Chapter V: Infant Mortality and Factory Labour

I

“What is not good for the bee-hive cannot be good for the bee.” A better appreciation of this truth and there had been less cause for this chapter. But in so grave a degree is a demonstrated danger to the race tolerated in the pursuit of an imagined profit to the individual, that it cannot be impertinent to recall the general truth and to point its specific application.

That there is danger to the race in the engagement in factory life of the mothers of young children, should be beyond challenge: always danger to the child, often danger to the mother; and sacrifice of infant life, failure of infant promise follow, have followed, and must follow, as surely as leaves fall to frost. Statistics abound, but for the most part they have received their lot of Bluebook burial; and the purpose of this article is, in the main, to rescue from the obscurity of the past its array of facts and its store of warnings. Upon the statistical evidence of the present there is less need to dwell. Dr Reid, in his admirable chapter, has dealt fully with the striking results of an inquiry conducted by him as Medical Officer to the Staffordshire County Council; and an inquiry instituted throughout England, upon similar lines, by the Parliamentary Bills Committee of the British Medical Association, supported, Dr Reid tells us, “in a remarkable way the conclusions drawn from the Staffordshire figures.” These are the Staffordshire figures:--

_Deaths of Children under 1 year in Three Classes of
Artisan Towns in Staffordshire per 1000 births._

CLASS I. CLASS II. CLASS III.
Many Women Fewer Women Practically no Women
engaged in work. engaged in work. engaged in work.
10 years (1881–90) 195 166 152
9 years (1891–99) 210 177 168[27]

At all moments they are figures to command concern, at this moment they compel alarm. On the one hand is the infant death-rate steadily rising, on the other the birth-rate steadily falling;[28] and to the rising death-rate maternal neglect gives impetus, while the State inattentively takes note. But though statistical speech is eloquent of death, it says nothing of withering injury to life; nothing of injury to the mother who, herself affected in health, produces less fitting children; nothing of those children who escape death to endure life, crippled in body and in mind, drugged and starved in infancy, neglected in childhood. What dare we ask of their womanhood and their manhood? What service of citizenship have we any right to demand, any reason to expect? We must seek our answer from within our reformatories and our asylums, from our hospitals, our workhouses, and our prisons. For the feeble in body and dwarfed in mind there is no room in the struggle for industrial supremacy. Their drifting place is among criminals, in the lowest ranks of industry, or in the homes of charity.

Every deadly industry has its octogenarian; and so, too, under this system there are those who escape, or escape at least its greatest evils of physical and mental disability. For the girl-children full escape seems impossible. Victims in their ignorance of home, they become vehicles to perpetuate the system; without knowledge of the sacred, the helpful, even the elementary elements of home life, they in their turn, in their own married life, seek mill employment as did their mothers before them. It is, in fact, the only occupation they know. Baking, washing, sewing, are dead arts; and in these children of mothers, “to a grievous extent denaturalised towards their offspring,”[29] the deepest forces of nature seem asleep. So from generation to generation the service of the mother to her child is entrusted to a stranger, whose introduction as substitute housewife, substitute mother is not without its cost. The net gain is sometimes in money a few shillings: in influence and training there is always loss; even in money sometimes loss. In evidence given to the Royal Labour Commission, a Yorkshire employer quotes a case “in which the woman drew 10s. a-week in wages, and paid 12s. a-week for the care of her home.”[30] The case may indeed be exceptional, but an abundance of other cases may be found where the actual gain in money is but slight. The companion to this picture of the mother in the factory and the paid stranger in the home, is that of the mother drudge who, neglecting her duty to her children, placing it perhaps in pathetically inadequate child hands, yet tries to fulfil it to her home. She may have worked in the factory from six in the morning to six or eight in the evening; but worker in the factory, she is worker too in the home. For her the day is never done, and through her youth of unending labour she is hastening to old age. There are advocates of such freedom to labour who can be convinced of hardship to the mother, who yet claim benefit for the child. Better far, they urge, the mother’s laboured addition to the family fund than scanty meals; home care and influence are necessary enough, but without bread what are they?

