalu- 
 able to him in practice, and will at the same time 
 have been in the receipt of a reasonable salary, 
 so that no hardship will have been entailed by 
 the delay. The recently qualified medical prac- 
 titioner who has no knowledge of infant manage- 
 ment is at the mercy of the monthly nurse when 
 
 83 
 
Infant and Young Child 
 
 she reports that " there seems to be no milk," or 
 that " the milk is very thin," or " doesn't seem to 
 be doing the baby any good," and has to assent 
 in consequence to quite unnecessary weaning. 
 Unless he is well up in the details he cannot hold 
 his own against a half-hearted mother or a tricky 
 monthly nurse. 
 
 The first point, then, with regard to the Medical 
 Service is that much greater attention must be 
 given by the medical schools to the question of 
 infant management, so that each new practitioner 
 may start practice with a good knowledge of the 
 subject. 
 
 The family doctor. — In whatever manner the 
 Medical Service is reconstructed, we need a system 
 in which each family will have its family doctor. 
 The relation of the family doctor to the special 
 institutions, such as School Clinics, Tuberculosis 
 Dispensaries, Maternity and Child Welfare Centres, 
 and Venereal Disease Clinics, will have to be deter- 
 mined. The family doctor must be linked up with 
 the ^consulting surgeons and physicians, and the 
 hospitals, convalescent homes, and also with mid- 
 wives, district nurses, and mothers* helps, so that 
 his patients may have the benefit of these services 
 in time of need. More l3dng-in hospitals are 
 needed, and more beds for the accommodation of 
 pregnant women suffering from syphilis, as it is 
 now recognised that this is a satisfactory time for 
 treatment from the point of view both of the mother 
 and of the unborn child. More children's hospitals, 
 convalescent homes, and open-air schools are re- 
 
 84 
 
An Eflacient Medical Service 
 
 quired. Especially do we need more hospitals for 
 crippled children on the lines of the Lord Mayor 
 Treloar Hospital at Alton, 
 
 A Dental Service. — Besides this, arrangements 
 must be made for dentists to look after the teeth 
 of the children. This is being done to some extent 
 with regard to the children of school age by School 
 Clinics, and power has recently been given to 
 Maternity and Child Welfare Centres to estabUsh 
 Dental Clinics. The system will have to be gener- 
 ally extended. There is probably no more wide- 
 spread cause of ill-health than bad teeth, and 
 certainly none which has been more neglected 
 hitherto. We need many more dentists, and the 
 prohibition of dental practice by unqualified and 
 untrained persons. 
 
 The Poor Law Medical Service will obviously 
 become involved in the changes which take place. 
 
 Out-patient Departments. — ^Another matter ur- 
 gently requiring attention is the reform of Out- 
 patient Departments. These are at present 
 swamped by patients who ought never to be sent 
 there. Mothers who take their children to Out- 
 patient Departments are fi;equently required, to 
 spend the whole day in the waiting-room, to the 
 great detriment of their homes. Out-patient De- 
 partments ought to be restricted to accidents, 
 cases requiring special treatment, and those cases 
 which are sent by a general practitioner for a con- 
 sultant's opinion. This will only become possible 
 when there is a satisfactory domiciliary medical 
 service available for the treatment of all children. 
 
 85 
 
Infant and Young Child 
 
 Medical treatment for all children. — At present 
 we have medical supervision of school children 
 and a satisfactory method of searching out de- 
 fects and ailments that require treatment, but we 
 have no really satisfactory method of securing 
 treatment for the defects and ailments found. In 
 many cases there is no family doctor because the 
 parents cannot afford to run up a bill ; some of 
 the special ailments are dealt with at the School 
 Chnic, some are sent to the already overcrowded 
 Out-patient Departments, and many go untreated. 
 There still remain, in addition to the disabling ail- 
 ments found by medical inspection, the dangerous 
 acute illnesses which attack school children, and 
 for these provision has yet to bf made. The opera- 
 tions of Maternity and Child Welfare Centres have 
 been extended so as to deal with children up to 
 the school age, but in this case attendance is quite 
 voluntary, so, of course, the searching-out of de- 
 fects and ailments among the pre-school children is 
 not nearly so perfect as among the school children- 
 Here again there is no adequate provision for 
 treatment of the defects and ailments found or 
 for domiciUary treatment of the pre-school child 
 when attacked by acute disease. 
 
 Claims of the wives and children of the in- 
 sured. — I am not in a position to express an 
 opinion as to whether the Insurance Act provides 
 a satisfactory domiciliary medical service for the 
 insured person, but it is quite clear that the insured 
 persons as a whole are the section of the com- 
 munity which, as a rule, needs the least medical 
 
 86 
 
An Efl&cient Medical Service 
 
 attention and at the time of the passing of the 
 Insurance Act suffered least from the want of 
 medical attention. The section of the community 
 which needs most medical attention and suffers 
 most from the want of it is made up of the wives 
 and chil4ren of the insured persons. In any re- 
 constructed Medical Service the mother must be 
 put into such a position that she can call in 
 her fanaily doctor for herself or her children when- 
 ever they need medical attention, without being 
 deterred by the fear of running up a biU which may 
 take her years to pay. This proposition does not 
 apply only to the famihes of working-men and 
 clerks. There are, in fact, very few householders 
 who can face a big doctor's bill with equanimity, 
 and it seems obvious that the securing of a satis- 
 factory Medical Service for all can only be met 
 by some system of insurance or all-round levy. 
 
 87 
 
CHAPTER VII 
 Management of the Baby 
 
 " Evety mother is nurse to her own child unless either death 
 or sickness be the let." 
 
 MORB'S "Utopia." 
 
 I ONLY propose to refer to some of the more import- 
 ant points with regard to the management of the 
 child during the first year of Ufe. 
 
 Breast-feeding. — By far the most important 
 point is that the baby should be breast-fed. 
 
 Statistics show that the breast-fed child will 
 flourish in spite of poverty and adverse sanitary 
 and social circumstances. Poverty only becomes 
 dangerous in the first year of life if the mother is 
 so underfed that she has not sufficient breast-milk 
 for her baby. Statistics show that all the improve- 
 ments in social conditions which have taken place 
 since i860, and which have produced a steady 
 dechne in the death-rate of children during the 
 second, third, fourth, and fifth years of life, had 
 no effect on the death-rate of children during the 
 breast-feeding year of Hfe till the beginning of the 
 present century, when attention began to be 
 focused on the question of infant management. 
 This fact is very weU shown by the table on the 
 opposite page, taken from one of Sir Arthur News- 
 holme's Reports to the Local Government Board. 
 
 88 
 
Management of the Baby 
 
 E ngland s Wales. 
 
 OlASRAM SHOWIMC TME AnnUAL INFANT MORTAUTY FROM 
 IB55 TO 1908. THE MORTALITY AT ASE |-2 FROM IS56TO 
 1908. AT AGE 2-3 FROM 1857 TO I908,AT AGE 3-4 FROM 
 
 1858 TO I9Q8.AND AT APE ^-5 FROM 1859 TO 1308 
 
 ::Ar' 
 
 pEATHS OF INFANTS PER lOOO BIRTHS! 
 INTHC YEARS 1655-1906, 1 
 
 lit 
 
 DEATHS OF CHILDREN AOE^ l*£ YEA^^ 
 PER JdOD SURVtyORS AOE 
 
 YtARS I65b-t90fli 
 
 ^Ml-^ 
 
 DEATHS ort EHILDREnIAqED 2-3 VCAftfe pe« lOotf^ 
 
 1 — 2 
 
 2-3 
 
 • DEA"rHS ojcHILDREN !ACED 3~4 Y^ARS ptp lojo- 
 ; SyftVIVOR^ ABED 3 iffA"^ jHSft-jaflat j . 
 
 3 3- 
 
 SURVIVORS AGED f YEARS IQ3B~l90e' 
 
 4-3 
 
 Diagram from the Thirty-ninth Annual Report 
 OF the Local Government Board (see text). 
 
 {By permission of His Majesty's Stationery Office). 
 89 
 
Infant and Young Child 
 
 Statistics also show that when the decline in 
 infant mortality did begin it affected the later 
 more than the earlier quarters of the year, again 
 indicating that social improvements have had most 
 effect in the portion of the first year least affected 
 by breast-feeding. Breast-feeding is the chief great 
 cause of difference in infant mortaUty as between 
 one country and another, as between town and 
 country, and as between a town where the mothers 
 go out to work and a town where they do not. 
 These facts have been well brought out by Sir 
 Arthur Newsholme, Sir George Newman, and many 
 other writers, and have already been referred to in 
 these pages. 
 
 All medical authorities agree that the proper 
 food for an infant is its own mother's milk, 
 and that the baby which is deprived of its 
 natural sustenance is thereby exposed to real 
 risk of early death or of permanently impaired 
 health. 
 
 The dire results of artificial feeding are, well 
 known. 
 
 Let us get rid of the idea that the disastrous 
 results of bottle-feeding are hmited to the babies 
 of the poor. It is not so, and I would be content 
 to prove this from my experience of the artificially- 
 fed babies of medical friends and acquaintances. 
 That experience shows me that apathy and ignor- 
 ance about breast-feeding and the lack of per- 
 severance in practising it extend even to doctors' 
 wives, and that the babies of medical men, in spite 
 of presumably greater knowledge and care expended 
 
 90 
 
Management of the Baby 
 
 upon artificial feeding, suffer badly as a result 
 of it. 
 
 Risks of bottle-feeding. — ^The risks run by the 
 bottle-fed baby may be summarised as follows : 
 
 A liability to all kinds of digestive disturb- 
 ance, which may result in impaired digestion 
 for Ufe. 
 
 A liability to rickets, with deformities, lasting 
 for Ufe. 
 
 An increased liability to adenoids. 
 
 A greatly increased liabihty to death during 
 the first year of Ufe from diarrhoea. 
 
 A lack of vital resistance, causing it to suc- 
 cumb more easily to the various diseases 
 which it may contract. 
 
 Interference with the proper development of 
 both the temporary and permanent teeth, 
 with effects lasting for Hfe. 
 
 Liability to scurvy. 
 
 Liabihty to contract tuberculosis by the in- 
 gestion of tuberculous milk. 
 
 The foregoing Ust of well - recognised dangers 
 is, no doubt, incomplete, but it is sufficiently for- 
 midable. 
 
 What are we to say of the mother who deliber- 
 ately refuses to feed her baby and condemns it to 
 run these risks ? Is she not guilty of an offence 
 under the Children Act for neglecting her child in 
 a manner Ukely to be injurious to its health ? And 
 if the biaby dies from some one of the ailments to 
 
 91 
 
Infant and Young Child 
 
 which she has rendered it Hable by her refusal, is 
 she not guilty of something akin to manslaughter ? 
 
 It may be that the artificially-fed infant will 
 get through its childhood somehow and live to 
 be a rickety epileptic, or that " the mother who 
 wouldn't " may live to see Caesarean section done 
 on her daughter, on account of a rickety pelvis, 
 when the latter bears her first child. At a recent 
 Congress on Infant Mortality which I attended, one 
 of the delegates mentioned that she had had this 
 serious operation performed on herself owing to 
 being a bottle-fed baby ! I suppose children under 
 such circumstances will not feel much bound by 
 the fifth commandment. 
 
 I If- the mother does not know the risks to which 
 she is exposing her child, is this ignorance the fault 
 of the medical profession ? If so, the sooner the 
 remedy is found the better. There must be no 
 uncertainty about the attitude of the "profession in 
 this matter. It must be clearly laid down that it 
 is a crime for any woman, be she princess or 
 peasant, who is able to feed her own baby, to refuse 
 to do so. It will then come to be recognised as 
 a disgrace to the community if a woman is pre- 
 vented from feeding her baby by having to go 
 out to work. 
 
 Are women unable to nurse their children ? 
 — The most important point with which we have 
 to deal is the alleged inability of women to feed 
 their offspring. This inability is discussed in Play- 
 fair's " Midwifery " (edition 1881), and one could 
 imagine it possible of the Early Victorian mother. 
 
 92 
 
Management of the Baby 
 
 The inability is said to be increasing, however, and 
 to be due to the effects of " high civihsation." 
 
 It is hard to believe that the woman of to-day, 
 brought up with much more regard for physical 
 development, is less able to nurse her babies than 
 was her Early Victorian predecessor. Again, one 
 wonders what is meant by civilisation in this con- 
 nection. Cannot a woman use her brain without 
 getting atrophy of the mamma ? 
 
 Everyone recognises the difficulty of distin- 
 guishing between inability and disinclination. 
 
 First of all, we have to consider the dictates of 
 fashion. The " woman who couldn't " has perhaps 
 in the past been considered rather a superior sort 
 of person, too intellectual for such an animal task. 
 There has been much ignorance of the importance 
 of breast-feeding, no doubt encouraged by the half- 
 hearted attitude of the medical profession on the 
 subject. 
 
 The ignorance of fathers in this respect is an 
 important factor. One hears of fathers who do 
 not Hke their wives to be tied, and wish them to 
 go away for a holiday as usual and leave the baby 
 to the nurse and the bottle. Fathers as well as 
 mothers need to be educated. The ordinary man 
 probably thinks it must be a g^reat nuisance to a 
 woman to have to feed her baby every few hours, 
 and does not appreciate the fact that to the nbrmal 
 healthy mother giving the baby the breast is an 
 actual physical pleasure. 
 
 There has been shirking by women who did 
 not wish to give up their usual pursuits, or to spoil 
 
 93 
 
Infant and Young Child 
 
 their figures. The refusal to breast-feed and the 
 refusal to lead the regular kind of life which makes 
 breast-feeding possible are, of course, the same 
 thing. 
 
 Influence of the monthly nurse. — Secondly, 
 there has been almost a conspiracy on the part of a 
 section of monthly nurses to discourage breast- 
 feeding, partly to please fashionable mothers, 
 partly to gratify a sort of perverted maternal in- 
 stinct and obtain complete control of the infant, 
 partly because it is more comfortable for the nurse 
 to heat up a bottle in her own room than to stand 
 by the mother's bedside, perhaps on a cold night, 
 during the thirty to forty-five minutes which is 
 often necessary to get the infant to take its first 
 meals. Some monthly nurses go so far as to keep 
 the baby from the breast for the first two days, 
 so as to avoid stimulating the secretion of the milk. 
 
 The attitude of the monthly nurse is no doubt 
 to some extent due to ignorance — a reflex of the 
 ignorance and apathy of the medical profession on 
 the subject. She does not know what the baby 
 is losing, and does not hear of its subsequent 
 history. 
 
 Thirdly, as I have pointed out in Chapter VI., 
 there is ignorance on the part of the medical pro- 
 fession as to the practical details of infant manage- 
 ment. The management of the infant is neither 
 medicine, surgery, nor midwifery, and has received 
 scant attention in the medical curriculum. It thus 
 comes about that it has been left to the monthly 
 nurse, and if the latter reports that the milk is 
 
 94 
 
Management of the Baby 
 
 insufficient, or poor in quality, the idea of breast- 
 feeding is given up light-heartedly, and the doctor 
 goes round saying, " How extraordinary it is 
 that so many women can't feed their babies 
 nowadays ! " 
 
 The doctor, not being well up in the details, 
 is not able to lay down the law to a shirking mother 
 or a monthly nurse who is playing up to her. The 
 advent of women into the profession might have 
 been expected to create an improvement, but an 
 unmarried woman doctor is not much better than 
 a man in these matters, and when a woman doctor 
 has had children of her own it has generally been 
 when she is not in practice, and the value of her 
 experience is therefore lost. 
 
