INFANT DEATH-RATE

In England, according to Dr Farr, out of 1000 infants born, 149 die annually before reaching their first year; and the same authority tells us that 311 out of every 1000 die during the first month in the same period. Amongst illegitimate children, the lives of one half never exceed the first month. The above figures represent the yearly average of infantile deaths throughout the whole of England, when we come to the large cities the mortality is notably higher. In Liverpool, for instance, out of 1000 children born, 239 died in their first year. When we examine into the infant mortality prevailing amongst different cla es, we find the proportion existing between the death-rate of the children of the nobility, and the general death-rate up to one year, to be as 3 to 8. In 1874, Mr Charles Ansell, jun., published a work entitled ‘Statistics of Families of the Upper and Profe ional Cla es,’ in which he showed, from investigations into the deaths occurring amongst 48,000 children of the wealthy, profe ional, and titled cla es, that in the first year of life, about 80 only of such children die out of every 1000. According to Dr Farr, the northern countries of Europe show a much lower infant death-rate than the southern ones. Infant mortality is lowest in Norway, and highest in High Bavaria, where 404 infants per 1000 die in their first year. In New York, in 1869, the mortality amongst infants under one year old was 27·4 per cent. and in 1873, 31·0 per cent. Both in France and England the mortality prevailing amongst illegitimate children up to the age of one year is very large. In 1860, the death-rate amongst the foundlings of the Loire-Inférieure, was as much as 876 in the 1000, and it averages between 500 and 700 in France. In Wake field, amongst the same cla of children, it was 26·22 per cent.; in Coventry, 40; in Padstow, 50; and in Bantry, 80; in manufacturing towns the average is 35 per cent. In London the number of illegitimate children who die annually under the age of a year is probably about 75 per cent. [357] [357] ‘Proceedings of the Obstetrical Society for 1870.’ In the Montreal Foundling Asylum, out of 4060 infants, only 7 per cent. lived one year. In the rural districts of England and also in Bavaria, the average of deaths at one year is about the same for the illegitimate as for the legitimate children. In the ‘Transactions of the Obstetrical Society for 1870’ there is a valuable and interesting report, throwing much light on the condition and treatment of the children of the poor in England. The following is the substance of this report, the information contained in which was collected by various members of the society:—It was found that amongst the poorer populations of villages 30 to 90 per cent. are attended by midwives, and that this custom prevails to an almost equal extent in the large provincial and manufacturing towns. Thus in Glasgow, 75 per cent., in Coventry, 90 per cent.; and in Leeds and Sheffield, equally large numbers of the population employ the services of these women. In Edinburgh the midwife is rarely called on; neither is she in the West End of London; but in the East End 30 to 50 per cent. of the accouchements are undertaken by women. Except in Glasgow, Sheffield, and London, the women are a erted to be totally ignorant and incompetent to meet any difficulty that might arise. In country districts the pernicious custom of giving an aperient to a newly born babe was very general, but le prevalent in London and the large towns. Amongst the married poor, suckling was found to be the rule; and it seemed to be pretty conclusively proved that it is often unreasonably prolonged for eighteen months or even two years, as a preventive to renewed pregnancy. It was found, however, that illegitimate children were rarely suckled, but almost always fed on artificial food. Amongst the married poor also it appears universal to give the children artificial food as well as the breast, and this from a very early and tender age. Further, it was found that the food was generally unsuited to the child both in quantity and quality. It consisted chiefly of bread soaked in water and milk, and sweetened, of arrow-root, sago and corn flour, and such like objectionable substances. In one case the mother admitted to giving her infant (who was a few months old only) a diet similar to that she herself partook of, viz.—cheese, bread, meat, salt fish, heavy pastry, vegetables and beer. Amongst the upper cla es it was ascertained that there is an increasing tendency amongst mothers to discontinue lactation, and to employ instead the services of a wet nurse; and where this was not done, it was found that the food partaken of by the babe was much more judiciously chosen than is the case amongst the poorer women. Mr Curquiven and others observed that a large number of women in London do not suckle their offspring, because of a deficient secretion of milk. It is satisfactory to find that both in the manufacturing and agricultural districts, the children of the poor are so constantly in the open air; but equally unsatisfactory to learn that at night they sleep in ill-ventilated and over crowded dormitories. The infant is encouraged to sleep to the utmost, and should it fail in securing renewed slumber (its waking being attributed to a desire for food), is very often dosed with gin, syrup of poppies, and paregoric. Another plan adopted for keeping infants quiet, consisted in letting them remain in the cradles and allowing them to suck the nipple attached to the empty feeding bottle, long after the food had been consumed; a practice that gives rise to infantile dyspepsia. As regards cleanline , it was learnt that poor people’s children are tolerably well attended to in this respect, or rather that the baby generally comes in for a larger share of ablution than the elder ones, who are sometimes much neglected in the matter of soap and water. The clothing of the little ones was much too scanty, and this was the case no matter what the season of the year. A prevalent practice, except in the agricultural villages, was that of giving the children cordials, spirits, and medicines. A still worse custom was found to be the systematic administration of opiates. At Long Sutton, in Lincoln shire, which has a population of 6000, one chemist alone sold 25 1 ⁄ 2 gallons yearly of Godfrey’s cordial (a mixture principally consisting of treacle and opium), whilst 6 1 ⁄ 2 pints were got rid of weekly by another chemist in the same town. This administration of anodynes was mostly confined to illegitimate infants, and factory children placed out to nurse. A habit not unusual was that of an intentional deferring sending for a doctor when the child