To this argument the answer comes from homes bread-starved during the cotton famine in Lancashire, during the great depression of trade in Coventry, and during the siege of Paris. “During the Lancashire cotton famine, while privation increased the actual death-rate, the infant death-rate was greatly lessened owing to mothers being compelled to suckle their infants. During the siege of Paris also, while the general mortality was doubled, the infant mortality fell 40 per cent. from similar causes.”[31] And, writing of the effect in Coventry of the prostration of trade in 1861, the Registrar-General says:--“The care of the mothers of Coventry has, it would seem, counteracted some of the effects of privation, so that neglect of their homes by mothers at work in factories is apparently more fatal than starvation.”

In the comparative figures given by the Registrar-General for the ten years (1859–68), the reduced infant mortality during the three cotton famine years (1862–64) is strikingly shown.

_Deaths of Infants under 1 year of age per 1000 Births in Lancashire,
and in the whole of England and Wales, 1859–68._

Year. Lancashire. England and Wales.

1859 176 153
1860 169 148
1861 184 153
1862 168 142
1863 171 149
1864 174 153
1865 189 160
1866 200 160
1867 185 153
1868 187 155

The Registrar of Little Bolton held that the decrease of deaths was mainly due to a greater amount of domestic superintendence, and other registrars united in similar conclusions. The slight rise in 1863 and 1864 was apparently due to the prevalence of smallpox, scarlatina, typhus, and measles, caused by overcrowding in workhouses and bad sanitary conditions.

Comparison between privation and maternal care on the one hand, and good cheer and maternal neglect on the other, to the advantage of the meaner diet and the greater care must, as the Registrar-General admits, be within limits. Under the stress of absolute starvation, no mother could provide nourishment for her child. But the obviousness of the limitation cannot diminish the significance of facts, and evidence, official evidence of convincing weight and appealing eloquence is, if we look for it, at our hand. It is easy to realise in its light, why the mother, even though poorly fed herself, is a better mother than the mother who earns a certain keep-money for her child.

Sir John Simon,[32] writing in 1897 of the inquiries conducted between 1859 and 1872 by the Medical Department of the Privy Council, of which he was Medical Officer, says of one:--“In addition to showing on a very large scale those sanitary wrongs of certain sorts of industry, we had also shown as an industrial influence of very wide operation, that in proportion as adult women were taking part in factory labour or in agriculture, the mortality of their infants rapidly increased; that in various registration districts, which had such employment in them, the district death-rate of infants under one year of age had been from two and a quarter to three times as high as in our standard districts; and that in some of the districts more than a few of the infants were dying of ill-treatment which was almost murderous.” Considering the subject in greater detail, in his fourth report to the Privy Council, he recalls the report[33] made to the General Board of Health in 1858, in which he drew attention to the fact that in different districts of England there were enormous differences of infantile mortality: “Such differences, that children in some districts die at perhaps four or five times the rate of children in other districts.” These wide differences of death-rate he attributed “to the varying prevalence of two local causes:--first, to differences of degree in _common sanitary defects of residence_; ... and secondly, to _occupational differences_ among the inhabitants; there being certain large towns where women are greatly engaged in branches of industry away from home; where, consequently, the home is ill kept; where the children are little looked after; and where infants who should be at the breast are improperly fed or starved, or have their cries of hunger and distress quieted by those various fatal opiates which are in such request at the centres of our manufacturing industry.” An inquiry was conducted by Dr Greenhow into the second of these influences, and commenting upon his report, Sir John Simon says: “It gives a very sad picture of suffering and demoralisation, caused by the present circumstances of female employment in factories. It corroborates very exactly the opinion above expressed as to the probable causes of the high mortality of infants in places of female factory occupation. And it shows that, while the infants perish under the neglect and mismanagement which their mothers’ occupation implies, the mothers become to a grievous extent denaturalised towards their offspring.”