 Ignorance of mothers. — ^At present the woman 
 who is bearing her first child is absolutely at the 
 mercy of the monthly nurse, and anything the latter 
 says about flatness or soreness of the nipples, or 
 thinness of the milk, is ex cathedra. 
 
 In the future, when the fashion changes and the 
 medical profession take more interest in the matter, 
 it is to be hoped that a woman wiU come to her 
 first confinement " armed and engined for the 
 same," with all the necessary preparation, deter- 
 mination, and knowledge for feeding her first-bom. 
 
 The encouragement of breast-feeding may seem 
 a task beneath the notice of the eminent physician, 
 surgeon, or obstetrician, Mke the advice to wash 
 in Jordan to the haughty Syrian captain ; and yet 
 if all mothers could nurse their babies the effect on 
 infant mortahty and the vigour of the race would 
 
 95 
 
Infant and Young Child 
 
 be enormous, and such diseases as infantile diar- 
 rhoea and rickets would practically disappear. 
 
 The results would be much more startling than 
 anything that has been achieved by antitoxins, 
 or by all the advances in abdominal surgery in 
 recent years. 
 
 The matter is therefore eminently worthy of 
 attention. 
 
 What is wanted at the medical schools is 
 teachers who combine the experience and know- 
 ledge of the doctor, the mother, and the monthly 
 nurse. All maternity hospitals do not sufi&ciently 
 impress on their students the importance of breast- 
 feeding. I have recently heard of a " Twilight 
 Sleep " home where " they were not keen on breast- 
 feeding." 
 
 Medical men who have given special attention 
 to the matter find that a large proportion of the 
 cases of alleged inability to breast-feed can be 
 dealt with if the mother is in earnest. Thus 
 difficulties due to depressed or sore nipples, or 
 supposed scanty supply, can often be overcome by 
 perseverance. 
 
 I wish in this connection to refer especially to 
 the work of Professor Budin,* of Paris, who has 
 shown that the supply meets the demand if the 
 proper stimulus is apphed to the breast. 
 
 This is where the difficulty of the medical man 
 comes in. He cannot be always there to see if 
 the nurse applies the proper stimulus by putting 
 
 'See "The Nursling," by Pierre Budin, translated by W. J 
 Maloney. 
 
 96 
 
Management of the Baby 
 
 the baby to the breast at the proper intervals, 
 and he is more or less helpless when the nurse 
 reports that there is no milk. 
 
 We must bear in mind that the theory of the 
 atrophy of the female breast is much more starthng 
 than anything that was brought out by the Com- 
 mittee on Physical Deterioration, and should not 
 be accepted without very complete proof. 
 
 The first steps are to make breast-feeding 
 fashionable, and to secure much more attention for 
 this and other matters in connection with infant 
 management in the medical schools. 
 
 When this has been done we shall be in a better 
 position for judging as to the facts with regard to 
 this alleged physical deterioration. 
 
 Let us leave off talking of high civilisation or 
 culture in this connection. Let us give the thing 
 its proper title, whether it be physical deterioration, 
 decadence, or the demands of fashion. Each sex 
 has its influence bn the other. Women are sup- 
 posed to admire athletic men, and no doubt the 
 cult of athletics is encouraged thereby. Man is 
 surely not going to adopt as his Queen of Beauty 
 a sham Venus, with breasts only useful for giving 
 a pleasing outline to her clothes. 
 
 When the fashion is so changed that a woman 
 who cannot nurse her own baby is looked upon as 
 a poor thing or a cripple, to be pitied, we shall 
 hear less of this " inability." 
 
 It could not have been of this sort of woman 
 that Napoleon thought when he exclaimed, " Oh, 
 those English mothers ! " 
 H 97 
 
Infant and Young Child 
 
 Nor, again, Rudyard Kipling, when he penned 
 his ode on the female of the species : 
 
 " And to serve that single issue lest the generations 
 fail. 
 The female of the species must be deadlier than the 
 male." 
 
 The fact is, we want the mother to be more 
 deadly ! 
 
 Difficulties of breast-feeding. — Of course, one 
 recognises that there are difficulties sometimes 
 in the management of breast-feeding, and these 
 difficulties have ' been dealt with by many able 
 writers, including Dr. Eric Pritchard, Dr. Truby 
 King, Dr. H. Waller, Dr. H. R. Carter, Dr. F. 
 Langmead, Dr. A. E. Naish, and Dr. Lucy Naish. 
 I am very grateftd to Dr. Lucy Naish for per- 
 mission to publish as an Appendix to this book 
 a paper of hers on this subject. 
 
 Number of feeds. — It may now be regarded as 
 estabhshed that the baby thrives better if not fed 
 so frequently as was at one time thought necessary. 
 Instead of the old practice of feeding every two 
 hours during the day and about every four hours 
 during the night, all authorities agree that every 
 three or four hours during the day from birth is 
 sufficiently frequent, and that the baby should 
 be allowed to sleep, if possible, for nine hours at 
 night. This system is, of course, incomparably 
 better for the mother, and lessens the strain on 
 her. Weaning should be undertaken between the 
 ninth and the twelfth month, and it is advisable 
 
 98 
 
Management of the Baby 
 
 not to wean during August and September, when 
 the risk of the baby contracting diarrhcea is greatest. 
 In some cases menstruation occurs fairly regularly 
 during lactation, but this affords no reason what- 
 ever for premature weaning. 
 
 Cow's milk. — If the unfortunate infant is denied 
 its birthright and relegated to the cow, we are 
 plunged into a sea of controversy as to what form 
 of cow's milk to give. 
 
 Some, like Budin, get satisfactory results with 
 unmodified whole milk steriUsed, others prefer 
 cow's milk modified slightly or elaborately so as 
 to imitate human milk. It seems probable that the 
 trouble taken to adjust exactly the proportion of 
 casein, milk sugar, and fat is not necessary, as 
 human milk shows fairly wide variations in this 
 respect. An extensive use of dried milk in Shef- 
 field, even without any special trouble being taken 
 to give fruit juice with it daily, seems to justify 
 the statement that the theoretical objection to 
 dried milk on account of the supposed reduction of 
 vitamines is not borne out in practice. The pro- 
 cess of desiccation certainly makes the casein 
 more digestible and avoids the necessity for the 
 extreme dilution of cow's milk so often adopted. 
 Desiccation also, if it does not entirely kill all the 
 tubercle bacilU there may be in the milk, seems to 
 attenuate them. 
 
 Most authorities agree as to the need for ex- 
 posing cow's milk to a su£&cient heat to kiU tubercle 
 baciUi, but this may not be necessary if one can 
 get fresh milk from cows guaranteed free from 
 
 99 
 
Infant and Young Child 
 
 tuberculosis by the tuberculin test when appUed 
 by a veterinary surgeon who knows all the facts. 
 This is seldom possible, and it is extremely difficult 
 to get reasonably clean and fresh milk in many 
 parts of our great towns. 
 
 Dried milk. — ^The difficulty is so great, and the 
 arrangements for the transportation of milk are so 
 inadequate, that one begins to wonder if it would 
 not be better to deal with the milk supply of the 
 country as a whole and only permit " wet " milk 
 to be supplied when it is produced near enough to 
 the customer to be dehvered twice a day in a fresh 
 condition, and to have the whole of the milk in the 
 outlying parts of the country collected by motor 
 vans and taken to specially erected factories to be 
 dried or condensed. I believe the evidence in the 
 possession of the Government is to the effect that 
 the cost of drying the milk and the ordinary cost 
 of distribution by milk-cart are approximately equal. 
 It seems to me better to have a reUable dried milk, 
 prepared near the source of production, than the 
 dirty, stale, wet milk brought from a distance by 
 rail, which is often aU that can be obtained in the 
 central areas of our large cities. I have always 
 been in favour of town cowsheds, because that is 
 the only way in which townspeople can get fresh 
 milk. The cooler is often a snare and a delusion, 
 because the water is not cold enough and there 
 is no ice, and further because the milk, losing a 
 few degrees of temperature, acquires an additional 
 supply of dirt. 
 
 The old superstition of feeding the baby from 
 
Management of the Baby 
 
 the milk of one cow without ascertaining if the 
 one cow was the victim of tuberculosis of the 
 udder is, I fancy, dead, and those who risk giving 
 raw milk to infants and children prefer to give 
 the mixed milk of a herd on the principle of 
 diluting the infection and lessening the dose of 
 living tubercle bacilU. 
 
 Food after weaning. — ^To return to the baby. 
 A point upon which much stress is laid nowadays 
 is that when the baby is weaned it should be taught 
 to chew and given food that will exercise its jaws 
 and teeth. Both dentists and doctors are now 
 agreed that weaned babies and Uttle children in the 
 past have been given far too much " pappy " 
 food. It is not the purpose of this book to attempt 
 to deal with the details of infant management, and 
 for these I must refer the reader to the many reUable 
 guides on the subject which have been recently 
 issued.* 
 
 Like a grown-up person, a baby to be healthy 
 requires not only suitable food, but fresh air, 
 rest, exercise, warmth and cleanliness, and I pro- 
 pose to touch on a few points with regard to these 
 matters. 
 
 Fresh air. — ^A baby can get fresh air by being 
 put outside the house in its pram from the time it 
 is a few days old, in almost all weathers. The 
 fact that it need not be wheeled about, and is, 
 
 • E.g. " Feeding and Care of Baby," by Dr. F. Truby King ; 
 " The Infant : Nutrition and Management," by Dr. Eric Pritchard ; 
 and the pamphlet "To Wives and Mothers," published by the 
 National League for Physical Education and Improvement. 
 
 ibl 
 
Infant and Young Child 
 
 in fact, better in a stationary -than in a moving 
 pram (however good its springs), is a great saving 
 of time and labour for the mother. By beginning 
 early the baby readily gets accustomed to sleeping 
 by itself outside. I have heard serious discussions 
 as to whether a baby was not more liable to catch 
 cold in a stationary pram, the disputants appear- 
 ing to forget that the sleeping baby goes through 
 no " cabman " exercises to keep itself warm. Of 
 course, a hot bottle in the pram is often necessary. 
 The open-air treatment of consumption has killed 
 the old idea about the deadliness of night air. 
 Did the idea originate when malaria was prevalent 
 in this country and was supposed to be caused 
 by a miasma ? If there are no scavengers about, 
 night air is probably more free from dust and 
 purer than day air. At any rate, the baby can 
 have fresh air at night by the window being left 
 open. 
 
 Sleep. — As regards sleep, one of our difficulties 
 is to persuade some mothers that a baby should 
 sleep in a cot or cradle by itself night and day from 
 birth. The danger of overlying may be small if 
 the mother is temperate, but a baby undoubtedly 
 gets worse air if it is in bed with a grown-up person 
 and liable to be buried under the clothes. 
 
 Posture. — A common mistake is to take babies 
 out strapped up in go-carts or mail-carts long before 
 their backs are strong enough. They should never 
 be made to sit up, but only allowed to do so when 
 they insist upon it. 
 
 Exercise. — A baby gets its exercise chiefly by 
 1 02 
 
Management of the Baby 
 
 Ipng on its back and kicking. Unlike a grown-up 
 person and a bottk-fed baby, the breast-fed baby 
 gets a good deal of exercise when it is having its 
 meals by twisting itself about and working its hmbs 
 and fingers and toes. Another form of exercise 
 which a baby thoroughly enjoys from a few weeks 
 old is kicking in a big bath. 
 
 There would not be much rickets if all babies 
 were breast-fed, had plenty of fresh air and exer- 
 cise, and had proper food after being weaned at 
 the right time. 
 
 Clothing. — A baby needs warm, loose clothes 
 which will not restrict its movements. One still 
 sees the tight binder used, as if Nature has done her 
 work so badly that the body needs to be held 
 together, and it is not realised that the binder is 
 only needed to keep the navel dressing on. 
 
 Money is often wasted by parents who cannot 
 spare it on long clothes, the process of shortening 
 being regarded as a kind of semi-religious ceremony. 
 
 The arms and legs of a baby are often too much 
 exposed, and one sees them taken straight from a 
 warm cot and dangerously exposed at the open 
 door. It is very important not to expose a baby's 
 skin to sudden changes of temperature. 
 
 Cleanliness. — Cleanliness is the best protection 
 against diarrhoea — cleanliness as regards the baby's 
 body, napkins, and clothes, cleanUness in the pre- 
 paration of its food. The dummy teat not only 
 deforms the mouth and nose and leads to adenoids, 
 it is also a fruitful source of dirt infections. The 
 dummy teat dies hard, and it wiU need all the 
 
 103 
 
Infant and Young Child 
 
 efforts of Anti-Dummy Leagues to kill it. Until 
 quite recently it was the invariable practice of 
 some monthly nurses in quite " good practices " 
 to teach their charges the use of the dummy by 
 smearing it with treacle or other delectable. 
 
 Old wives' fables. — ^The management of the 
 infant having been until recent years in the hands 
 of untrained women, it is not surprising that a large 
 number of superstitions and customs have arisen 
 in connection with childbirth and infancy. Some 
 examples of these superstitions may be worth 
 recording. 
 
 Birthmarks are often supposed to take the 
 shape of something which the mother desired 
 when she was pregnant, or to be the result of some 
 incident of the mother's pregnancy. This latter 
 idea has been brought up to date. Cases of oph- 
 thalmia neonatorum are attributed to the strain 
 on the mother's eyes caused by attendance at 
 picture palaces ! 
 
 If the baby cries apparently without reason, 
 it is thought to be due to the fact that the mother, 
 when pregnant, had some desire which she cotdd 
 not gratify. The baby is therefore tested with 
 aU sorts of articles of food or drink which the 
 mother remembers she desired and did not obtain 
 during her pregnancy. 
 
 It used to be believed that mother's milk and 
 cow's milk did not agree, and that the baby could 
 not be fed on both. 
 
 It was supposed to be unlucky to weigh a baby 
 before it was twelve months old. 
 
 104 
 
Management of the Baby 
 
 Wiping out the baby's mouth with its own wet 
 napkin was supposed to be a cure for thrush. 
 
 It is considered dangerous to cut a baby's 
 nails during the first year of life. They should be 
 bitten ! If you cut the baby's finger-nails it will 
 be a thief, and when the time comes to cut them 
 the toe-nails should also be cut, so that it may 
 be able to run away. 
 
 Children born with teeth wiU be either drowned 
 or hanged. 
 
 Other superstitions are that the mother must 
 get out of bed on the ninth day, even if she has 
 to go back to bed and stay there for several days 
 afterwards ; that if, after the child is born, the 
 mother goes to sleep before passing water, she will 
 die in her sleep ; and that if a woman is one of 
 twins she cannot have children of her own. 
 
 So much for old wives' tales ! 
 
 The practice of squeezing the breasts of the 
 newly born infant used to be very prevalent. At 
 least two midwives have assured me that they 
 were taught to do this as a matter of routine by 
 the Sister at the Lying-in Hospital where they were 
 trained. This is another example of the small 
 attention given in the past to the needs of the 
 infant by the obstetrical staffs of such hospitals. 
 
 Another custom which has been responsible for 
 much harm in the past is the giving of a dose of 
 castor oil to the newly born infant, from the mis- 
 taken idea that the meconium (as the greeny-black 
 substance in the baby's bowels at birth is called) 
 needs to be forcibly cleared out by an aperient. 
 
 los 
 
Infant and Young Child 
 
 The whole question of constipation in infancy has 
 been much simplified by the introduction of paraffin 
 oil as an internal lubricant for the bowels. 
 
