CHAPTER XIV

Chapter 435,274 wordsPublic domain

THE NATION'S CHILDREN

Let us begin at the beginning with what should be the chief care of the reformer—the child.

Every year in the United Kingdom there are some 700,000 deaths and some 1,200,000 births. The social structure which we seek to improve thus offers us a double hope. However degraded, however enfeebled, however criminal many of the units of the present generation may be, they must pass away. Unit after unit is cancelled; unit after unit is replaced. The child, save in a small percentage of cases, is given to us an unsullied page, upon which we may write what we will.

If the reader would realize fully the truth which I have just expressed, let him ponder the following utterance by Professor D. J. Cunningham when under examination by the recent Inter-Departmental Committee on Physical Deterioration. After referring to the manner in which changes in the condition of life affect the growth of an individual class, and more especially how poverty with its squalor, its bad feeding, and its attendant ignorance as to the proper nurture of the child, lowers the physical standard of the poor, he went on to say:

"In spite of the marked variations which are seen in the physique of the different classes of people of Great Britain, anthropologists believe, with good reason, that there is a mean physical standard which is the inheritance of the people as a whole, and that no matter how far certain sections of the people may deviate from this by deterioration (produced by the causes referred to) the tendency of the race as a whole will always be to maintain the inherited mean. In other words, those inferior bodily characters which are the result of poverty (and not vice such as syphilis and alcoholism) and which are therefore acquired during the lifetime of the individual, are not transmissible from one generation to another."

I break the quotation to accentuate the conclusion:

"Therefore, to restore the classes in which this inferiority exists to the mean standard of national physique, all that is required is to improve the standard of living, and in one or two generations the ground that has been lost will be recovered."

According to Dr Alfred Eichholz, H.M. Inspector of Schools, fully 90 per cent. of the children born in poor neighbourhoods are healthy. Dr Edward Malins, President of the Obstetrical Society, gives it as his opinion that 80 to 85 per cent. of children are born physically healthy, whatever the condition of the mother antecedently.[41] The weight of new-born children, he thinks, is, speaking generally, not below the average—there is a constant reversion to the race standard.

It is probable that these statements of Dr Eichholz and Dr Malins require some modification. Other evidence goes to show that it is far from true that the majority of children born in poor neighbourhoods are healthy. Thus Dr Henry Ashby, of Manchester, a leading authority on the diseases of children, said in a letter to the "Lancet" on October 1st, 1904:—

"My own experience in the out-patient room entirely confirms the opinion that the nutrition of the mother has a very important bearing on the nutrition of the fœtus and that the statement that the percentage of unhealthy births among the poor is small is not justified by facts. We constantly see fully developed infants a day or two old brought by midwives or neighbours exceedingly badly nourished, blue and feeble, and who are clearly ill fitted, as the event indeed proves, to withstand the conditions of an external existence. There must be numbers of such born in this city that perish within a few weeks of their birth, and who fail to thrive for even a day. There is no question of syphilis; they are the children of poor mothers who have lived lives of hard wear and tear during pregnancy, are themselves badly nourished and weakly, and have felt the pinch of poverty, though often perhaps poverty of the secondary sort. I have a strong conviction also that the infants of the poorer and weaker mothers, even though they are born fairly well nourished, are difficult to rear, and easily waste even when under fairly favourable conditions in a home or hospital."

Evidence to the same effect was given to the Physical Deterioration Committee, but unfortunately ignored in their report. It seems to a layman a common-sense view that if, in the period when a woman has to eat to "feed two," she is badly nourished, and exposed to undue fatigue, the child must suffer. Nevertheless, the striking phrase of Dr Malins, "Nature intends all to have a fair start," may be fully accepted, and Professor Cunningham's words of hope require no modification. What we have to remember is that pre-natal as well as post-natal conditions must be improved if we wish to rehabilitate our stock. If we have not a renewed opportunity with each birth, at least we have it, save in quite exceptional cases, in the person of each pregnant woman. The weight of evidence goes to show that the influence of heredity upon disease has in the past been greatly exaggerated. The chief causes of deaths from debility, atrophy and premature birth are to be found in the evil environment and malnutrition of the mother during pregnancy. The unborn child fights hard for its life, but in a number of cases, sufficiently large seriously to affect the total population, it is born unfit. It either succumbs rapidly or lingers on to be a curse to itself and its kind.