The following quotations, Sir John Simon continues, tell the main facts of the case:--“Factory women soon return to labour after their confinement. The longest time mentioned as the average period of their absence from work in consequence of child-bearing was five or six weeks; many women among the highest class of operatives in Birmingham acknowledged to having generally returned to work at the expiration of a month.[34]... Mothers employed in factories are, save during the dinner-hours, absent from home all day long, and the care of their infants during their absence is entrusted either to young children, to hired nurse-girls, sometimes not more than eight or ten years of age, or perhaps more commonly to elderly women, who eke out a livelihood by taking infants to nurse. Young girls, aged seven or eight years, are frequently removed from school for the purpose of taking charge of younger children while the mother is absent at work, and are sometimes said to return, on the death of the child, evidently rather pleased that this event has released them from their toil.... Pap, made of bread and water, and sweetened with sugar or treacle, is the sort of nourishment usually given during the mother’s absence, even to infants of a very tender age; and in several instances, little children not more than six or seven years old were seen preparing and feeding babies with this food, which in such cases consisted only of lumps of bread floating in sweetened water.... Illness is the natural consequence of this unnatural mode of feeding infants.... Children who are healthy at birth rapidly dwindle under this system of mismanagement, fall into bad health, and become uneasy, restless, and fractious. To remedy the illness caused by mismanagement various domestic medicines are administered, more particularly some kind of opiate such as Godfrey’s cordial or laudanum. Wine, gin, peppermint, and other stimulants are often given, for the purpose, as alleged, of relieving flatulence, the actual effect being, however, rather to stupify the child. The quantity of opiates sold for the purpose of being administered to infants in some of the manufacturing towns is very large.... Indeed, there seems to be no doubt that the habitual administering of opiates to infants must be included among the causes of a high infantile mortality in certain manufacturing towns, not only on account of an overdose being given, but also because infants kept in a state of continual narcotism will be thereby rendered disinclined for food, and be but imperfectly nourished.... Parents who thus entrust the management of their children so largely to strangers become more or less careless and indifferent about them, and as many of these children die, the mothers become familiarised with the fact, and speak of the deaths of their children with a degree of nonchalance rarely met with among women who devote themselves mainly to the care of their offspring.... Abundant proof of the large mortality among the children of female factory operatives was obtained during the inquiry. An operative of the better class in Birmingham reported that he collects money for the expenses attendant on the deaths of children among the workers in a factory where 150 women were employed, and that he believed ten out of every twelve children born to the married women in this factory died within a few months after birth. Many married women were questioned, as opportunity served, in the several factories visited regarding their families, the number of children they had borne, the number that survived, and the manner in which they were brought up. The evidence of these women tallied exactly with that of other persons.... It was frequently found that two-thirds or three-fourths of the children borne to these women had died in infancy.” In his report, which appears in the Appendix,[35] Dr Greenhow continues: “And on the other hand, it was remarkable how, in other instances, the majority of the children were reared when the mothers did not work in factories, or discontinued doing so whilst nursing, or when the infant’s supplementary food consisted partly or chiefly of milk.” In the same report Dr Greenhow states that “all the medical men who gave evidence on the subject of the present inquiry, besides several clergymen, ladies who are accustomed to visit the poorer classes at their dwellings, scripture readers, relieving officers, and other persons who have paid attention to the subject, unhesitatingly expressed an opinion that the system under which the mothers of young children are employed at factories and workshops away from home is a fruitful cause of infantile sickness and mortality.”

Among the most interesting figures in the report are those which relate to the sale of Godfrey’s cordial. It appears that in Coventry alone at least 12,000 doses weekly were administered, and “even a larger quantity of opiate, in proportion to the population, is said to be sold in Nottingham than in Coventry.” In conclusion, Dr Greenhow reports: “The results of the inquiry may be stated as follows:--

“_1st._ The infantile death-rate bears no definite relation to the general death-rate, but their comparative proportions to each other vary in different districts.

“_2nd._ The infantile death-rate bears the largest proportion to the general death-rate in districts where the infantile population is specially exposed to unwholesome influences, as in Coventry, Nottingham, and other manufacturing towns.

“_3rd._ The unwholesome influences to which infants are exposed in the manufacturing towns comprised in the present inquiry may be attributed mainly to the industrial employment of the married women, which leads them to consign the tendance of their infants at a very early age to young children or strangers.

“_4th._ That infants thus deprived of the mother’s care are habitually fed on diet ill adapted to their digestive powers, and are very frequently drugged with opiates, in order to allay the fractiousness arising from the illness induced by improper food.

“_5th._ That infants in manufacturing towns where women are much engaged in factory labour are likewise exposed to other causes of sickness, proceeding from the ignorance or carelessness of the mothers or nurses, such as deficiency of exercise, and exposure to inclement weather.”

There is constant reference in public inquiries to the excessive use of opiates. Mr Ernest Hart, giving evidence in 1871 before the Select Committee on the Protection of Infant Life, says:--

“... We wish also to take measures to prevent the habitual drugging of children in those day-nurseries. You will get evidence easily from the manufacturing districts that opiates are sold by gallons by druggists there. The sale of opiates for that purpose forms a very large part of the trade of many of the druggists in those districts.” Later, Dr Lyon Playfair (afterwards Lord Playfair), a member of the same Committee, in examining a witness, refers to “the evidence of three druggists in Deansgate, who state that they supply 1260 families per week with opiates,” and to the experience of “Mr Ransome, a distinguished surgeon who lived in Manchester, ... that out of the children who attended his dispensary, about one-half he found to be drugged with opiates.”