 Ophthalmia neonatorum. — This disease still 
 does not receive the prompt special treatment 
 which it requires. The cases occurring in the prac- 
 tice of midwives come promptly under the treat- 
 ment of the ophthalmic surgeon, but it is in. the 
 confinements attended by medical practitioners 
 where the chief failures occur. This is an example 
 of defective " team work." A practitioner who is 
 not accustomed to handle such cases may under- 
 take the treatment, the home nursing faciUties 
 may be inadequate, and as a result the case fre- 
 quently only comes to the ophthalmic surgeon 
 when irreparable damage to the eye has been done. 
 Ophthalmic surgeons agree that with prompt skilled 
 treatment appUed at once no eyes should be lost 
 and few damaged from this cause. 
 
 Dr. Sydney Stephenson, in a lecture deHvered 
 under the auspices of the National Association for 
 the Prevention of Infant MortaUty, points out that 
 if simple precautions, such as are recommended by 
 the Central Midwives Board, were adopted at 
 birth the disease would be prevented in ninety-nine 
 cases out of a hundred, and he estimates that the 
 maintenance of persons blinded by ophthalmia 
 neonatorum in these islands costs the community 
 £350,000 per annum. 
 
 Mistakes of the past. — Owing to the lack of 
 knowledge on the subject of infant management, 
 advice which is now regarded as bad has in the 
 
 106 
 
Management of the Baby 
 
 past been distributed officially by Medical Officers 
 of Health in leaflets. For instance, we used to 
 recommend the baby being fed every two hours 
 during the day and every four hours at night from 
 birth, and to exhibit posters showing the size of 
 the baby's stomach at birth in support of this 
 frequent feeding. It was also customary to recom- 
 mend the " wiping out " of the baby's mouth. 
 This is now regarded as a pernicious practice and 
 one of the causes of thrush, the very ailment it was 
 intended to prevent. A third common error in 
 advice leaflets was to recommend much too 
 " mushy " a dietary after weaning, and to dis- 
 regard the need for giving the jaws and teeth 
 something to do. 
 
 Protection from infectious disease. — A great 
 deal more might be done to protect babies from 
 the ordinary fnfectious diseases. Mothers fre- 
 quently display the most blameworthy negligence 
 in carrying their babies into infected households. 
 They seem to adopt a fatalistic attitude of mind 
 in the matter. Whooping-cough is most fatal in 
 the first year of life, measles in the second, and 
 it cannot be urged too strongly that the longer 
 an attack of infectious disease is postponed the 
 better is the child's chance of recovery. 
 
 Town life. — Great advances have been made in 
 the last fifteen years in investigating the exact 
 method in which the evils incidental to town life 
 operate injuriously on infants. Apart from ante- 
 natal influences, the chief causes of death are still 
 diarrhoeal diseases, pneumonia, and bronchitis, and 
 
 107 
 
Infant and Young Child 
 
 we must all of us be convinced that if we could 
 secure for each baby the " simple life " which it 
 needs, infant mortality would soon be reduced 
 to half its present figure. If it gets the first great 
 essential — ^its mother's milk, the other needs, 
 namely, fresh air, rest, warmth, exercise, and 
 cleanliness, ought to be easily obtained. 
 
 1 08 
 
CHAPTER VIII 
 Management of the Ex-Baby 
 
 The end of the first year of life marks an epoch 
 in several respects. The fact that the baby is 
 beginning to speak and is therefore no longer an 
 infant in the strict sense of the word is not the 
 most important development from the health 
 point of view. 
 
 It has just passed the only period of life during 
 which it can be supphed with absolutely clean 
 food, its mother's milk, and wiU now have to eat 
 its peck of dirt with the rest of us. Whether it will 
 get more than its peck depends upon the care 
 and intelUgence of those whose duty it is to pre- 
 pare the food. It also needs food which it will 
 have to chew. 
 
 Its exercise will no longer be taken by kicking 
 on its back or squirming and twisting at its mother's 
 breast, and it will soon be able to walk into infec- 
 tion instead of being carried into it. 
 
 We have seen how the breast-fed infant flourishes, 
 whether in the peasant home of Connaught, the 
 " black house " of the Hebrides, or the slums of 
 our large cities, but when we come to consider 
 the fortunes of the child from i to 5 years of age 
 we find that he has no amulet to enable him to resist 
 adverse sanitary and social conditions. 
 
 109 
 
Infant and Young Child 
 
 The ex-baby, like the infant, still needs proper 
 food, fresh air, and exercise, rest, warmth, cleanh- 
 ness, and protection from infection. Opinions will 
 vary greatly as to which of these necessities is 
 most often lacking and by being absent leads to 
 disaster. 
 
 Prolonged lactation. — On the whole I should be 
 inclined to think that in a large industrial town 
 improper feeding is the item responsible for the 
 most trouble. Sometimes lactation is prolonged 
 into the second year under the mistaken idea that 
 its continuance prevents conception. This is an 
 unnecessary drain on the mother, and certainly 
 tends to weaken the child and to produce a 
 liability to rickets. 
 
 Irregular feeding. — This is very common. At 
 the end of the first year the infant should be fed 
 four times in the twenty-four hours. Milk is often 
 regarded as a drink, but is, of course, a food, and 
 should not be given except at one of the four feeding 
 times. In a month or two the baby will only need 
 three meals in the day, like a grown-up, and should 
 not be given anything to eat between those meals. 
 
 Improper food. — The food is often unsuitably 
 chosen and badly prepared. For an improvement 
 in this respect we must look to the efforts of Schools 
 for Mothers, and more especially to the thorough 
 training in domestic economy which is to be in- 
 cluded in the educational curriculum of future 
 mothers. 
 
 Care of the teeth. — The teeth are a matter of 
 the greatest importance. On the one hand there 
 
Management of the Ex-Baby 
 
 must be a sufficiency of food that requires chew- 
 ing and masticating, in order to secure the proper 
 development of the jaw-bones and -muscles, and 
 the proper blood-supply and nutrition of the teeth ; 
 and on the other hand a look out must be kept 
 to see that the child is not prevented from chewing 
 or masticating by the presence of tender or decayed 
 teeth. The Government grant is now available 
 for Dental Clinics in connection with Maternity and 
 Child Welfare Centres for both mother and child. 
 The child must not only have food that it requires 
 to chew, but it must be taught to chew. 
 
 In order to prevent decay of the teeth an effort 
 should be made to see that at the end of the meal 
 the spaces between the child's teeth are not filled 
 up with particles of starchy food, such as bread, 
 biscuits, or milk puddings. A piece of apple and 
 a drink of water help to cleanse the teeth, and the 
 use of the tooth-brush after breakfast and after 
 tea ought to be taught at an early age. The tooth- 
 brush should be well washed after use and put 
 where it can dry. It is not advisable to use too 
 hard a brush, or to rub very vigorously, for fear 
 of making the gums bleed or wearing away the 
 enamel. 
 
 Fresh air. — Many doctors are of opinion that 
 the requirement which the ex-baby most frequently 
 lacks is fresh air. This is where a smaU garden plot 
 attached to each house would come in — a safe place 
 where the toddlers can play. In infancy the baby 
 can have its fresh air in the stationary pram, and 
 the practice of putting it out to sleep should be 
 
Infant and Young Child 
 
 kept up as long as it is safe in the pram. After this 
 it can be put out in a cradle to sleep, or in a bed 
 close to the open window. It is difficult to see 
 how a mother of, say, four children under six 
 can see that they all get out enough, but fortunately 
 the " mothering " instinct is present in both boys 
 and girls, and, if there is a safe place for them to 
 play, the three-year-old girl will act as mother to 
 the eighteen-months-old baby, and the five-year- 
 old boy will act as father to both. 
 
 Fresh air at night is an easy matter if there 
 are sufficient bedclothes. The bedroom window can 
 then be open. 
 
 Rest and sleep. — Other doctors are of opinion 
 that the thing from which the ex-baby most gener- 
 ally suffers is lack of rest and sleep. Children under 
 five years of age should sleep the clock round, and 
 in addition they should have a sleep in the day- 
 time during the second if not during the third 
 year of life. It is wonderful what food, fresh 
 air, and midday rest do for the older children at 
 the Open-Air Recovery Schools. 
 
 The child wiU not get the full benefit of fresh 
 air and rest if it is a mouth-breather. Every 
 effort must therefore be made to keep a fairway 
 through the nose from birth. Mucus and dirt are 
 apt to accumulate and block the nostrils, and 
 must be gently removed by the mother with pointed 
 pieces of cotton-wool moistened in water. To 
 keep the nose clean is one of the most effective 
 ways of preventing adenoids and promoting a 
 healthy condition of the back of the throat. The 
 
Management of the Ex-Baby 
 
 child should be taught to blow its nose from the 
 first, although it will not be able to do this very 
 effectively for a year or two; The only way to 
 prevent a child becoming a mouth-breather is to 
 keep its nose clean. 
 
 The success or failure of institutions estab- 
 hshed for looking after babies and ex-babies, such 
 as Day Nurseries, Residential Nurseries, and Nursery 
 Schools, depends upon whether they are able to 
 provide food, fresh air, exercise, and rest; and 
 there is no doubt that they all ought to give special 
 attention to the toilet of the nose and the care of 
 the teeth. The standard of institutions which take 
 over responsibility for the care of other people's 
 children must be the standard of the most careful 
 and inteUigent mother, and not simply care a 
 grade better than the children might receive in 
 an indifferent home. 
 
 One of the hopes is that by the extension of 
 the work of Child Welfare Centres to include 
 children up to five years, fewer children will pre- 
 sent themselves at school in a disabled condition. 
 
 Some of the disabling ailments of school entrants 
 are rickets, discharging ears, deafness, enlarged 
 tonsils and adenoids, bad teeth, eye complaints 
 such as blepharitis and squint, skin complaints 
 such as impetigo, ringworm, and scabies, anaemia 
 and malnutrition. 
 
 Rickets. — ^This affection most frequently shows 
 
 itself between the sixth and the eighteenth months 
 
 of Ufe. Several causes are at work in producing it. 
 
 Improper food comes first, and this is especially 
 
 I 113 
 
Infant and Young Child 
 
 helped by lack of fresh air, sunshine and exercise. 
 We can say with certainty that if all babies were 
 breast-fed, weaned at about the ninth month, given 
 proper food after weaning, and ample fresh air, 
 sunlight, and exercise, rickets would disappear. 
 
 If rickets shows itself, the great thing is to 
 consult a doctor before bony deformities have had 
 time to develop. The warning signs are sweating 
 about the head, especially at night, lateness in 
 walking or in cutting teeth, flabby limbs, pot belly, 
 fretfulness, troubled sleep, and enlarged joints. 
 
 I can imagine no inquiry that would be more 
 profitable to child welfare than a well-co-ordinated 
 investigation into the causation of rickets and 
 scurvy throughout these islands. Modern research 
 tends to show that certain accessory food factors 
 have to do with the causation of rickets and scurvy, 
 and that bad teeth are a prominent symptom of 
 both these conditions. Medical inspection of school 
 children would give a valuable indication of the 
 prevalence of rickets in the various parts of the 
 country, if some uniformity of standard as to what 
 constitutes a rickety deformity could be agreed 
 upon. The inquiry would, of course, deal with 
 such matters as the cause of the freedom from 
 rickets enjoyed by the Jews and the absence of 
 rickets in the West of Ireland and among the 
 crofters of Lewis. Scurvy is much less common 
 than rickets, but for each well-marked case of 
 either disease there are hundreds of minor mani- 
 festations which probably account for a large pro- 
 portion of the deplorable dental conditions found 
 
 114 
 
Management of the Ex-Baby 
 
 among the population at all ages. It is therefore 
 no exaggeration to say that rickets and scurvy 
 are " key " diseases to a dietary which will enable 
 children to develop into healthy men and women. 
 
 Discharging ears and adenoids. — ^These conr 
 ditions are often associated. A child with deafness 
 or a discharging ear should be taken to a doctor at 
 once. There is an old superstition that it is danger- 
 ous to stop the discharge, and that the child will 
 " grow out of it." Nothing could be more dis- 
 astrous than this idea. In many cases the child 
 becomes permanently deaf, and neglected ear dis- 
 charge is a frequent cause of death from brain dis- 
 ease. There are few of the common ailments of 
 childhood that more urgently caU for prompt and 
 skilled treatment than this. 
 
 As regards prevention, the measures which are 
 useful for preventing adenoids will remove the 
 commonest cause of discharging ears, and if signs 
 of adenoids are present they should be treated 
 promptly before the ear has become affected. 
 
 Bad teeth. — The causes which lead to adenoids 
 and bad teeth are largely similar. In this connec- 
 tion I must return for a moment to the subject of 
 breast-feeding. Dentists maintain that this is of 
 the utmost importance for the development of good 
 teeth, not only because the right food is provided 
 thereby, but because the muscular action of the 
 baby in munching and puUing at the .nipple is 
 much better for the development of the jaws than 
 that involved in sucking at a bottle, however well 
 the teat of the bottle is adapted to its purpose. 
 
 "5 
 
Infant and Young Child 
 
 They also maintain — and doctors agree^hat the 
 constant sucking at a dummy teat tends to deform 
 the upper jaw and leads to there being less room 
 for the teeth and less room for nose-breathing. 
 
 After weaning the food must be such as needs 
 mastication in order that the jaws may so develop 
 as to give room for the teeth and a free passage 
 for air through the nostrils. 
 
 In addition to these common requirements, if 
 adenoids are to be avoided care must be taken 
 to remove mucous obstructions and preserve the 
 fairway through the nose and to encourage nose 
 breathing. A frequent discharge from the nose 
 and an inability to say " jam " (the child with 
 adenoids pronounces it "jab," owing to the block- 
 age of the nose) are among the signs that a child 
 has adenoids which require treatment, often before 
 earache and discharge from the ear develop. 
 
 Blepharitis. — Inflammation of the eyelids is a 
 very common complaint among young children. 
 The condition often dates from an attack of measles 
 or scarlet fever, and may begin as conjunctivitis. 
 It is commonly associated with dirty conditions 
 in the home, and frequently with anaemia and mal- 
 nutrition. An investigation made by Dr. Percival 
 Hay, of Sheffield, among the elementary school 
 children in 1913, showed that the disease had 
 frequently begun during the pre-school age, and 
 had persisted for many years. It is very important 
 that prompt treatment should be secured, as the 
 difficulty in effecting a cure is greatly increased if 
 the disease has existed for a long time. 
 
 116 
 
Management of the Ex-Baby 
 
 Of course, any ease of squint should receive 
 the attention of the ophthalmic surgeon as soon 
 as it is noticed, and not be left till the child begins 
 its schooling. 
 
 Skin affections. — Impetigo is a common skin 
 disease which is highly contagious, and begins as 
 spots and bUsters. It may residt in the child's 
 whole face being covered with scabs, and calls for 
 prompt treatment. 
 
 Scabies, or itch, and ringworm are two other 
 common skin diseases which may arise in the 
 pre-school age, and persist for a long time if treat- 
 ment is not persevered with. 
 
 The difficulty in all these cases of affections of 
 ear, eye, nose, and skin is to get the treatment 
 continued til]i a cure is effected. If the child is 
 taken to the hospital there is no one to follow up 
 the case at the home if the attendance of the patient 
 ceases or is irregular. If the child has reached 
 school age, this is where the School Chnic comes 
 in : the school nurse visits the home to see that 
 the treatment is continued. When cases such as 
 these are discovered through the Maternity and 
 Child Welfare Centre, the most convenient way 
 of deaUng with them is to have an arrangement 
 by which the Centre pays the School Clinic to 
 treat them and follow them up tiU a cure is effected. 
 Infectious diseases. — When we turn to the 
 death-roll of the ex-baby we find that the chief 
 change as compared with that of the infant is the 
 disappearance of the developmental and wasting 
 diseases (i.e. premature birth, congenital defects, 
 
 117 
 
Infant and Young Child 
 
 atrophy, debility and marasmus), which account 
 for one-third of the deaths of infants, and the relative 
 increase in importance of the specific infectious 
 diseases, such as measles, diphtheria, scarlet fever, 
 and tuberculosis, as causes of death. Bronchitis and 
 pneumonia still bulk large in the death returns. 
 Whooping-cough is most fatal in the first year of 
 life, and this is not surprising when one thinks 
 of the difficulty a small baby has in coping with 
 paroxysms of coughing. Diarrhoea exacts a big 
 toll in the second year of life, but its evil effects 
 greatly lessen during the next three years. 
 