These all-important facts once realized, an avenue of hope stretches out before us. 1,200,000 new births every year; 1,200,000 new units added to the national stock, and the possibility of ensuring that nearly the whole of them shall be born healthy. Here is Nature ever endeavouring to reform the race—ever offering us opportunity. Combine with knowledge of this opportunity knowledge of the means to take advantage of it. Combine with the determination to secure reform the application of national wealth to truly national ends and all things become possible.

Under what circumstances are the children of the new generation now born? It follows from our examination of incomes that a large proportion of our new births are of mothers who exist in conditions of extreme poverty. Fully one-fourth to one-third of the 1,200,000 are born to want and squalor. In England and Wales, at the census of 1901, of a population of 32,527,843, there were 12,983,109 persons belonging to families living in four rooms or less. In one room each lived families forming 507,763 people. In two rooms each lived families forming 2,158,644 people. In three rooms each lived families forming 3,186,640 people. In four rooms each lived families forming 7,130,062 people.

If the one-third of very poor could be gifted with all the virtues, if drink were abolished and every penny spent upon scientific principles, we have seen that they would still be unable to command a healthy existence. One-third of our hope of the future is thus mortgaged. One-third of the new-born go to feed the ranks of misery and to form, such of them as do not perish in infancy, the raw material of the social problems of those who are to follow us.

In England and Wales, in 1908, 940,000 children were born. In the same year 113,000 infants died under one year of age, or 120 per 1000 births. The conditions which exist in some of our towns can be gathered from the following figures:—

INFANT MORTALITY (Rates per 1000 births in 1908)

The towns with low rates cannot be said to possess ideal conditions, but merely to take them as a standard we see how considerable is the wastage of life which goes on in Lancashire and Yorkshire and Staffordshire and South Wales. In some of the poorer wards of our great towns one in three of the children born perish within twelve months. That is the case in some parts of Birmingham, where the Medical Officer of Health recently stated that "a reduction of 50 per cent. in the rate of infant mortality in Birmingham would mean the saving of 1500 lives per annum."

But death is only one of the symptoms we have to consider in this connexion, and death itself were preferable to the survival of a large proportion of the children of neighbourhoods where the rate of infantile mortality reaches one in every three or four births. Death is the extreme case. Those who do not die in infancy have physical degeneracy as their portion, and, in a world where virility and energy were never more needed by the labourer if he is to bargain successfully for a decent livelihood, enter the fierce lists of modern industry with enfeebled bodies. Docile units thus flood the casual labour market, or, totally unfitted for labour, swell the ranks of the "residuum."

A woman ought not to work for the last three months of her pregnancy or during the three months after her child is born. Further, if the child is to be fed as Nature intended it should not be weaned until about the seventh or eighth month of its life.

What cognizance does the law now take of these simple physiological facts? The Factory Act is not aware that pregnancy precedes childbirth. It recognizes, however, that children are born, and provides that the occupier of a factory or laundry shall not allow a woman to be employed "within four weeks after she has given birth to a child." Thus a feeble attempt is made to protect the working mother for a month after childbirth, but no law whatever protects the child. It is legal for the mother to go back to the factory on the twenty-ninth day and leave the child to take its pitiful chance.

The "four week" provision is largely a dead letter. How is an employer to "know," when a woman applies to him for work, that she bore a child a fortnight before her application? And who shall blame the woman for seeking work, when she must work or starve? Miss A. M. Anderson, Principal Lady Inspector of Factories, gives the following three cases found in a single town in one week's inquiry:—[42]

A. B., aged 24, unmarried, jute worker, had to leave work, being unfit, seven weeks before confinement. Became destitute, and found work with new employer, saying nothing about the baby. Earns 9s. 8d. per week.