Mr Curgenven, another surgeon witness before the Committee, speaking of the high death-rate among insured children, says:--

“... They know that if they put their children out with their neighbours, as it is said, to be nursed, brought up by hand, while they are at work in the factories, there is very great chance that they will die, and therefore they calculate that the sum which they receive from the burial club will more than cover the expense of the burial. And the deaths amongst the children of the operatives in the manufacturing towns amount to about 40 to 56 per cent., because they are left by their mothers at an early age, when they are only a few weeks old, and are placed in the hands of women to be brought up. They are drugged frequently with Godfrey’s cordial and other opiates to keep them quiet. They are fed upon bread and water with very little milk, so that they are half-starved. The consequence is that more than half of them die.”

And again:--“... The infantile mortality has decreased so far as the mothers were enabled to remain at home to nurse their children. It is only when they are employed in the factories, away from their homes, leaving their children to be brought up by hand by their kind neighbours, that they die.”

Turning to another inquiry, we find Mr Foulkes, a certifying surgeon, giving evidence before the Factory and Workshops Acts Commission of 1875, and pleading for a prohibition upon the return of mothers to their employment within six months of their confinement. “... Many of the women are at work within a month after they are confined; the result is that the child is left at home, and it is invariably fed upon the same thing, bread, water, and sugar, and the children dwindle away, and that has a great deal to do with the infant mortality of the place. What is done with the children in this district generally when the mothers are at work? They are often left with the other children; there is no provision made, and they are very badly treated and sadly neglected....”

Before the same Commission, Mr Baker, first a surgeon in practice at Leeds and then joint chief of the Factory Department with Mr Redgrave, gives it as his experience that “very considerable mischief arises with women going to work, not only to the mother, but also to the child.” He is then asked by the Chairman Sir James Fergusson: “We may take it for granted that it is not theoretically desirable that women should go to daily work immediately after confinement, leaving the child all day to somebody else; but, practically speaking, do you think from your experience of this matter, that if Parliament interfered with it, it could be enforced with uniformity and without hardship?” And his answer is: “Yes, I think it might. I think that by the visitation of certifying surgeons it might be enforced decently, and delicately, and sufficiently, so as to make it very useful.”

One more reference to Sir John Simon shall almost close this array of quotations from buried reports. In this last instance the inquiry was conducted in agricultural districts:--

“The discovery that an enormous infantile mortality was prevailing in several purely agricultural districts, suggested at first sight that perhaps in these districts some third[36] sort of destructive influence was at work. The result of this new inquiry, however, has been to show that the monstrous infantine death-rate of the examined agricultural districts depends only on the fact that there has been introduced into those districts the influence which has already been recognised as enormously fatal to the infants of manufacturing populations--the influence of the _employment of adult women_. ‘The opinions’ (says Dr Hunter) ‘of about seventy medical practitioners, with those of other gentlemen acquainted with the condition of the poor, were obtained. With wonderful accord, the cause of the mortality was traced by nearly all these well-qualified witnesses to the bringing of the land under tillage--that is, to the cause which has banished malaria and has substituted a fertile though unsightly garden for the winter marshes and summer pastures of fifty or a hundred years ago. It was generally thought that the infants no longer received any injury from soil, climate, or malarious influences, but that a more fatal enemy had been introduced by the employment of the mothers in the field.’ On this agricultural employment of women there follow identically the same results as have already been traced to result from the employment of women in manufacture.”

This, then, is the finding of skilled inquirers, the teaching of half a century’s statistics: that, for the child, the employment of the mother in the field is “a more fatal enemy” than malaria; and her employment in the factory, “apparently more fatal than starvation.” And what is our answering record of effort? A pathetic capacity for inquiry. Not certainly because we lack facts, or because the need for action has passed; for, on the contrary, it becomes cumulatively more acute. In Dundee, for example, in 1881, 19.4 per cent. of married women were employed in its mills and factories; in 1891, 24 per cent. were so employed, and the infantile death-rate rises accordingly. In the following table, prepared by Dr Templeman, Dundee’s able medical officer of health, this death-rate can be seen for a period of twenty-eight years:--

Average General Death-rate of Infantile
Death-rate. Children. Death-rate.