 Measles is most fatal in the second year of 
 life, and continues to cause nearly one-fifth of the 
 total deaths during the next three years. 
 
 Pneumonia and bronchitis cause about one-fifth 
 of the total deaths throughout the first five years 
 of Ufe. 
 
 Some valuable lessons may be learnt from these 
 death-rates. It is obviously important that the 
 mother should not carry her baby into the in- 
 fection of whooping-cough, and yet this is quite 
 often done. The longer an attack of whooping- 
 cough or measles can be postponed, the less Ukely 
 is it to prove fatal. 
 
 Tuberculosis is very important both as a dis- 
 abUng disease and as a cause of death to children. 
 During 1911-14 tuberculosis in England and Wales 
 caused 2.9 per cent, of the deaths under i year of 
 age, 8.6 per cent, of those in the second year of life, 
 and 12.6 per cent, of the deaths occurring at the age- 
 period 2-5. Babies are born free from infection, 
 
 118 
 
Management of the Ex-Baby 
 
 but the percentage of babies infected rises rapidly 
 during each month of the first year of life and 
 during each of the subsequent years of ex-baby- 
 hood. 
 
 General tuberculosis, tubercular meningitis, and 
 abdominal tuberculosis are the most fatal forms of 
 this disease, while tuberculosis of the hip, knee, and 
 spine are the commonest causes of disablement. 
 
 Bad home conditions lessen the powers of re- 
 sistance, but wiU not cause the disease without 
 infection by the tubercle baciUus. The infection 
 by the tubercle baciUus comes from one of two 
 sources, either from a sufferer from tuberculosis, 
 generally living in the home with the child, or 
 from drinking the milk of a cow affected with 
 tuberculosis of the udder. This condition is quite 
 common among cows, and any herd of a hundred 
 cows wiU on an average produce one case of tuber- 
 culosis of the udder every year. 
 
 A large proportion of tuberculosis of the abdomen 
 and glands in children and a considerable propor- 
 tion of the tuberculous meningitis and tuberculosis 
 of the bones and joints is caused by the bovine 
 tubercle bacillus as the result of drinking the milk 
 of infected cows. There has never been any weU 
 conceived attempt made in this country to diminish 
 the amount of cattle tuberculosis, probably owing, 
 to the fact that the matter has been in the hands 
 of two Government Departments. It has been 
 the business of the Local Government Board to 
 attack the cow and the duty of the Board of Agri- 
 culture to defend it. 
 
 119 
 
Infant and Young Child 
 
 However, there is no doubt that if all milk 
 were boiled or sterihsed before being given to 
 children, this source of infection would be cut 
 off, and there would then only remain the unpleasant 
 idea of drinking milk from a cow with a tuberculous 
 abscess of the udder, fortunately camouflaged, as 
 a rule, by being mixed with the milk of a number 
 of healthy cows. 
 
 There can be Httle doubt that the human source 
 of tuberculous infection is incomparably the more 
 important. It is one of the objects of Tuberculosis 
 Dispensaries to teach the infectious human con- 
 sumptive, by occupjdng a separate bedroom, by 
 the cult of the open window, and by the collection 
 and destruction of the infectious sputum, to live 
 in such a way that he may not endanger the health 
 of the other members of his family. This is a 
 difl&cult problem in any case, and has been rendered 
 much more difficult by the War. There is the 
 scarcity of hospital accommodation for the ad- 
 vanced consumptive whose home conditions are 
 bad, and there is the scarcity of house accommoda- 
 tion which prohibits the consumptive who is able 
 and willing to pay for it from having a bedroom 
 to himself. There are a few wilfully negligent 
 consumptives in whose cases, in the interests of 
 the wife and children, compulsory powers for 
 removal to and detention in hospital are 
 needed. 
 
 Clothing. — The clothes of the ex-baby should 
 be warm, Mght, and loose. Children are usually 
 dressed with a view to the gratification of their 
 
Management of the Ex-Baby 
 
 mother's artistic sense rather than from the point 
 of view of their own comfort and health. 
 
 In choosing clothes one should consider first 
 the health and comfort of the child, and aesthetic 
 considerations should come in afterwards — a long 
 way afterwards. 
 
 Every effort should be made to encourage the 
 use of woollen garments in preference to flannelette. 
 Deaths of children from burns now make up nearly 
 2| per cent, of the total deaths under five years of 
 age. The Registrar-General's figures show what 
 an enormous increase has taken place in this cause 
 of death since the introduction of flannelette. In 
 his Report for 1916 he shows that, as a rule, more 
 deaths from accidents occur among boys than 
 girls, apparently owing to the greater spirit of 
 adventure in boys, but that deaths from burns 
 •present exceptional features. For the first three 
 years of Ufe more boys die from burns than girls ; 
 during the fourth year the mortality is about 
 equal. During the fifth year the boys' mortaUty 
 is only two-thirds of the girls'. During the age- 
 period 5-10 the boys' mortaUty is only one-third 
 of the girls', and during the age-period 10-15 it 
 is further reduced to less than one-fifth. On the 
 other hand, deaths by drowning are always, at 
 every age, except the first year of life, many times 
 more frequent among boys than girls. The Regis- 
 trar-General's inference is that so long as both 
 sexes are dressed aUke in petticoats they are 
 equally liable to death from burns, but that after 
 four years of age, when the boys have been put 
 
 121 
 
Infant and Young Child 
 
 into knickers, their liability to death from burns is 
 in consequence greatly reduced. 
 
 Why not put both sexes into jerseys and knickers 
 from the second year onwards and give them an 
 equal chance of escaping being burnt ? The ex- 
 baby may surely have the benefit of the progress 
 in rational dressing brought about by the War 
 without offending anyone's idea of modesty. 
 
 Death-rate of children. — ^The comparative death- 
 rates under five years from measles, whooping- 
 cough, bronchitis, and pneumonia are a safe guide 
 as to whether the social and sanitary conditions of 
 a town are good or bad for children. Sir Arthur 
 Newsholme, in the Supplement to the 45th Annual 
 Report of the Local Government Board, gives a 
 valuable table showing these death-rates for all 
 the great towns, and also another interesting table 
 for all the great towns showing the death-rates 
 under i, from i to 2, and from 2 to 5 years of age. 
 This shows that some towns improve their position 
 after the first year, while others are notably worse 
 for children after infancy. 
 
 Bradford is one of the large industrial towns 
 which have a better position as regards death-rate 
 during the second and subsequent years than during 
 infancy, which seems to justify the deduction that 
 the efforts of the Bradford Corporation, already 
 referred to, are more effective when they no longer 
 have to struggle against the failure to breast- 
 feed. On the other hand, Sheffield, Manchester, 
 Liverpool, Salford, Rotherham, and Newca,stle-on- 
 Tyne are examples of towns which occupy a worse 
 
Management of the Ex-Baby 
 
 position for the second and subsequent years than 
 they hold for the first. 
 
 It would be difficult to say which of the v9,rious 
 causes is most responsible for this heavy mortality 
 at ages from one to five ; it is usually several causes 
 acting together that constitute what we call bad 
 home conditions. 
 
 Thus, a child with its powers of resistance 
 already weakened by unsuitable food and want of 
 rest is attacked by measles or pneumonia. The 
 bedclothes are insufficient, and it cannot be kept 
 warm and have a well-ventilated bedroom at the 
 same time, and the mother has had no education 
 in invalid cookery. One might multiply hj^o- 
 thetical cases. The prime essentials, food, fresh 
 air, rest, warmth, and cleanUness, all dovetail into 
 one another. 
 
 At Sheffield we notice that many of the children 
 attending our Centre do worse in the second year 
 than they did in the first. I have discussed this 
 matter with the staff, and the following are some 
 of the causes which seem to operate in producing 
 this effect. 
 
 The two-year-old may get less attention be- 
 cause the mother is pregnant or because another 
 baby has arrived. He may be fed irregularly, get- 
 ting a bit of bread instead of a meal, or food in 
 between meals, and an inadequate quantity of 
 mUk. In some cases the ex-baby suffers from 
 lactation being prolonged into the second year. 
 Rest is not insisted upon during the day as among 
 the middle classes. Once the child can run about, 
 
 123 
 
Infant and Young Child 
 
 it is allowed to do so until it either falls asleep from 
 fatigue or becomes so fretful and peevish that the 
 mother takes it up and puts it to sleep. Speaking 
 generally, the children are not so well clad during 
 the second year. Inadequate clothing in the first 
 year is to some extent compensated by the baby 
 being carried in its mother's arms and getting 
 warmth from her body. When the child begins to 
 run about, napkins are discarded, and it is a common 
 practice for the mother, in order to save washing, 
 to pin up the petticoats round its waist, leaving 
 the legs and buttocks quite bare. The toddler, of 
 course, has more opportunities of picking up dirt. 
 During the second year, again, the child is more 
 likely to suffer from digestive troubles in connection 
 with the cutting of the molars, and it is also more 
 liable to suffer from most of the infectious diseases. 
 
 The protection of little children from infection 
 is very difficult if the common yard or court system is 
 in vogue. It is important, therefore, that there should 
 be a self-contained yard or garden to each house. 
 
 The diagram on p. 89 shows what an enormous 
 and steady reduction (about 60 per cent.) in the 
 death-rate of the ex-baby has been accomplished 
 since i860. But we who know the causes of death 
 and the conditions in our big towns must feel con- 
 vinced that further improvements in social and 
 sanitary conditions could quite easily further 
 reduce even the present death-rates by one-half. 
 
 Education. — Lastly, one cannot deal with the 
 physical welfare of children apart from their mental 
 and moral welfare. The education of a child begins 
 
 124 
 
Management of the Ex-Baby 
 
 directly it is born, and we must see that its educa- 
 tion is really education, that is, bringing out the 
 good points, rather than a system of repression by 
 everlasting " don'ts." The better educated and 
 less harassed mother of the future, with a home 
 equipped with labour-saving appliances, wiU have 
 more opportunity for attending to the training 
 of her children. The doctrine of original sin and 
 the essential " naughtiness " of children has been 
 responsible for a great deal of harm in the up- 
 bringing of children in the past. 
 
 The paragraphs on discipUne and character 
 training in the booklet " To Wives and Mothers," 
 published by the National League for Physical 
 Education and Improvement, are so excellent that 
 I copy them in full. 
 
 Discipline 
 
 The good mother makes her child obey her without 
 question, never goes back from her word, or argues 
 the point. Do not " wheedle " or " nag," or let the 
 child think you are in doubt, for even the youngest 
 baby wiU take advantage of a weak mother. Children 
 are highly imitative ; therefore, do not deceive them 
 or tell a Ue, or they wiU do the same to you. The 
 strictest parents are the best beloved, if only they are 
 just. Do not frighten children into obedience by 
 fooUsh tales of " bogies," or by threatening to tell the 
 doctor or fetch the policeman ; and do not punish 
 them by boxing their ears or by putting them into 
 the dark, as the child may dread the hour of bedtime 
 for years afterwards, and thus permanently damage 
 the nervous system. 
 
 125 
 
Infant and Young Child 
 
 Character Training 
 
 It is important to feed and clothe children in the 
 best possible way. But it is much more important 
 to train their characters in the best way. 
 
 Why do we especially want to train children well ? 
 
 1. To build up in them strong and noble characters. 
 
 2. To make them fit to face Ufe. 
 
 Mothers should begin to train their babies as early 
 as possible. No baby is too young to know whether 
 he can manage his mother, or whether his mother can 
 manage him. Teach a baby at once that he will not 
 get all he wants because he cries for it. A little crying 
 will not hurt him, but to give him everything he cries 
 for will hurt him very much. It will make his character 
 weak, undisciphned, self-willed, uncontrolled. 
 
 The child's mind grows with his body, and as the 
 one needs right conditions, so does the other, or it will 
 be stunted. 
 
 How can we train and educate the mind and thus 
 influence the character ? To do this, we should inter- 
 fere as little as possible with Nature's methods. A 
 baby has great power of concentration ; he will look 
 steadily at one thing for a long time. He will make a 
 movement over and over again until he can control it. 
 He should be left undisturbed ; he should not be spoken 
 to only for the sake of seeing him smile. Excepting 
 during his regular occupations — ^his meals, sleep, and 
 going out — ^he should not be disturbed when he is 
 absorbed. When awake in his cot he should be able 
 to see what is going on around him. This will always 
 be enough to occupy him. As he gets older he should 
 be taught to occupy himself, not to want constant 
 attention from his mother. He will be much happier 
 
 126 
 
Management of the Ex-Baby 
 
 and much less trouble if he can occupy himself, but 
 he will never learn to do it if he is taken up and amused 
 whenever he cries. To help him to gain a habit of 
 self-occupation is to help to educate his mind and 
 character. 
 
 A baby's mental business is to learn all he can 
 about the world in which he lives, and he does not 
 Uke to be interrupted whilst learning. Do not speak 
 to a child unnecessarily when he is absorbed and good. 
 
 We learn and grow by trying and succeeding. There- 
 fore, unless it is hurtful to himself or to others, do not 
 prevent a child from doing what he can for himself, 
 thus teaching him self-reliance. 
 
 One morning a child of 2j came to breakfast. 
 There were many delightful things he wished to do. 
 He would climb on to his high chair, unfold his feeder, 
 and painfuUy tie the tapes round his neck in front, 
 and then turn the feeder round ! He would take a 
 spoon and crack his own egg. But instead of letting 
 him do all these things, and so gradually learn how to 
 do them, a grown-up rushed at him, tied his feeder 
 and broke his egg, and he broke into a howl of dis- 
 appointment. 
 
 Too often, out of mistaken kindness, people thwart 
 a child when he tries, and enjoys trying, to attain his 
 end by himself. 
 
 Do not indulge children. It makes them soft and 
 selfish. 
 
 Do not nag or be harsh to them. You may make 
 them cowardly and deceitful. 
 
 Always be gentle, but always be firm. 
 
 Let your yes be yes, your no, no. Never shake 
 children or box their ears or frighten them. 
 
 Moral education helps children to learn self-control ; 
 127 
 
Infant and Young Child 
 
 and remember you want to make them fit to go out 
 into life, where they will need a great deal of self- 
 control, where they will not find everything made easy 
 for them, where they will not be spoilt and get every- 
 thing they want. Regularity in good habits when 
 children are small is a very important part of moral 
 education, because through good habits a child learns 
 to make a right choice, to choose the good and refuse 
 the evil. 
 
 Let him hear only kind words and pleasant voices. 
 Let that to which he is accustomed be right, that to 
 which he is unaccustomed be wrong. If he is never 
 told to do unreasonable things he will see that obedience 
 to the reasonable actions he is asked to do is right ; 
 and he will be more Hkely to refuse wrong when it comes 
 his way. 
 
 Some day he will certainly have to choose between 
 right and wrong. He can only choose rightly if he 
 knows the meaning of right-doing. And whilst he 
 is small this knowledge comes through good habits, 
 and trust in the kindness of those he loves best. The 
 first time he makes a good choice he shows control 
 over his will. 
 