C. D., aged 34, married, jute spinner; the child illegitimate. Went back to work three weeks after childbirth. The new employer knew nothing of the confinement.

F. F., aged 32, married, jute spinner. Went back to work in 15 days—to a new employer. Earns 11s. to 12s. per week. Father out of work and disappeared one week after the birth. The woman's mother "takes care" of the new baby and two other children, the eldest of whom earns 8s. a week in a jute mill. Thus 19s. or so per week supports two adults and three children. They all live in a single room which is very dirty.

In spite of an overwhelming mass of evidence as to the devastating effect of the employment in factories and workshops of pregnant women and mothers, the Physical Deterioration Committee's recommendations on the subject were exceedingly timid. They appear to have been impressed with the terrible consequences of the employment of women "from girlhood, all through married life and through child-bearing"; they realized that "the decreasing physical capacity of the child-bearing woman brings her at last some relief at the hands of the manager of the mill and she is sent away, often to take up the equally unsuitable occupation of charwoman or house scrubber." But, after setting out pages of good reason for action, the Committee, in effect, came to the conclusion that little or nothing could be done, because they were reminded of "the enormous practical difficulties that would accompany any sort of legal prohibition." Even as to extension of the period after confinement during which employment is forbidden, a point as to which, as in many other matters, we are falling behind Western civilization as a whole, the Committee did not advocate the enactment of a longer period than four weeks. They pinned their faith to a medical certificate as to fitness, and production of proof that reasonable care is made for the child in a municipal crèche or otherwise. They also strongly urged the application of "voluntary assistance" in the shape of maternity funds.

Thus lastly they came to the crux of the matter, the subject of "ways and means." The cause of the Committee's timidity is only too plain. It is impossible to make a recommendation of any value which does not entail expense. What is the use of talking of "medical certificates," unless we can ensure that, when the medico has certified unfitness, the poor mother shall have the means of refraining from work? Of what use to talk of "reasonable care" of the infant, unless the means of reasonable care be provided, and what form of care other than that of the mother is "reasonable"?

The whole aspect of the question is changed when we consider the extent of our national resources. Miss Anderson, in the invaluable memorandum on the subject which she supplied to the Committee, said: "It ought not to be impossible to link together in one great national provident and protective association all the isolated, half-informed societies and agencies at work in aid of maternity and for the saving of infant life. More than that, I believe, with Miss Squire (Lady Factory Inspector), that all over the country, but particularly in the great centres in the Midlands and the North, it needs only an organizing mind and purpose to bring such a national movement into being."

The Committee did not take up the idea of a "national movement." They preferred to urge that "voluntary assistance" should devote itself to the formation of maternity funds. But a problem of so much gravity demands national effort, and the use of the national purse. Out of the labour of the poor is drained the rents, profits and dividends which make the gross assessment to income tax in 1908-9 as much as £1,010,000,000. Of this sum, how much is needed to deal with the problem of the poor mother?

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

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

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

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

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

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

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

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

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

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

The nation must set its face against the employment of married women in factories or workshops, and gradually extend the period of legal prohibition. There is only one proper sphere of work for the married woman and that is her own home. In the case of factory workers the employer must be made to furnish a maternity fund if he wishes to employ married women. Thus penalized he will probably prefer not to employ them—to the very great advantage of the labour market and the nation. There are several model factories in the United Kingdom where the female workers are dismissed upon marriage. This is found to prevent the girls falling victims to loafers who desire to play three days a week. The Jewish community amongst us, the very aliens who are despised by the race they are supplanting in the East End of London, set us an example which we should do well to imitate. The Jewish children are much healthier and stronger than their Gentile neighbours because they are better mothered. Jewish women find their true avocation at home. The Jew, however poor, does not live on his wife's earnings, and it would be counted shame for a Jewess to work during pregnancy or after childbirth.

But what of the poor woman in her home? We can safely confer upon our medical officers and women inspectors power to report upon and advise the assistance of necessitous cases, before and after childbirth. The mother and child must be fed. Nature must be allowed to fulfil her desire to give the new unit of population a fair start in life. The cost would be surprisingly small. If 300,000 cases were assisted to the extent of £10 each it would entail an expenditure of only £3,000,000 per annum. With £10 per case a great deal could be done.