was first seized with illne , medical advice being only sought when in many cases it could be of no avail. Desertion by fathers and mothers of their children, especially of illegitimate ones, as well as concealment of birth and infanticide, were found to be much more general in London and the larger cities than in the country. The causes of the high rate of infant mortality prevailing amongst the poor, seem very clearly indicated in the above abstract. For instance, the deaths of nearly half the children under one year of age are referable to diarrhœa, convulsions, atrophy, mesenteric disease, and allied disorders; all of which maladies are caused by the gro ly erroneous and unsuitable diet upon which the children are fed. In the article “Infants’ Food,” we have already pointed out that the proper and only safe aliment for an infant up to the age of eight or nine months is the maternal milk, and failing this, the pure and unadulterated milk of the cow; and we have furthermore shown that the admi ion into the dietary of infants even above nine months old, of farinaceous foods, should be regulated with great caution. Yet we learn from the above report, that in the early days of the infants’ existence, amongst the poor the breast milk is in most cases supplemented by large quantities of these very farinaceous matters, which we have shown to be so prejudicial and dangerous. That the deaths from these causes are clearly preventable, in a large measure, if not wholly, is proved by the very much le extent in which they occur amongst the higher cla es, who use much greater judgment in the selection of their children’s food. Another important factor in the high infant death-rate is the extensive use of narcotics, a practice there is no doubt which yearly carries off a large number of infants, by poisoning, more or le prolonged. Inadequate clothing is likewise another source of mortality amongst the very young, whose tender frames easily succumb to inclement weather, and the sudden changes of temperature occurring in our variable climate. Hence we shall have no difficulty in understanding why pneumonia, bronchitis, ., should be so prevalent among poor children. The habits of overcrowding and bad ventilation which prevail amongst the poor must also be fertile sources of disease amongst their offspring—the more immediate effect of such violations of sanitary principles resulting in bronchitis. That the extensive recourse by the poor to uneducated and unskilful midwives, also adds to infant mortality, seems indisputable. In the report already alluded to, beyond reference to the fact that infanticide was rare, we find no mention made as to the number of violent deaths occurring amongst infants. It appears that about a sixteenth of the mortality amongst infants under one year old is due to violence, mostly accidental, the great majority of such deaths being caused by the mother lying upon and smothering her babe. These misadventures are said to occur mostly on Saturday nights, and raise the question as to whether a large proportion of such deaths are not due to the drunkenne of the mothers, who retire to rest in a state of alcoholic stupor. [358] [358] Blythe. The inference, we think, to be drawn from the above statements is, that the preponderating mortality prevailing amongst the children of the poor is due to ignorance and poverty, and not to intentional neglect or want of parental affection. Bearing in mind that poor women much more frequently suckle their babes than rich ones, it might perhaps be argued that this was evidence of greater maternal solicitude, and that, therefore, the poor mother exhibits more natural affection than the lady who consigns her offspring to the arms of the wet-nurse; but, po ibly, were the circumstances of the two inverted, the lady might be found giving her infant the breast, whilst the humbler wife might call in the services of the wet-nurse; neither of them perhaps reflecting that, in choosing the latter alternative, they were depriving another little human unit of the maternal sustenance, and exposing it to the dangers of vicarious nurture and supervision. What these dangers are that beset the children of the poor when removed from their mother, the revelations of baby-farming and the appalling statistics of illegitimate infant mortality serve very forcibly to illustrate. For every 311 legitimate children of all cla es 500 illegitimate out of every 1000 die each year under one month old, this large increase being due to cruel neglect and substitution of bad, insufficient, and improper food for the maternal milk. That in their own homes they are exposed to the serious hardships arising from errors in diet has already been shown, but in their own homes they die at little more than half this rate; hence the deduction is unavoidable that half of these poor little waifs perish because they are deprived of the care and solicitude of the mother. Writing on this subject M. Hanon says that of 59,927 infants born in Paris, 20,049 are sent into the country to nurses. Of those children that remain in Paris, and that are so rarely suckled by their mothers, no le than 8250 die from 0-1 year, which gives a death-rate of 243 per 1000 births. As to the mortality of the unfortunate infants, 20,049 in number, sent off to nurse, this amounts to 500 or 700 per 1000 in the first year of life. We extract the following from the ‘Echo’ of October 9th, 1878: “ALLEGED BABY-FARMING. “Dr Hardwicke, the coroner for Central Middle sex, held an inquest at the Isling ton Coroner’s Court, Hollo way Road, this morning, relative to the death of the female child of Emily Corley, a servant at 49, Gower Street, Euston Road. Mr Baby, the inspector under the Infants Life Protection Act, watched the case. The mother of the child had gone to service as a wet nurse after coming out of the workhouse, leaving it with one Ann Leach, who said it was a very delicate child. She added that she had for a time two children under one year of age with her, and had been told that this was contrary to the Act. The inspector under the Infant Life Protection Act pointed out that persons having more than one child to nurse under a year old had to obtain a licence. The coroner characterised the Act as a mere farce. It left children to take care of themselves after they were twelve months old—the most critical time of their existence. He also remarked on how prolific a source of prostitution such cases as the present were, where mothers had to forsake their own illegitimate offspring, depriving them of breast milk in order that they might sell it to the rich. The jury found that the child died from exhaustion following from diarrhœa, accelerated by want of breast milk.”