 Therefore teach children from the very beginning : 
 
 1. How to be obedient. 
 
 2. How to be self-controlled. 
 
 3. How to be unselfish. 
 
 4. How to be pure. 
 
 5. How to be truthful. 
 
 Teach them to be unselfish by encouraging them 
 to do things for you and for others ; by making them 
 think of other people first, not of themselves first. Do 
 not always slave for them, but show them how they 
 
 128 
 
Management of the Ex-Baby 
 
 can help you. A mother often makes her children 
 selfish by doing everything for them, and saving them 
 trouble. That mother is not really a good mother. 
 A good mother thinks chiefly of what is best for 
 her children's characters, not of what is easiest and 
 pleasantest for them. 
 
 To cultivate and practise good habits, bodily, 
 mental, and moral, is to build up a great and good 
 character, and the famous old sajdng bears this out : 
 
 " Sow an action, you reap a habit. 
 Sow a habit, you reap a character." 
 
 Therefore teach your children to do right actions 
 over and over again, until the right actions become 
 habits, and the habits are built into a character. 
 
 129 
 
CHAPTER IX 
 
 Institutions to help the Mother 
 
 First and foremost among these institutions comes 
 the Maternity and ChUd Welfare Centre. Some 
 of these Centres have sprung up as voluntary in- 
 stitutions supported by subscriptions, others have 
 been from the beginning municipal institutions. 
 These pioneer institutions have done splendid work 
 in showing what is needed and in preparing the 
 way for complete schemes under the Maternity and 
 Child Welfare Act of 1918. 
 
 The Local Governmient Board's circular of 
 August, 1918, gives the following list of additional 
 services for which the Government grant is now 
 available : 
 
 Hospital treatment for children up to five years 
 of age. 
 
 Lying-in homes. 
 
 Home helps. 
 
 The provision of food for expectant and nursing 
 mothers, and for children under five years of 
 age. 
 
 Creches and Day Nurseries. 
 
 Convalescent Homes. 
 
 Homes for the children of widowed and de- 
 serted mothers and for illegitimate children. 
 130 
 
Institutions to Help the Mother 
 
 Experimental work for the health of expectant 
 and nursing mothers, and of infants and 
 children under five years of age. 
 
 The same circular states why the comprehensive 
 schemes should, as a rule,' be prepared by the 
 Councils of Counties and County Boroughs : 
 
 " The Councils of counties and county boroughs 
 are the local supervising authorities under the Md- 
 wives Act, 1902, and they are also entrusted with the 
 initiation and execution of schemes for the treatment 
 of tuberculosis ; if the organisation of a maternity 
 and infant welfare scheme is also undertaken by them, 
 it will be practicable to secure the unification of home 
 visiting for a number of different purposes." 
 
 I should Uke to refer to a few points with regard 
 to the component parts of a complete scheme. 
 
 The primary object of the Centre is to provide 
 skilled advice for mothers with regard to their 
 own health and that of their children, and to secure 
 early treatment in the case of ailments affecting 
 either mother or child, and in this way carry back 
 the medical supervision which is exercised in the 
 schools not only to the pre-school age and infancy, 
 but also to the ante-natal period. 
 
 As in the case of the School Medical Depart- 
 ment, the searching out of ailments is of no use 
 unless the ailments are treated, and the need for 
 a reconstruction of the^Medical Service by which 
 there is secured a family doctor for each family is 
 evident. In the meantime, arrangements can gener- 
 
 131 
 
Infant and Young Child 
 
 ally be made with hospitals for the treatment of 
 mothers and children who cannot afford to pay a 
 doctor, or with the School CMnic in the case of 
 special ailments such as those of the skin, eye, teeth, 
 ear, and nose. 
 
 The staff of the Centre consists of the medical 
 staff and the women sanitary inspectors or health 
 visitors, and may also include voluntary unpaid 
 workers interested in the scheme, who, to quote 
 the circular of the Local Government Board, " can 
 be of great assistance in weighing babies, in enter- 
 taining the mothers, and in giving instruction in 
 elementary hygiene, cookery, sewing, etc." 
 
 Health visitors and women sanitary inspectors. 
 — There has been a good deal of discussion lately 
 as to the qualifications and training of women 
 sanitary inspectors or health visitors. 
 
 We must freely admit that health visitors 
 and women sanitary inspectors have to learn their 
 work after appointment, unless they have had the 
 opportunity of going through a stage of pupilage 
 or apprenticeship in an already established Centre. 
 Are we not involved in a discussion similar to that 
 which- took place when the old practitioners re- 
 garded with scorn the newly-fledged medico who 
 had never been apprenticed ? 
 
 There is a difference in this respect, that the 
 modern medical student, in addition to acquiring 
 knowledge by " looking on," reading, and attend- 
 ing lectures, is also trained to do practical work 
 under supervision in the dissecting room, the 
 laboratory, and the hospital. 
 
 132 
 
Institutions to Help the Mother 
 
 Hospital nurses and midwives are also trained. 
 On the other hand, speaking broadly, sanitary 
 inspectors and health visitors acquire knowledge 
 by " looking on," reading, and attending lectures, 
 without being trained ; that is to say, without doing 
 practical work under supervision. The possessor 
 of a University degree requires to be trained before 
 becoming a teacher. The woman who has acquired 
 useful knowledge and been trained as a hospital 
 nurse and a midwife needs to be trained as a health 
 visitor. Every hospital nurse will not make a 
 good health visitor, but, given a suitable woman, 
 hospital training, with a considerable portion of 
 the time spent in children's wards, must be in- 
 valuable to her in deahng with children. Some 
 knowledge of disease must be useful to a health 
 visitor as weU as to a Medical Officer of Health, 
 provided we do not go to the other extreme and 
 assume that nothing else is required. Most health 
 visitors are single women, and the qualification of 
 a hospital nurse is one for which the mothers of 
 children, who are apt to look with scorn on the 
 advice of unmarried women, have some respect. 
 Up to the present no system of training has been 
 devised which competes with that of the hospital 
 nurse. The health visitor receives her training as 
 such after appointment, but the hospital training 
 makes a good foundation to build upon. One pre- 
 fers, of course, to secure a hospital nurse who is 
 receptive of new ideas and has not spent half her 
 working lifetime in an institution. 
 
 Another important point is the avoidance of 
 X33 
 
Infant and Young Child 
 
 overlapping and the overvisiting of the homes. 
 In Sheflfteld we have adopted the practice of ap- 
 pointing as health visitors women who are qualified 
 as hospital nurses and midwives, and of expecting 
 them to obtain the sanitary inspector's quaUfica- 
 tion within a reasonable time of appointment. 
 We do not want the same home visited by a number 
 of different women, such as the woman sanitary 
 inspector, the health visitor, the tuberculosis in- 
 spector, the measles inspector, and the inspector 
 of midwives. In Sheffield the woman sanitary 
 inspector acts as health visitor and assistant in- 
 spector of midwives, and also visits measles and 
 tuberculosis cases. In a smaller town, I think, 
 the woman sanitary inspector might also act as 
 school nurse, and perhaps as school attendance 
 officer. The Sheffield inspectors do not undertake 
 district nursing, but work in co-operation with the 
 Queen Victoria District Nurses. Quite apart from 
 the avoidance of overlapping and overvisiting of 
 the homes by different inspectors, I think it is a 
 great mistake from the point of view of the in- 
 spectors themselves to go in for over-speciaUsation 
 and to restrict their work to a very narrow groove. 
 If, in order to discharge these various duties, 
 the inspector possesses the triple qualification of 
 hospital nurse, midwife and sanitary inspector, she 
 will, as a rule, be a woman of higher attainments 
 than the midwives whom it is her duty to super- 
 vise, a point upon which a good deal of stress has 
 been laid lately. The chief inspector of midwives 
 must, of course, be a medical practitioner (whether 
 
 134 
 
Institutions to Help the Mother 
 
 the Medical Officer of Health or his duly qualified 
 assistant), and the assistant inspectors must act 
 under his directions. When difficulties arise, the 
 njidwives must be interviewed and advised by the 
 medical inspector of midwives. 
 
 A health visitor or woman sanitary inspector 
 who has these varied duties can be given a com- 
 pact district and become well known in it as the 
 friend of the mothers and children, and she will 
 also have no difficulty in working in friendly 
 co-operation with the two or three midwives 
 resident in her district. 
 
 While I hold a strong opinion as to the value 
 of a hospital nurse's training, I quite appreciate the 
 fact that, if we restrict our choice of women in- 
 spectors to hospital nurses, we shall debar many 
 suitable women from undertaking the work, and 
 for that reason I hope it may be possible to arrange 
 for a satisfactory course of real training which will 
 be something more than acquiring knowledge by 
 " looking on," reading, and attending lectures. 
 
 When a Centre opens, most of the women who 
 bring up their children for advice are those who 
 are recommended to come by the women inspectors 
 as the result of visiting the home after the notifica- 
 tion of a birth. After a time a large number of 
 the new mothers come, with a baby or child that 
 is not thriving, on the recommendation of other 
 mothers who have benefited, and a large number 
 of new babies are brought by mothers whose earher 
 babies have profited by attendance at the Centre. 
 According to Sheffield experience, the Ante-natal 
 
 135 
 
Infant and Young Child 
 
 Clinic will only develop gradually, as it has not 
 been customary for expectant mothers to consult 
 a doctor unless they have had very good reason 
 to suspect that something was wrong. The in- 
 vestigation of the causes of stillbirths by the ihedical 
 staff of the Centre will no doubt contribute to the 
 increase of ante-natal work. 
 
 The work of a Centre and the agencies which 
 arise in connection with its work must vary with 
 the circumstances of each district. Thus, the need 
 for the provision of meals for expectant and nursing 
 mothers will vary according to the prosperity of 
 the district, and the need for the provision of 
 Creches and Day Nurseries will depend upon the 
 extent to which mothers are compelled to leave 
 the home and go out to work. 
 
 Day Nurseries. — A considerable number of 
 Day Nurseries were in existence before the War, 
 and many new ones have been established during 
 the War to meet the emergency caused by many 
 mothers of little children going to work at muni- 
 tion factories in response to their country's call. 
 There is just the danger that Day Nurseries may 
 come to be regarded as a legitimate part of a scheme 
 of sanitary reform. The method and order of an 
 institution appeal to some minds, and one reads 
 glowing articles on State Creches as if they repre- 
 sented the MOW plus ultra of progress. There is 
 nothing new in the idea. Plato advocated com- 
 munal nurseries, but he went further than most 
 reformers because the nursing mothers of his 
 Republic, when admitted to the State nurseries, 
 
 136 
 
Institutions to Help the Mother 
 
 were not allowed to know or suckle their own 
 babies. I conjecture that Plato was a bachelor 
 and failed to realise what is meant by " mothering." 
 We cannot make an ideal of Day Nurseries. All the 
 ideals of progress in child welfare must be centred 
 round the mother and the home. The best Day 
 Nursery can only be a makeshift to lessen the bad 
 effect of mothers having to leave their Httle children, 
 and in a really well organised community it should 
 be made possible for every mother of httle children 
 to stay at home. Until that day comes we shall 
 no doubt have Day Nurseries with us, but do not 
 let us make the mistake of coming to regard them 
 as things desirable in themselves. Their use almost 
 inevitably leads to premature weaning, and is 
 specially undesirable in the case of babies in the 
 first year of Ufe, when they are most helpless and 
 most in need of mothering. 
 
 Medical men who have special experience of 
 children's diseases have a great fear of the bad 
 effects of the aggregation of little children in in- 
 stitutions, owing not only to the danger of the 
 spread of the ordinary infectious diseases, but 
 also to the danger of the spread of catarrhal in- 
 fections causing many of the children to sink into 
 a chronic state of poor health. In order to avoid 
 this, when Day Nurseries are necessary they should 
 be managed as far as possible on open-air hues, 
 and there should be an adequate trained staff in 
 order to ensure the children getting the full advan- 
 tage of open-air conditions. There should also be 
 paid medical supervision, and the Medical Super- 
 's? 
 
Infant and Young Child 
 
 intendent should inspect the babies at least once 
 a week. A chart should be kept for each baby 
 or child and its weight entered up from time to 
 time, so as to record its progress or want of 
 progress. 
 
 The following recommendations were drawn up 
 in 1917 jointly by the National Society of Day 
 Nurseries and the National Association for the 
 Prevention of Infant Mortality : 
 
 («) That the Nursery be approved as suitable 
 for the accommodation of a definite number of 
 children, and that no more be allowed. 
 
 (6) That the Nursery be run, as far as possible, 
 on open-air lines. 
 
 (c) That there be an adequate trained staff, 
 including a specially trained matron. 
 
 (1^) That weight and progress charts be kept of 
 all children admitted to the Nursery in order to 
 record their progress. The Inspector of the Depart- 
 ment which gives the grant will then be able to 
 see at a glance whether the children of the Nursery 
 are thriving. 
 
 (e) That there be paid medical supervision. 
 
 (/) That no child be admitted to the Nursery 
 until the home has been visited for the purpose 
 of ascertaining the reason why the mother wishes 
 to leave her child at the Nursery, and that such 
 reason be recorded. 
 
 (g) That special attention be given to prevent 
 the total weaning of children under nine months. 
 
 {h) That there be systematic attention given to 
 the homes from which the children are brought, 
 
 138 
 
Institutions to Help the Mother 
 
 so as to secure continuity of feeding and care, 
 especially in the case of infants. 
 
 There was a further recommendation that every 
 effort be made to ensure that the Nurseries be 
 used as Centres for training in mothercraft. 
 
 Many of these institutions have been supported 
 by voluntary subscriptions, and o\<ing to in- 
 adequate funds have been unable to employ a 
 sufficient staff. One of the effects of an insufficient 
 staff is that the babies cannot be taken out during 
 the day. Would any middle-class mother inter- 
 ested in her baby's welfare send it for the day to 
 be kept in a room with a lot of other babies ? 
 
 What some mothers have to do. — It is hardly 
 possible to do much in the way of teaching th6 
 mothers who bring their babies to a nursery. The 
 life of a mother who goes to work and takes her 
 baby or children to a nursery does not leave much 
 time for learning mothercraft, as the following 
 diaries of mothers actually using the Sheffield Day 
 Nursery wiU show : 
 
 Mrs. A., a widow with two children, aged 6 years, 
 and I year and lo months. The elder attends school 
 and is looked after by a neighbour. The younger is 
 taken to the Day Nursery. Mrs. A. works at a factory 
 from 8 A.M. to 5.30 p.m. 
 
 Monday. — Gets up at 6 a.m. Lights the fire and 
 puts on the kettle, washes and dresses the two children. 
 Gets the breakfast ready and has it with the children. 
 Elder child then goes to the neighbour's. At 7.15 a.m. 
 takes the younger child to the Day Nursery (distant 
 about one mile, uphill). Has to walk, as the tram is 
 
 139 
 
Infant and Young Child 
 
 no advantage. At 8 a.m. arrives at work. Has dinner 
 there. Leaves at 5.30 p.m., goes to Day Nursery for 
 younger child. Arrives home at 6.15 p.m., Ughts fire. 
 At 6.30 P.M. the elder child comes home, and the two 
 play while Mrs. A. makes the beds. At 7 p.m. she 
 gives the children their supper, at 8 p.m. " baths " the 
 younger child, washes the elder, and puts them to bed. 
 Then washes crockery and does mending. Supper at 
 9.30, goes to bed at 10 p.m. 
 