1860–69 30.4 per 1000 Not ascertained Not ascertained
1870–79 25 „ 81 per 1000 153 per 1000 births
1880–89 22.2 „ 63 „ 155 „ „
1890–97 20.8 „ 68 „ 176 „ „

First among the causes Dr Templeman puts “Industrial Conditions:” first, too, this recognition should be in the conscience of the parent, in the conscience of the employer, in the conscience of the State. Of all who are responsible, the State has least acknowledged the responsibility. The examples may be rare, it is true, of parents who make sacrifices themselves that their homes and children may have benefit, but yet there are examples. The efforts of employers of labour may, too, be rare, but still they are appreciable, notably in Yorkshire; more frequent are the efforts of philanthropy: there is one effort by the State;[37] not to save the life of the child, for that admittedly it does not do, one effort, barely calculable in its result, to protect the health of the mother.

All credit to those who, singly as employers, or collectively as philanthropists, have endeavoured to save life and preserve efficiency for the nation. But such effort of necessity is ineffective. It can never be complete, and the abstention of a few mill owners in a district is sufficient to annul the effort of the majority. The helplessness of such a position was so strongly felt by one mill owner in Yorkshire, that his rule prohibiting the employment of married women was abandoned: “Other mills being open to married women, the rule failed to serve the purpose for which it had been designed--that of keeping the women at home.”[38]

The attempt of philanthropy to establish day nurseries, discouraging as it has been, would even in apparent success serve but as a prop to an evil system, as an anæsthetic to the manufacturer’s conscience. It can but alleviate, it cannot cure; and its condemnation many years ago, for the involved exposure of the infant to unsuitable hours and inclement weather, holds equal force to-day. Better than the drug-nursery, but bad in itself, for the most excellently managed crèche might well provoke the situation described by Dr Greenhow, in Coventry[39]:--“Women being obliged to attend at the factory at an early hour are always hurried in the morning, and may be seen on their way to the mills, hastening along the street with their children only half dressed, carrying the remainder of their clothes, and their food for the day, to be left with the person who has charge of the child during its mother’s absence; and this ofttimes on a cold winter’s morning in the midst of sleet or snow.”

Widows without children of earning age may, as part of their burden, be forced to imperil the welfare of their infants in one direction while they seek it in another. And here philanthropy has just scope, for, save in exceptional cases, the crèche is the only practicable form of aid to the mother. Better, then, this care of her infant than its abandonment to a child, itself a candidate for the nursery, or to the elderly woman who confesses unfitness for all other employments. But this is the smallest section of the whole. In its widest aspect it is not a question for the make-shift, though devoted, benevolence of philanthropy; it is a problem for the State in its responsibility to the nation. What are the terrors that lie in its handling? The dread of a barrier raised before the freedom of employment: the fear that the prohibition of employment within say six, or even three, months after childbirth might embarrass a large class in its endeavour to earn a living. But the freedom to labour is no sacred right when its exercise involves injury to others; it is not even so held when it clearly threatens injury to ourselves. The worker in a dangerous trade is suspended from employment on the verdict of the certifying surgeon during such period as he considers to be necessary: in certain departments in a white-lead factory the employment of women and girls is altogether prohibited. There is therefore no inviolate right. Is there in this case necessity? What is the motive-power which drives the mothers of young children into factories? Commonly, ignorance of home duties, and the consequent unattractiveness of the home; the companionship of factory life, where the companionship of children has no meaning; often, fashion; least often, true poverty. There is poverty in Glasgow and in Paisley, as in Dundee, but its cure is not felt to lie in the employment of mothers. The father accepts the obligation of breadwinner; he is ashamed that his wife should work outside his home. “If a Glasgow lad wearies o’ work, he must marry a Dundee lassie.” There poverty conjures excuse, and a man is not ashamed to claim his wife before her time in the hospital is over, that she may come out and earn his bread. Exceptional, it must be hoped, are such cases, but at least the system which breeds them is not, and what some towns claim as a necessity, others will not tolerate, in their rejection disproving the need.