 The routine is the same on all days except the 
 evenings, which vary as follows : 
 Tuesday. — Similar to Monday. 
 Wednesday. — Similar to Monday, except that after 
 8 P.M. Mrs. A. cleans the shelves and steps of the cellar. 
 Thursday. — Similar to Monday, except that after 
 8 P.M. she cleans the windows, cupboard shelves, fender 
 and fire-irons. 
 
 Friday. — Same as Monday, except that after 8 p.m. 
 she cleans the living-room, thoroughly washes floor, cleans 
 step, dusts furniture, and makes all clean for Saturday. 
 Saturday. — Day Nursery not open. Leaves both 
 children with neighbour. Goes to work from 7.30 a.m. 
 to I P.M. Arrives home at 1.30 p.m. Gets dinner for 
 herself and the children, and washes up. In the after- 
 noon does her shopping. In the evening " baths " 
 both children. 
 
 Sunday. — Gets up at 7 a.m. After breakfast cleans 
 the bedroom and attic. Gets dinner, and washes up. 
 Finishes cleaning upstairs. Finishes in time for tea. 
 Inspector's note. — " This is a very clean home, and 
 the children are clean and tidy. Mrs. A. gets her 
 washing done by a neighbour. She does not bake, but 
 buys her bread. She buys all clothing ready-made, as 
 she has not time to make clothes." 
 
 140 
 
Institutions to Help the Mother 
 
 Mrs. B. Her husband works away from Sheffield ; 
 sometimes sends her money. Six children, ranging 
 from 12 years to i year. 
 
 Monday. — Gets up 6.30 a.m. Gives the children 
 breakfast, and gets the potatoes ready for boiUng for 
 dinner. Sends the school children to school. Takes 
 two children to the Day Nursery, which is one mile 
 distant, uphill, then goes to her work as a cabinet case 
 coverer. She works only a few minutes' walk away 
 from her home. She goes home at dinner-time for one 
 hour. Gives the school children their dinner. Returns 
 to work. A neighbour helps to give the children their 
 tea. Mrs. B. returns from work at 6 p.m., and fetches 
 the two children from the Day Nursery. Has a cup 
 of tea, then brushes the Sunday clothes and puts them 
 away. Mixes about three-quarters of a stone of flour 
 and bakes bread. Prepares the dinner for the next 
 day. Monday evening is a slack evening. 
 
 Tuesday. — Similar to Monday, except that in the 
 evening she does the family washing and hangs the 
 clothes on Unesin the living-room to dry during the night. 
 
 Wednesday. — Similar to Monday, but before going 
 out in the morning she takes down the dry clothes, 
 folds them, and re-fills the lines with wet clothes. In 
 the evening she folds, mangles, and irons all the clothes, 
 and makes use of the hot fire necessary for the irons 
 to bake ij stones of flour into bread. 
 
 Thursday. — Similar to Monday, except that in the 
 evening she cleans the bedrooms. 
 
 Friday. — Similar to Monday, except that she re- 
 turns from work at 7 p.m. She cleans the flues, black- 
 leads the range, cleans the fender and fire-irons, cleans 
 knives and forks, scrubs boards, cleans cellar steps, 
 makes 14 lb. of flour into bread, and bakes it. 
 
 141 
 
Infant and Young Child 
 
 Saturday. — ^Day Nursery closed. Neighbour looks 
 after baby. Mrs. B. comes home at i p.m. for the day. 
 She cooks the dinner and washes up after it. Cleans 
 the windows, and the floor of the living-room, gives the 
 children tea and has it herself, goes out to do her 
 shopping (meat, groceries, etc.) for the week-end. The 
 children have baths on the Saturday night. 
 
 Sunday. — Gives the children breakfast and sends 
 them to Sunday school. Prepares dinner (which also 
 does for Monday cold). Tidies up the.house and has 
 a rest, by lying on the bed for the afternoon until the 
 children come back from Sunday school. 
 
 Note. — The house has always been clean and the 
 children well looked after. Mrs. B. has never been 
 laid up since her marriage except for confinements, and 
 has never had a, bottle of medicine, and the children 
 also have had good health and have troubled the doctor 
 very Uttle. She is thin, but thinks that " people are 
 not killed by hard work." The set-pot is used once a 
 week for washing clothes, otherwise all hot water 
 has to be heated in a saucepan or kettle over the 
 fire. 
 
 Day Nurseries without gardens. — The follow- 
 ing extract from the Carnegie Report on Scottish 
 Mothers and Children, written by Sir W. Leslie 
 Mackenzie, is of interest : 
 
 " Of the Day Nurseries visited, some are well pro- 
 vided with gardens ; others are gardenless. A day 
 nursery without the means of placing the children in 
 the open air, either on balconies or in gardens, is one 
 of the least desirable of institutions. Of those visited, 
 several were open to this criticism. But there is a 
 criticism even more fundamental ; it has been found 
 
 142 
 
Institutions to Help the Mother 
 
 that, in many places, the ideal is to keep the young 
 children sitting, correctly clothed, and stiU. As a 
 means of generating rickets, nothing could be better. 
 If there is one thing that the very young children 
 need more than another it is constant activity of 
 muscle. Anything that restricts the movement of a 
 child is physiologically bad. The very young children 
 do, of course, need much sleep ; but this is not the 
 point criticised. The criticism is levelled against the 
 care of the children emerging into the toddler state 
 or actually arrived there. To be kept in a still room, 
 sitting, or bored to death by the monotony, is the least 
 and worst service that any child can receive. Un- 
 fortunately, few Day Nurseries without access to the 
 open air, either by balcony or otherwise, can provide 
 the necessary stimulus. With fair justice, it has been 
 said of these closed nurseries that if the children could 
 be kept from being run over they would be better in 
 the gutter. It is necessary to put this point forcibly, 
 because our inspection proves that the cleanhness, 
 quietness, prettiness, and cosmetic effects generally 
 are apt to take the first place in the minds of 
 the attendants ; the children's physiological demands 
 for activity tend to take the second place. Wher- 
 ever the conditions made it possible to keep the 
 children in the hght and under the stimulus of fresh 
 air, the whole spirit of the nursery service was 
 different. 
 
 " The conditions criticised flow less from a want of 
 will than from a want of knowledge. It is not fully 
 recognised that all children require opportunities for 
 action. As they emerge into the walking stage, the 
 opportunities for action become imperative. The still 
 nursery is then an anachronism. The real need is a 
 constantly varied field of activity." 
 
 143 
 
Infant and Young Child 
 
 The " toddler's playground." — Sir Leslie Mac- 
 kenzie goes on to commend " toddlers' playgrounds" 
 as a relief for the overburdened mother and a 
 tonic for the badly housed child. He speaks 
 very highly of the success of the experiment in 
 Edinburgh, and quotes Dr Brownlee's opinion 
 " that children are most depressed by unhealthy 
 surroundings between the ages of two and 
 three." 
 
 The playground in Edinburgh is managed by 
 the health visitors, and these are the conditions 
 for admission : 
 
 " Firsts there must be a baby at home needing 
 nursing ; second, the mother must undertake to pre- 
 pare the school children properly for school and to 
 prepare the toddler for transference to the play- 
 ground ; third, she must maintain a reasonable standard 
 of tidiness in the home. With the school children at 
 the school and the toddler in his superintended play- 
 ground the mother is enabled to attend both to her 
 baby and to the preparation of the mid-day meal. 
 In time for the mid-day meal the toddler is taken 
 home, and has the rest of the day to look forward to 
 his next visit to the playground. The equipment of 
 the playground is of the simplest : sufi&cient open 
 space, with the usual infant properties of sand, rocking 
 horse, etc., and an open-air shelter for the rainy days. 
 Even in the conditions of our Edinburgh climate, the 
 experiment has succeeded in every respect. The 
 homes are stimulated to maintain a better standard, 
 the mother's energies are economised, the baby receives 
 more attention, the toddler has improved, not merely in 
 habits, but materially in health." 
 
 144 
 
Institutions to Help the Mother 
 
 For further particulars of this interesting ex- 
 periment I must refer the reader to the Scottish 
 Carnegie Report. 
 
 Factory Creches have been established both 
 in France and in this country with the object of 
 allowing the mother working at the factory to 
 continue breast-feeding her baby. These again are 
 open to the objection that the home-maker is taken 
 out of the home, and there may be other insuper- 
 able difficulties to their establishment. 
 
 As the result of a discussion with the welfare 
 workers, it was deemed impossible to establish a 
 Factory Creche in Sheffield. The times of the 
 shifts were the first difficulty. At some of the 
 works there were three shifts in the day, at others 
 two, at others one, and at others shifts varpng 
 every day. The transport of the children in the 
 alrea:dy overcrowded trams was another difficulty. 
 The welfare workers also considered that the 
 atmosphere and noise of the works made them un- 
 suitable places for creches, and, further, that much 
 of the work was unsuitable for nursing mothers. 
 
 In Sheffield, in normal times, very few mothers 
 of little children are forced to go out to work, 
 and even during the War our women inspectors 
 did not come across many cases where children 
 of munition workers suffered owing to the neglect 
 of the neighbour or relative in whose charge they 
 had been left. The children in Sheffield who were 
 neglected during the War were the children of 
 mothers who were not at work, who had acquired 
 drinking habits before the War, and who had 
 K 145 
 
Infant and Young Child 
 
 more money and leisure at their disposal than 
 usual owing to their husbands being on active 
 service. Unless the Day Nursery is an open-air 
 one and run on quite first-class hnes I have no 
 hesitation in saying that it is better for the babies 
 to be left in the charge of a relative or friend while 
 the mother is at work. 
 
 It must be borne in mind that a Day Nursery 
 is an expensive way of helping the mother. Many 
 of them cost 2s. per attendance, and the mother 
 pays perhaps sixpence. A mother who takes three 
 children to a Day Nursery five days a week can only 
 lead the life of drudgery described in the diaries on 
 an earlier page because of the philanthropy (?) of 
 the State and the community in being willing to 
 spend 22S. 6d. per week on her and her family. 
 
 Residential Nurseries. — As regards Residential 
 Nurseries, I should say they are more difficult to 
 manage than any other institution. In a Day 
 Nursery you can try to exclude the infectious child 
 and send it home. In the Residential Nursery you 
 cannot do this. I recently heard of a smaU Resi- 
 dential Nursery which within a few months of the 
 opening had epidemics of whooping-cough, ophthal- 
 mia, and diarrhoea, with some deaths. I think it 
 may fairly be said that progressive Boards of 
 Guardians have succeeded in running successfully 
 every kind of institution under their charge with 
 the exception of the nurseries. It is well that the 
 difficulties of managing a Residential Nursery 
 shoxild be thoroughly realised, as it is quite probable 
 that there may be a movement to promote more 
 
 146 
 
Institutions to Help the Mother 
 
 of these institutions for the care of illegitimate 
 children now that the question of the unmarried 
 mother and her child is being considered in earnest. 
 Sir Arthur Newsholme's remarks on this question 
 in the supplement to the 47th Annual Report of 
 the Lbcal Government Board (1917-18) are very 
 much to the point : 
 
 " Charitable agencies which undertake the reform 
 of unmarried mothers can only effect the greatest good 
 by keeping the mothers and their infants together. 
 Commonly, their activities take the form of admitting 
 the mother to a home, the infant being boarded out 
 separately or admitted into an infants' home, under 
 zealous and devoted women who often have no nursing 
 and hygienic knowledge, and under whose care an 
 appalling loss of infant life and health occurs. It is hoped 
 that the giving of grants by the Board for the care 
 of illegitimate infants under regulated conditions will 
 bring most of such institutions under inspection and 
 result in great improvements in their administration. 
 At present, outside London there is no adequate pro- 
 vision for this. 
 
 " The more usual plan has been to place the infant 
 out with a foster mother : and if a trustworthy person 
 is available, this is more in the infant's interest than 
 an institution, however well-regulated." 
 
 Mother 'Substitutes not wanted. — It seems to 
 me that the test of most of these institutions is 
 whether they are aids to the mothers or mother- 
 substitutes. We do not want mother-substitutes. 
 In the course of time, when the homes are improved 
 and playgrounds adjacent to the home, however 
 
 147 
 
Infant and Young Child 
 
 small, are provided, one hopes that the develop- 
 ment of a system of trained " home helps " who 
 may be available for the relief of the mother in 
 times of emergency and special stress, may render 
 many of these institutions unnecessary. Already 
 the local authority is empowered to supply a " home 
 help " during the mother's lying-in period, whether 
 the confinement takes place at the home or else- 
 where, and an extension of the plan to other emer- 
 gencies seems quite feasible. Of course, in very many 
 cases the mother could pay the home help herself. 
 It would be convenient for the local authority to 
 keep a list of such home helps, either at the Mater- 
 nity and Child Welfare Centres or at some central 
 place in each ward or subdivision of the district. 
 
 Nursery schools. — As regards the new move- 
 ment for establishing Nursery Schools, provided 
 for in the Education Act of 1918, one feels that 
 if they are carried out in the spirit of the memoran- 
 dum issued by the Board of Education they will 
 have great opportunities for doing good in the 
 congested districts of our large towns. If, on the 
 other hand, they are looked upon simply as modified 
 or glorified Infants' Departments, the whole move- 
 ment is foredoomed to failure. In order to achieve 
 success it will be necessary to have in charge of 
 the nursery schools women imbued with something 
 of the enthusiasm and idealism of Miss Margaret 
 MacMillan, and it would be well if Education 
 Committees, before doing anything in the matter, 
 would send deputations to study the methods of 
 the MacMillan Nursery School at Deptford. 
 
 148 
 
CONCLUSION 
 
 Much research work is no doubt necessary before 
 we can solve many of the problems of infancy and 
 early childhood, but we know enough now to 
 transform England if we could but put our know- 
 ledge into practice. 
 
 We want healthy parents and healthy homes ; 
 we want well-educated mothers provided with a 
 Sufficient income and backed by an efficient medical 
 service. 
 
 Above all, we want to raise the ideals of mother- 
 hood, both of its duties and of its rights. We 
 must make motherhood one of the chief features 
 of the new social heredity which we are to impose 
 on the nation during the coming period of recon- 
 struction. To do this we must enHst the help 
 of all. This is a cause in which the members of a 
 League of Nations can honourably compete with- 
 out fear of jingoism or a reversion to barbarism. 
 In order to produce the maximum effect we must 
 begin with the young. All philosophers from 
 Plato onwards recognise the importance of be- 
 ginning with the young. The strength of the 
 Jesuit movement always rested on the schools 
 which they estabUshed. The Germans, in their 
 almost superhuman bid for world power, began from 
 the elementary schools upwards. The Japanese, 
 
 149 
 
Infant and Young Child 
 
 in modernising their country, began with the 
 schools. Critics say that our schools fail to teach, 
 character. If that is correct, we must find the 
 remedy. 
 
 The founder of the Boy Scout movement, which 
 has already achieved such splendid results, says : 
 " The whole object of our scheme is to seize the 
 boy's character in the red-hot stage of enthusiasm 
 and to weld it into the right shape, and to encour- 
 age and develop its individuality, so that the boy 
 may educate himself to become a good man and 
 a valuable citizen for our country in the imme- 
 diate future." Perhaps something more about the 
 ideals of fatherhood and motherhood could be 
 incorporated in the ethics of Boy Scouts and Girl 
 Guides. 
 
 Benjamin Kidd concludes his book, " The 
 Science of Power," with the following words : 
 
 " The will to attain to an end imposed on a 
 people by the emotion of an ideal organised and 
 transmitted through social heredity is the highest 
 capacity of mind. It can only be imposed in all 
 its strength through the young. So to impose 
 it has become the chief end of education in the 
 future. 
 
 " Oh, you blind leaders who seek to convert 
 the world by laboured disputations ! Step out 
 of the way, or the world must fling you aside. 
 Give us the Young. Give us the Young, and we 
 will create a new mind and a new earth in a single 
 generation. 
 
 " The idealism which will win_out in the stress 
 "5o 
 
Conclusion 
 
 of the world is that through which Power must 
 obtain the completest expression. Power in its 
 highest expression is the science of organising the 
 individual mind in the service of the universal. 
 Truth is nothing else than this science of Power. 
 This is the test by which every religion v(dU have 
 to stand or fall." 
 
 We look hopefully to the Churches and the 
 great teaching profession. 
 
 There is much talk of the union of the Churches. 
 Could they unite for a nobler purpose than that 
 of raising the ideals of motherhood ? 
 
 The teaching profession has a great part 
 to play, and we must see to it that the best men 
 and women are attracted into this service and 
 that their devotion is 'recompensed much more 
 adequately than is the case at present. 
 
 Every boy or girl, before leaving school, what- 
 ever the status of the school may be, should know 
 what is meant by good citizenship, and something 
 of the duties and responsibiUties of parenthood. 
 
 If we can raise the ideals of motherhood and 
 family Hfe and impress them on the youth of both 
 sexes, the citizens that are to be, we shall leave 
 the problems of human progress and social evolu- 
 tion in safe hands. 
 
 151 
 
APPENDIX 
 
 Breast-feeding 
 
 The paper on Breast-Feeding, read by Dr. Lucy 
 Naish, formerly Assistant Physician to the Municipal 
 Infant Consultations, Sheffield, at the Second 
 Annual Meeting of the General Council of the 
 Association of Infant Consultations and Schools 
 for Mothers, is so valuable that I have obtained 
 her permission to reproduce it in these pages : 
 
 Weaning at or shortly after birth is, I need hardly 
 say, very common among the well-to-do classes, and 
 there are signs that the custom is spreading gradually 
 to the less well-to-do. There is a tendency amongst 
 medical men and others to accept this as an inevitable 
 outcome of modern life, and to oppose it merely with 
 a few generalisations and platitudes. The historical 
 evidence of Dr. Forsyth and the clinical evidence of 
 Drs. Pritchard and Carter certainly seem to point in 
 the direction of women's lessened capacity for nursing, 
 but I think that the subject has never been thoroughly 
 investigated, and one reason for this seems to me to 
 be that the " baby expert " does not usually arrive 
 on the scene until some weeks after birth. Without 
 making any dogmatic assertion that all this modem 
 increase of weaning is unnecessary, I hope to be able 
 to raise in your minds the doubt whether a consider- 
 able amount of this leakage from natural to artificial 
 
 152 
 
Breast-Feeding 
 
 feeding js not avoidable and due to mismanagement at 
 birth. Some of the details may seem trivial enough but 
 my subjective experience, for I have nursed six now 
 eight] babies of my own, leads me to believe that 
 neglect of such details will have a profound effect upon 
 the after course of the feeding. I believe that few doctors 
 appreciate the difficulties attendant on the commence- 
 ment of lactation, and that a mother without the in- 
 telligent and S3mipathetic help which comes from such 
 appreciation often lapses into a course of feeding which 
 would otherwise be avoidable. Forewarned is fore- 
 armed, and if the mother understands that certain 
 things that appear to her in her weak and aching 
 condition to be unusual and unnatural are really 
 common and natural, her mind will be set at rest and 
 she will not try to remedy that which requires no 
 remedy. 
 
 The Mother's State During the First Two Days. — 
 At this period she feels weak and aching all over, and 
 a prime necessity for her is sufficient rest and sleep. 
 But this it is often very difficult for her to get. It is 
 not always possible for a housekeeper to relinquish 
 entirely the reins of office, and the nurse, if strange, is 
 unable to shield her from the daily cares. It is at this 
 period that the baby so often cries both long and loud, 
 and has no sense of the division of night from day. 
 It will be trite to you that the milk flow is not established 
 for the first two or three days, but in my experience few 
 mothers understand that the crying of the baby at 
 this time is not a cry of hunger, but a natural process 
 for the fun expansion of the lungs. The consequence 
 of aU this is that the mother gets worked up into a 
 feverish state of anxiety, and when an opportunity for 
 sleep comes she is unable to take advantage of it. The 
 probable effect of this state on the function of the mam- 
 
 153 
 
Appendix 
 
 mary gland may be easily imagined. A vicious cirde 
 is easily set up, in which the mother's nervous state 
 acts prejudicially to the milk, and anxiety from the 
 poor milk supply keeps up the nervous condition. 
 
 The Baby's Difficulty in Sucking. — It is a rather 
 curious and unexpected phenomenon that, apart from 
 the condition known as depressed nipples, a baby 
 should show any aversion to taking its natural sus- 
 tenance. It is, nevertheless, a fact that many babies 
 will struggle and scream for long periods before they 
 will suck effectively, and will often repeat this per- 
 formance again and again as their meal times come 
 round. Among the poor it is quite common to find 
 mothers who feed from one breast only, and this upon 
 careful inquiry is found to be due in many cases, not 
 to an abscess having developed on one side, but merely 
 to the predilection of the infant. My own personal 
 experience bears out not only the infantile aversion to 
 sucking, but that the aversion is sometimes noticeably 
 unilateral. The usual position for the nurse to place 
 the baby for its meal is Ij^ing parallel to and at one 
 side of the mother. Now with this arrangement the 
 mother has to turn sideways and support herself in 
 an uncomfortable position, in which she gets tired 
 within a few minutes. Even when the baby takes with 
 readiness she feels cramped and tired before the end 
 of the meal, but when the baby struggles and refuses 
 she is exhausted before any proper attempt at sucking 
 has been made. The baby should be laid across the 
 mother's body, and a pillow under the arm that sup- 
 ports the child's head. The finger placed in the baby's 
 mouth acts as a stimulus to sucking, and by rapidly 
 withdrawing it and substituting the nipple the oppo- 
 sition of the child may with patience be overcome. 
 Cracked Nipples. — ^The pain caused by these minute 
 
 154 
 
Breast-Feeding 
 
 fissures is frequently intense, and acts as a most power- 
 ful deterrent to -lactation. A short time ago a friend 
 told me that it was only the experience of what she had 
 gone through with her first baby, which was bottle-fed 
 and a waster, which enabled her to endure the agony 
 with her second child. It is not my intention to plunge 
 deeply into treatment, but I may say that thb avoidance 
 of the hardening agents that are so often recommended, 
 the strict limitation of the time of sucking during the 
 first two or three days, and the application of bland 
 ointments and fomentations are to my mind the things 
 of most importance for the alleviation of this condition. 
 
 The After-pains brought on by the baby sucking 
 during the first two or three days are sometimes in- 
 tense and sufficient to make the mother feel quite faint. 
 I have known mothers quite worried over this, think- 
 ing there was something wrong. An assurance that 
 this pain is really beneficial in helping the organs to 
 regain their normal size again is a great comfort, and 
 removes one more hindrance to lactation. 
 
 After about sixty hours the breasts begin to be hard 
 and very tender ; it hurts the mother to move her arms 
 or to turn over ; she feels uncomfortable ; the tempera- 
 ture may rise slightly, and the pain may even keep her 
 awake. It is at this time that the stimulus of sucking 
 causes what is known as the " draught " to appear. 
 This ^s a sharp, cutting pain radiating through both 
 breasts. It occurs about a quarter of a minute after 
 the breast is stimulated, and the earher the lactation 
 period the earlier it comes on. If now the infant brings 
 up the draught by mouthing the nipple without firmly 
 catching hold, the breast soon gets soft again, and this 
 is often mistaken by the mother and the nurse for an 
 indication of a poor supply of milk. A mother should 
 be informed beforehand that the breast only secretes 
 
 155 
 
Appendix 
 
 whilst the sucking action is going on, and that if that 
 stimulus is not present the gland will become softer. 
 
 Periodic Feeding. — Some people have scoffed at the 
 careful arrangement of hours for feeding, saying that 
 it is an artificial interference with the natural pro- 
 chvities of the infant ; but the secretion of the breast 
 certainly tends to be periodic. During the first few 
 months the draught comes into the breast at regular 
 periods, and if the baby is not there to suck the milk 
 runs away. I think there can be Uttle doubt that it 
 is best to let the baby have its meal at what is evidently 
 the optimum time of secretory activity, and this is 
 borne out by the observation that if the baby sleeps 
 over the time when the draught comes, he is usually 
 more disturbed and fretful after his meal. It is a 
 common thing to hear mothers say that the milk goes 
 when they come downstairs, and I have some reason 
 to think that the cause of this is partially, at any rate, 
 the deficiency of regular periodic stimulation during 
 the lying-in period. Babies do seem to sleep most 
 soundly during the first month, and there is often 
 great difficulty in rousing them for their feed. A 
 quick way is to wash the face with water that is almost 
 cold. 
 
 Rapidity of Flow. — ^The milk flows from the 
 breast very quickly during the first two or three min- 
 utes ; it comes out in several strong jets at this time, 
 while during the latter part of the sucking period the 
 flow is very slow. This may be demonstrated in more 
 than one way. If while the baby is sucking at one 
 side a breast pump be appUed to the opposite side, the 
 whole process may be watched, and this rapid squirting 
 out for the first minute or two be seen. It may also 
 be demonstrated by means of the test feed. If say 
 the usual period of sucking is ten minutes, in the first 
 
 156 
 
Breast-Feeding 
 
 three minutes the baby will receive something Uke 
 two-thirds the total amount of its average meal. I 
 have known a baby weighing less than ii lb. to take 
 over 3 oz. in just over three minutes. This vigorous 
 flow may irritate the back of the child's throat and 
 cause it to choke, so that it begins to scream and re- 
 fuses to suck. The mother may imagine that the 
 milk does not suit the child, and finding that this 
 choking and screaming does not occur with the bottle, 
 she may be strengthened in her erroneous conclusion. 
 She should, of course, be told of the possibility of this 
 occurrence, and that the symptoms are of no serious 
 import. As the milk flows out so rapidly at first it 
 may be heard gurgling into the stomach. I have 
 known a mother who, hearing this, thought that some- 
 thing was seriotisly wrong, and it was once quoted 
 to me as a cause of weaning. 
 
 The Crying of the Baby. — ^This is often taken as 
 an indication of deficient supply of milk. The simplest 
 way of investigating this is to give the child a test 
 feed by weighing it before and after a meal on sensi- 
 tive scales. Such scales are often, however, not avail- 
 able, but a fairly accurate estimate may be made by 
 using the pump to the opposite breast while the baby 
 is sucking : the amoimt obtained is rather less than 
 what the baby gets. The indiarubber ball of the pump 
 should be held squeezed tight until the mother feek 
 the draught, and then released, when the milk will 
 flow out and fill the reservoir without further pump- 
 ing. Nurses frequently use the pump in an entirely 
 wrong manner by applying it to a breast while the 
 baby is not sucking, nor due to suck. It is easy to 
 demonstrate that by this means the flow often appears 
 to be quite inadequate when in reality it is nothing 
 of the kind. The mother, of course, is much impressed 
 
 157 
 
Appendix 
 
 when she sees the flow into the pump is so small, and 
 needs very httle further persuading that her milk is 
 of little use to the baby. 
 
 Returning to the question of crying as an indication 
 of the quantity of the supply, I have carried out a 
 series of test feeds on one baby during the first month 
 of life, testing almost every meal during this period, 
 and was unable to find any relationship between the 
 amount taken and the amount of crying between the 
 feeds. 
 
 Nervous Phenomena. — ^The process of suckling a 
 child is associated with distinct nervous pheiiomena. 
 This is probably due to the stimulation of a little-used 
 gland at a time when the general tone is lowered owing 
 to the pain and shock of childbirth. Insanity has, you 
 know, a tendency to appear at such times, and the 
 lesser grades of insanity merge gradually into what may 
 be considered as a normal, or at any rate a very usual, 
 condition, namely, hyper-excitability and Uability to 
 be upset by very trivial causes. A headache which 
 comes on with greater intensity when the mother tries 
 to go to sleep, and which effectually prevents sleep, 
 is quite common. It is often easily controlled by some 
 phenacetin and caffeine, and it is the duty of the nurse 
 so to arrange the work of the sick-room and the baby's 
 outings that the mother can have undisturbed quiet 
 from say 2 to 4 p.m. Such rest in my opinion is most 
 essential, and should be insisted upon by the medical 
 attendant. Bromides at night will enable the mother 
 to get to sleep again quickly if she is aroused to feed 
 the baby. When lactation is firmly established bromide 
 is no longer required, for the mother then usually feels 
 very sleepy, and will, as the Irishman said, " wake up 
 to find herself asleep." The phenacetin, however, often 
 needs to be continued for a month or six weeks/ as 
 
 158 
 
Breast-Feeding 
 
 the day headache not infrequently persists for this 
 length of time. 
 
 The length of time that a mother should stay in 
 bed is a matter on which there is some divergence of 
 opinion. There is a school of obstetric physicians now 
 who recommend their patients to rise almost imme- 
 diately after parturition. They may be (and probably 
 are) quite right that the absolutely recumbent position 
 is not the best for the woman's internal organs, but 
 it seems to me that they leave out of count the cir- 
 cumstances attendant on early rising from bed. The 
 mother wiUy-niUy gets plunged into the whirl of her 
 household duties as soon as she is actually found to 
 be up. If then she is suffering, as is only too likely, 
 from some nervous instabiUty, something is bound to 
 suffer, and it is quite Ukely that this wiU be the milk 
 supply. I am convinced that a large number of wean- 
 ings take place because the mother is not sufficiently 
 shielded from worries during these very important few 
 weeks immediately after birth. The more careful and 
 apt to act with foresight the mother is, the more likely 
 she is to be affected, and this is perhaps the reason why 
 the poor, who are generally more haphazard^and leave 
 things more to chance, do not seem to suffer so much. 
 By all means get rid of the totally recumbent posture 
 and let the mother sit up in bed, but have her treated 
 as an invahd, both as regards caUers and affairs of 
 management. After the mother does get up I think 
 it is a good plan for her to lie down while feeding the 
 child for the first month or two. This ensures a quMter 
 of an hour's rest every two or three hours. You may 
 think that I am exaggerating in describing these 
 nervous conditions, but how many babies are weaned 
 because the doctor says that Mrs. So-and-So is not 
 equal to the strain, and in how many of these cases 
 
 159 
 
Appendix 
 
 is a moment's consideration given as to whether some- 
 thing else may not be sacrificed rather than the natural 
 food of the child ? I am sure that a lot of weanings 
 take place, not because the mother is definitely un- 
 willing to feed, but because she thinks that she can 
 combine the feeding with a lot of social duties and 
 pleasures ; in other words, she has never counted 
 the cost. I heard of a case the other day where a 
 mother had determined to start that insidious " one 
 bottle a day " in order to be able to go out to dinner 
 and theatre, and was inquiring as to what to put into 
 it. Fortunately, the medical man pointed out the 
 Hkelihood of one leading to more, and a week or two 
 later the mother, having thought it all out, had come 
 to the conclusion that the sacrifice of a few pleasures 
 was a small price to pay for not only ensuring a good 
 basis of health for her child, but giving herself that 
 intimate interest in the child's welfare which can 
 only be gained through sacrifice. 
 
 Fissures of the Anus. — ^This is a very common con- 
 dition after childbirth, and excruciatingly painful, and 
 yet the doctor is hardly ever informed of this pain. So 
 much may be done for its prevention and alleviation, 
 yet because the mother looks worn out and this cause 
 is not suspected, weaning may be ordered. 
 