Within the space of this chapter it has been impossible to consider arguments to which place would otherwise have properly been given. It is left only to suggest a comparison of the possible evils which lie in action, and the certain evils which have come of inaction. The principle of regulation is already accepted in our laws, and in the laws of other countries, as Miss Anderson’s deeply-interesting chapter shows; it but needs extension to render it effective. The State holds the scales: difficulties on the one side, not light it is true; but on the other, forces weighted already with accomplished evil, charged with greater evil to come: on the one side, the fancied interests of the individual; on the other, the deepest interests of the nation. “It cannot be too distinctly recognised,” says Sir John Simon, “that a high local mortality of children must almost necessarily denote a high local prevalence of those causes which determine the degeneration of the race.”

MAY TENNANT.

II

Although a steady decline has taken place in the general mortality of the country coincident with, and, no doubt, in the main, consequent upon sanitary progress, it cannot be said that the infant mortality has diminished in like proportion, and among the many factors which contribute to the maintenance of a lamentably high death-rate among infants, not the least important is improper feeding, the result of ignorance on the part of mothers. If by some means the simple fact could be brought home to mothers that milk, and preferably human milk, is the only permissible diet for infants, the natural instincts of motherhood would prevail in the majority of cases, and thousands of otherwise healthy infants who do not now survive the first few months of life would reach an age when greater license in diet is permissible, and the chances of living are immensely greater. But, in a humanitarian sense, the saving of life which would thus be effected is of small moment when compared with the mitigation of the pain and misery which infants now have to suffer, and which has to be borne, not only by those whom death ultimately relieves, but by the still larger number who manage to survive the ordeal, and who thus have to suffer for a longer period.

From inquiries made some years ago, Dr Hope of Liverpool came to the conclusion that among the artisan classes in that town upwards of 50 per cent. of infants during the first three months of life are entirely breast-fed, 35 per cent. are reared on other food in addition to breast-milk, and 15 per cent. are entirely artificially fed. Analysing upon this basis a large number of deaths from diarrhœa, he found that for every death attributed to that cause among entirely breast-fed infants under three months’ old, 15 occurred among the mixed class, and that for every death which occurred among the breast-fed and mixed class combined, 22 occurred among the entirely artificially fed class. He also found that among infants aged from three to six months, for every death from diarrhœa among the partially breast-fed, 6 occurred among the entirely artificially fed class. Other observers who have devoted attention to this matter bear out Dr Hope’s conclusions, and it is a well-known fact that in countries where artificial feeding of infants is largely practised, the mortality is very high compared with other countries where natural feeding prevails.

Now the practice as regards the feeding of infants varies in different districts according to circumstances which will presently be referred to, and no one can dispute the fact that, other things being equal, infants reared for the first few months entirely on breast-milk have a far better chance of survival than either of the other two classes. No doubt this is very largely due to the gross ignorance which prevails, especially among the artisan classes, as to the only permissible substitutes for breast-milk; but we must deal with circumstances as we find them, and, up to the present at any rate, our efforts to bring about a better order of things have proved unavailing. When we ultimately succeed, as we must do, in getting the teaching of elementary hygiene introduced as a compulsory subject in all elementary schools, the more rational feeding of future generations of infants must follow as a natural consequence, and then, even if the proportion of breast-fed infants is not increased, the difference in the death-rates among the different classes (entirely breast-fed, partially breast-fed, and entirely artificially fed) will be greatly lessened, for the artificial food administered will more nearly approach nature’s requirements.

From what has been said, it follows that if from any cause the proportion of entirely artificially fed infants in a district were abnormally large, in the absence of any counteracting influences the infantile death-rate of the district would compare unfavourably with that of other districts in which circumstances did not prevail which disturbed what may be called the normal grouping of the children according to the methods of feeding. If, for example, taking Dr Hope’s figures, instead of 15 per cent. only of the infants under three months being entirely artificially fed, the number, from disturbing causes, more nearly approached say 85 per cent., the remaining 15 per cent. only being either partly or entirely breast-fed, it would certainly be surprising if the effect were not apparent in a greatly-increased mortality among infants.