 Thrush. — I cannot close without alluding to what 
 I believe is a very common, if not the commonest, cause 
 of unnecessary weaning among the poor. Thrush 
 commonly causes vomiting, loose motions and loss 
 of weight, and it is not at all surprising that such 
 symptoms are taken as an indication that the breast 
 milk is not agreeing with the baby. As the condition 
 is a totally preventible one, it is the more a pity that 
 it should be the starting point of so much trouble. 
 
 i6o 
 
INDEX 
 
 Adenoids, 115 
 Alcoholics and marriage, 12 
 Ante-natal clinics, 135 
 Atrophy erf breasts, theory of, 
 92. 97 
 
 Babies' Welcomes, 63 
 
 Baby, management of [see In- 
 fant management) 
 
 Bath and bathroom, 33 
 
 Bigger, Dr. E. Coey, and Car- 
 negie Trust Report on Ire- 
 land, 50 
 
 Blepharitis, 116 
 
 Bottle-feeding, risks of, 91 
 
 Boy Scouts, 150 
 
 Bradford, infant mortality in, 
 compared with Connaught, 
 S3; compared with Sheffield, 
 54 
 
 Breast-feeding, in Norway and 
 Sweden, 42 ; among Jews, 46, 
 47 ; among Irish, 48, ji ; in 
 Outer Hebrides, 53; among 
 Friends, 57; monthly nurses 
 and, 84, 94; influence of, in 
 reducing infant mortality, 
 88 ; disinclination not to be 
 confused with inability for, 
 93; ignorance of ifaihers con- 
 cerning, 93 ; doctors and, 95, 
 96; ignorance of mothers con- 
 cerning, 95 ; difficulties and 
 management of, 98, 152 
 
 Breasts of new-born, infants, 
 squeezing, 105 
 
 Brownlee, Dr., 144 
 
 Budin, Professor, on stimulat- 
 ing mammary gland, 96; and 
 cows' milk for infants, 99 
 
 Burns, deaths from, 121 
 
 Burns, Mr. John, on mother- 
 hood, 38 
 
 Carnegie Trust Report on Ire- 
 land, 50; on Scottish Mothers 
 and Children, 52, 142 
 
 Carpets, 33 
 
 Castor-oil for new-born babies, 
 
 Character training, 125, 126 
 Cheetham, Manchester, infant 
 
 mortality in, 46 
 Child pensions, 70; how the 
 
 system would work out 
 
 in Sheffield, 72 
 poverty, , classification of 
 
 victims of, 69 
 
 young {see Young child) 
 
 Child-welfare centres, 113, 117 
 'Children Act, and neglectful 
 
 parents, 77 
 of insured persons, claims 
 
 of, to medical attention, 
 
 87 
 Cleanliness, babies and, 103 
 Clinics, school, 117 
 Clothing, for babies, 103 
 — ^ for young children, 120; 
 
 deaths from burns and, 
 
 121 
 Connaught mothers, 51, 52 
 Cows' milk, for infants, 99; 
 dried, 99, 100 
 
 Darwinism, so-called, and in- 
 fant mortality, 3 
 
 Day nurseries, 113, 136, 139; 
 gardens and, 142 ; disadvan- 
 tages of, 146 
 
 Death-rate of young children, 
 122 ; in Bradford, 122 ; in 
 Sheffield, 123. {See also In- 
 fant moriaiity) 
 
 Dental service for children, 85. 
 [See also Teeth) 
 
 Discharging ears, 115 
 
 161 
 
Index 
 
 Discipline, 125 
 
 Doors, and healthy dwellings, 31 
 
 Drying clothes, facililties for, 
 
 Dublin, infant mortality in, 55 
 
 Education of children, promo- 
 tive of temperance, 14 
 — — ;- of the young child, 124 
 Epileptics, and marriage, 12 
 Erasmus, an illegitimate child. 
 
 Eugenics, and practical politics, 
 
 7 
 Ex-iblaiby {see Young child) 
 Exercise, babies and, 102 
 
 Facioky creches, 145 
 Families, large. State help for 
 
 {see Child pensions) 
 Family doctor, place of, in 
 
 medical service of future, 84 
 Feeding, of infant, 98, 152; 6i 
 
 young child, no 
 Food, improper, for young 
 
 child, no 
 Fresh air, and babies, loi ; and 
 
 young child, in 
 
 Girl Guides, 150 
 Gonorrhoea, effects of, on family 
 life, IS 
 
 Hall, Dr. W., on Jewish chil- 
 dren in Leeds, 45 
 
 Hay, Dr. Percival, 116 
 
 Health visitors, 132 
 
 Heredity, social and inborn, 8 
 
 Hill, Miss Octavia, 36 
 
 Homes, healthy, minimum re- 
 quirements of, 25 
 
 Hope, Dr., on Jewish commu- 
 nity in Liverpool, 47 ;• on in- 
 fant mortality in Irish com- 
 pared- with English slums in 
 Liverpool, 55 
 
 Hospitals for crippled children, 
 need for more, 85 
 
 Hot'Water supply, 27 
 
 Illegitimate children, care of, 
 147; need for further legisla- 
 tion in interests of, 78 
 Impetigo, 1117 
 
 Infant management, and medi- 
 cal curriculum, 80; breast- 
 feeding and, 88 
 
 mortality, so-called Dar- 
 
 ' winism and, 3 ; parental 
 Tfesponsibility for, 41 ; 
 breast-feeding and, 41, 
 42, 46, 51 ; low rate of, 
 among Jews, 41, 48; low 
 rate of, in ilrisb country 
 districts, 48; tables of,, 
 in areas of Preland and 
 England, 49; in Irish 
 and E-nglish counties, 
 So ; causes Of low rate of, 
 fn Ireland, S' j pre- 
 maturity and, 52; rate 
 of, in Bradford com- 
 pared with Cohnaught, 
 S3 ; in ShefiSeld com- 
 pared with Bnadfbrd, 
 ^4; in Dublin, 55; in 
 English and Irish slums 
 of Liverpool, 55 ; among 
 Quakers, 57 
 Infectious diseases, ro7, 117 
 insurance, and a m^didal ser- 
 vice for all, 87 
 Interdepartmental Committee on 
 Physical Deterioration, Re- 
 port of, 40 
 Irish (see iBreast-feeding and 
 
 Infant mortality) 
 Itch, 117 
 
 Jews, and parental warning of 
 sexual dangers, 19; and re- 
 verence for motherhood, 20; 
 and sobriety, 43, 46, 47; and 
 care of expectant and nursing 
 mothers, 44 ; and education of 
 children, 44; and absence of 
 overlying, 44; and care of 
 children, 44, 47 ; and educa- 
 tion, 45 ; didtary and physique 
 of children of, 45 ; and breast- 
 
 162 
 
Index 
 
 feeding^ 46, 47; and infent- 
 inortafiiy rate, 46, 48 
 Judge Neill, and child pensions, 
 70 
 
 KiDD, Benjamin, on survival of 
 the fittest, 6 ; on social here- 
 dity, 8; on- cultivation of 
 ideals in the young, 19 ; on 
 the young as creators of the 
 future, 150 
 
 King, Dr. F. Truby, loi (foot- 
 not^) 
 
 Kitchen, aspect of, 30 
 
 I^CTATiON, prolonged, no 
 
 Landlord and tenant, 35 
 
 Larders, 28 
 
 Leeds, Jewish children in, 45 
 
 Leonardo da Vinci, an illegiti- 
 mate child, 78 
 
 Liguor Control Board, success 
 oi policy of, 13 
 
 Liverpool, Jewish community 
 in, ' 47 ; infant mortalilty in 
 Irish oomjpared with English 
 slums of, 55 
 
 Mackenzie, Sir W. Leslie, on 
 day nurseries, 142 ; on " tod- 
 dlers' playgrounds," 144 
 MaoMillan, Miss Margaret, 148 
 Madonna^ cult of, influence of 
 
 on motherhood; 55, 56 
 Manchester, infant mortality in 
 
 Cheetham district of, 46 
 Mann, Mr. John, j'un., on bad 
 
 tenanits, 36 
 Marriage, certificates of fitness 
 
 tor, 25 
 Maternity, and Child Welfare 
 Act ' ' ('I 9 1 8), 
 schemes under, 
 130 
 
 centres, 63, 130 
 
 Medical curriculum, infant hy- 
 giene and, 80 
 
 OflScers of (Health, past 
 
 mistakes of, 107 
 Society of, on 
 
 infant man- 
 agement, 82 
 Medical practitioners, and 
 training in infant hy- 
 giene, 80, 83 
 
 — service, need for an effi- 
 
 cient, 80 
 — rrr treatment for all children, 
 
 86 
 Mental defectives, and mar- 
 riage, 10 
 Midwiyes, instruction of, in in- 
 fant masnagement, 81 
 Milk, cows', for infants, 99 ; 
 dried, gg, 100; sterilised, 120 
 Monthly nurses, and breast- 
 feeding, 84, g4 ; and infant 
 hygiene, 81 
 Mother suibstitutes^ 147 
 Mothercraft, scheme of lectures 
 on, 65 ; scheme for teaching 
 of, ' in elementary schools, 65 ; 
 scheme for teaching of, in day 
 continuation schools, 67 
 Motherhood, ideals of, 38 ; Mr. 
 John Burns on, 38; Sir 
 George Newman on, 39; 
 among Jews, 43; among Irish, 
 51, 55; among Italians, 56; 
 among Friends, 57 ; the 
 Churches and, 60, 151 
 Mothers, training of future, 61 ; 
 training of existing, 63 ; 
 institutions to help, 130; 
 pensions for {se& Child 
 pensions) 
 ' working, time-tables of, 139 
 Mou'th-bieathang, 112 
 
 Naish, Dr. Lucy, on breast- 
 feeding, g8, 152 
 
 National Association for Pre- 
 vention of Infant Mor- 
 tality, and infaat man- 
 agement, 82, 138 
 
 Council for Combaiting 
 
 Venereal Diseases, 
 
 — : — for the Unmarried 
 
 Mother and Her 
 Child, 79 
 
 163 
 
Index 
 
 National League for Physical 
 Education and Improve- 
 ment, 125 
 
 ■ Society for Prevention of 
 
 Cruelty to Children, 
 inifiuence of, in 
 raising standard of 
 parental responsi- 
 bility, 75 
 
 ■ of Day Nurseries, 138 
 
 Nelson, a, weaily child, 7 
 Newman, Sir George, on 
 motherhood, 39; on parental 
 responsibility for infant mor-^ 
 tality, 41; on breast-feeding,' 
 41, 42; and maternity and 
 child welfare centres, 63 
 Newsholme, Sir Arthur, and 
 death-rate of young children 
 in large towns, 122; on care 
 of illagitimate infants, 147 
 Nipples, treatment of, 96 
 Niven, Dr., on Jewish com- 
 munity in Cheeitham district, 
 46 
 Nursery schools, 113, 148 
 
 Old wives' tales concerning 
 childbirth and babies, 104 
 
 Open-air recovery schools, 112 
 
 Ophthalmia neonatorum, infre- 
 quency of, in Ireland^ 51; de- 
 fective " team work " in, 106 
 
 Out-patient departments, reform 
 of, 85 
 
 Palmer, Miss M. V., training 
 schemes of, 64 
 
 Papworth Colony, 22 
 
 Parents, neglectful, 74 ; Children 
 Act and, 77 
 
 Parr, Mr., and rarity of cruelty 
 to children among Jews, 48 
 
 Posture, for babies, 102 
 
 Poverty, child, classification of, 
 69 
 
 Pritchard, Dr. Eric, on anstruc- 
 tion of mid-wives in infant 
 management, 81 ; loi (foot- 
 note) 
 
 Quakers {see Society of Friends) 
 
 Race, and motherhood, 42 
 Religion, and moltherhood, 42 
 Residential nurseries, 113; 
 
 difficulties of managing, 146 
 Rest, for young child, 112 
 Rickets, 113 
 Ringworm, 117 
 Roman Catholic Church, and 
 
 ideals of motherhood, 56 
 
 Saleeby, 'Dr. C W., on infant 
 mortality, 53 
 
 Scabies, 117 
 
 School children, need for ade- 
 quate medical treatment 
 of, 86 
 
 clinics, iiy 
 
 Schools for mothers, 63 
 
 Scurvy, 114 
 
 Self-contained cdtteges or flats, 
 34 
 
 Servants, domestic, lack of, 62 
 
 Sheffield, Jewish community in, 
 44; infant mortality in, com- 
 pared with Bradford, 54 ; 
 how system of child pensions 
 would work out in, 72 ; how 
 neglectful parents are dealt 
 with in, 77 ; use of dried 
 milk in, 99 ; blepharitis in 
 elementary schools of, 116; 
 organisation of health visitors 
 in, 134; women sanitary in- 
 spectors in, 134 ; day nursery 
 of, 139; factory crfeches in, 
 
 HS 
 
 Simpson, Sir A. R., and needs 
 of new-born, 80 
 
 Sims, Mr. G. R., on alien 
 mothers, 42 ; on Jewish ideal 
 of motherhood, 43 
 
 Sink, in living room, 32 
 
 Sleep, babies and, 102; young 
 child and, 112 
 
 Social heredity and inborn 
 heredity, 8 
 
 Society of Friends, iufant-mor- 
 talilty rate in, 57 ; and breast- 
 feeding, 57; high moral stau- 
 
 164 
 
Index 
 
 dard in, 57 ; parenthood in. 
 
 Squint, 117 
 
 State creches, 136 
 
 Stephenson, Dr. Sydney, on 
 ophthalmia neonatorum, 106 
 
 Sterilisation of milk, 99 
 
 Superstitions concerning ba- 
 bies, 104 
 
 Survival of the fittest, and in- 
 fant mortality, 3; and tuber- 
 culosis, 5 
 
 Syphilis, clinics for, 16 ; pro- 
 hibition of quack treatment 
 of, 16; congenital form of, 17; 
 prophylaxis and, 18; moral 
 and educational propaganda 
 and, 18 ; infrequency of, in 
 Ireland, 51 "^ 
 
 Teeth, of young child, care of, 
 
 no; breast-feeding and, 115; 
 
 suitable food and, 116. (See 
 
 also Dental service) 
 
 Tenant and landlord, 35 
 
 " Toddlers' playgrounds," 144 
 
 Town life, evils of, and infants, 
 
 107 
 Tuberculosis dispensaries, 120 
 
 heredity and, 20 ; family 
 
 infection in, 21 ; insuf- 
 ficiency of sanatorium 
 treatment of, 22 ; milk 
 and, 99; in infants and 
 young children, 118 
 
 Venereal diseases {see Gonor- 
 
 rhoaa and Syphilis) 
 Ventilation, 29 
 
 Walwokth estate of Ecclesias- 
 tical Commissioners, 36 
 
 Weaning, food after, loi 
 
 Wives and children of insured 
 persons, claims of, to medical 
 attention, 87 
 
 Women architects, 26 
 
 — — sanitary inspectors, 132; 
 in Sheffield, 134 
 
 Women's Housing Sub- Com- 
 mittee of Ministry of Recon- 
 struction, 27, 37 
 
 YoDNG child, management of, 
 109; prolonged lactation and, 
 no; irregular feeding of, 
 no; improper food for, iio;- 
 care of te^th of, no; fresh 
 air for, in; rest and sleep 
 for, 112; rickets in, 1x3; dis- 
 charging ears and adenoids 
 in, 115; ibad teeth in, 115; 
 blepharitis in, 116; skin affec- 
 tions in, 117; infectious dis- 
 eases in, 117; tuberculosis in, 
 1 18; clothing for, 120; death- 
 rate of, 122 ; eduoartion of, 
 124; discipline of, 125; char- 
 acter training of, 126 
 
 165 
 
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