Some twelve years ago, when, in my capacity as County Medical Officer, I first had occasion, among other duties, to inquire into the mortality returns of the various districts in Staffordshire, I was greatly impressed by a very marked dissimilarity in the infant mortality of the two groups of populous artisan towns, one in the north and the other in the south of the county, a dissimilarity which I subsequently found could not be accounted for by any apparent difference in the sanitary surroundings of the northern and southern towns. In view of the fact, however, that, generally speaking, the trades carried on in the southern group of towns did not afford much employment for women, whereas in the northern group the conditions in this respect were different, it occurred to me that in this was to be found the explanation of the high infant mortality of the northern compared with the southern towns. In order to test the accuracy of this conclusion, with the help of the District Medical Officers of Health, and from information obtained from manufacturers regarding the proportion of married women workers, I classified the purely artisan towns in the county into three groups, and obtained the infant mortality figures for previous years, in order to allow of more reliable conclusions being drawn. Since then I have continued to record the figures according to the same plan annually, and I have now records covering a period of 20 years, and relating to artisan towns only, with a mean total population of about 529,000. One may fairly claim, allowing that the home conditions in the towns in question, in other respects, apart from the proportion of artificially-fed infants, are practically identical, that records from such a large population and for so long a period may legitimately be used for our purpose from a statistical point of view, provided care is exercised in the classification of the towns in accordance with the number of young married women workers employed away from home, and who are thus prevented from suckling their children.

In the classification of the towns it was found impossible to arrive at the actual number of married women workers, but one was able to divide them into three groups, as follows:--

(1) Many Married Women Workers.
(2) A good number of Married Women Workers.
(3) Practically no Married Women Workers.

Adopting this classification, the figures of infant mortality in the different groups of towns are set forth in the following table:--

_Deaths in Children under One Year per Thousand Births in Three
Classes of Artisan Towns in Staffordshire._

CLASS I. CLASS II. CLASS III.
Many Women Fewer Women Practically no Women
engaged in work. engaged in work. engaged in work.
10 Years (1881–90) 195 166 152
10 Years (1891–1900) 211 177 167

The figures speak for themselves, and it will be noticed that while there has been a general increase in the infant death-rate, practically the same relative proportion has been maintained between the three groups of towns.

As the outcome of a paper I read before the Public Health Section of the British Medical Association, at the Annual Meeting held at Nottingham in 1892, the question was taken up by the Parliamentary Bills Committee, with a view to securing some legislative remedy, and an inquiry was instituted throughout England on similar lines to the Staffordshire inquiry. Returns were thus obtained from a large number of artisan towns, and these returns bore out in a remarkable way the conclusions drawn from the Staffordshire figures.

It appears, then, to be a fact that the State is permitting a practice to be followed which is directly responsible for the deaths of thousands of infants annually. Deliberate cruelty on the part of parents is a punishable offence, and in a strict sense starvation comes within this category; it does not seem to matter, however, what sort of food is provided, so long as, theoretically, some provision is made for the care of the infant during the absence of the mother. Possibly, in many cases, owing to ignorance and other causes, the infant might not receive any better care at home, but there, at least, the natural food would be available, and in the majority of instances it would be given. It is true we cannot legislate as to how mothers shall feed their infants, but surely it is not too much to ask that the legislature shall not allow any deliberate disregard of parental responsibilities.

The law at present does provide some amount of protection, by making it illegal for a mother to return to work under one month after the birth of her child; but although this restriction is valuable from the point of view of the mother’s health, it can hardly benefit the child, for, if factory work is to be engaged in after a month’s interval only, it is not likely that the mother will commence suckling her child. The period of restriction should undoubtedly be extended, and the shortest serviceable time is probably three months. The probability is that if such an extension of time limit were enforced the mother would suckle her child until she returned to work, and thus the most precarious period in the life of the child would be tided over, and its chances of survival would be considerably increased.

In many cases the wife--it may be from choice, or because of improvident habits on the part of the husband--goes to work, while at the same time the husband is earning ample wages. In Lancashire it is common for a man to receive 25s. a week while his wife earns from 15s. to 20s., and in Staffordshire, when the potting trade is ordinarily prosperous, the weekly wages of a man and his wife amount to 30s. and 12s. respectively. These figures represent a fair average, but many of the men workers receive much higher wages.

In seeking for a solution of the question, we may learn something from other countries. In Switzerland, for example, a period of absence from work of eight weeks is enforced on mothers, the time to be counted from two weeks before confinement; and in Germany, by a process of compulsory assurance, the working woman, while prevented from working owing to childbirth, receives a sum equal to half her ordinary daily wages. In the former case the period, for reasons already given, is not long enough, and the latter expedient could hardly be made applicable to economic conditions in this country. However, a way out of the difficulty ought to be found, and it would seem that it should be sought for in the direction of State control.

GEORGE REID.