By assistance to the extent of £10 each I do not necessarily mean a money payment. Often the assistance which is most wanted is personal help. The poor Jewish women of East London have the aid of that excellent institution the Sick Room Helps Society, which is practically a charitable institution, the poor mothers contributing less than one-third of the expenditure. The "Sick Room Helps" provided by this Society are thus described by Miss Bella Löwy:

"They had to take the place of the house-mother when, through confinement or sickness, she was laid low, and when, were it not for their ministrations, the children and husband, and the home (sometimes consisting of one room only) would be absolutely uncared for. The Helps were only sent in where there was no woman or girl old enough and able to do the work. The Sick Room Helps, for the time being, took the place of the housemother, washed the baby, got the children ready and sent them to school, cooked the food, tidied and cleaned up the home, saw that any accumulation of washing was done. In fact, she attended to the hundred and one little things which required to be seen to even in the most modest home, and they could readily understand how much more cleanliness and order became indispensable when the family had to live, eat and sleep in one room only. The advent of the Sick Room Helps also ensured for the mother peace of mind, as well as of body, at a time when she sorely needed both, and if she knew that her husband and children were well-cared for and well looked after she was assisted on the road to health and strength, and was, thereby, enabled to take up afresh the routine of her numerous daily duties. Formerly the poor mothers used to grudge themselves even a few days of enforced idleness, and, by premature activity in getting up and about, they but too often sowed the seeds of illness and sickness, and brought untold troubles on themselves and their families. Notwithstanding that these facts were well-known and were perfectly obvious to every thinking person, the opposition to what was erroneously termed a new form of pauperization had been very great. But an institution which not only benefited the recipients by nursing them when it was imperatively necessary, but, at the same time, gave employment to deserving women, enabling them to support themselves, and, perhaps, their family, could not be accused of encouraging pauperism in any way."

Mrs Alice Model, the honorary secretary, tells me that the Jewish Board of Guardians applies a sum annually for the relief of destitute women in childbed, which is handed to this Society and applicants for relief are referred to it. If a case is found suitable, a nurse is sent in twice daily and milk and other suitable nourishment provided. Excellent results are obtained and many lives saved. Work on such lines might easily be carried on given a sufficient staff of Women Health Inspectors and an expenditure such as I have mentioned to provide nurses and nourishment.

In this connexion a municipal milk service, which will be discussed in these pages hereafter, would be of the first importance, and it would be found a simple matter to supply pregnant women and nursing mothers with an ample quantity of pure milk. Such a supply might be made universal and be specially supplemented in necessitous cases. In any case, the mother has a special claim upon the community and that claim should be recognized. The birth of a child is a special tax upon the family in which it occurs, a tax which is deliberately avoided by many people. Yet the unit not only belongs to its family; it is an integral part of the nation, and entitled to the care of a country which desires strong and healthy citizens.

Such provisions should be accompanied by drastic punishment of parents who neglect their duties. Upon report of the Health Officer, the prosecution and punishment of offenders against the nation's children would swiftly follow. We must make the man who neglects his child, which is also the nation's child, feel that he is the greatest criminal of them all.

It is impossible to leave the subject of the birth of the new generation without reference to the necessity for the segregation of the unfit. It must be made no longer possible for the habitual drunkard, the vagrant, the criminal, the mentally defective, to reproduce their terrible kind. The subject is so rarely brought before the public that few people realize the nature and extent of the danger. _Fully two per cent. of our existing elementary school children will never be fit to direct their own lives._ The State has but one duty in the matter and that is to protect society from the breeding of the unfit, while protecting the unfit from themselves. The child of the habitual drunkard is often feeble-minded. The child of the feeble-minded is frequently an idiot. Need we wonder, while the State has no control of the feeble-minded, that our lunatic asylums are ever growing too small for their pitiable populations. Our criminal and workhouse records are full of testimony as to the terrible results of the unchecked propagation of the insane by the mentally weak. A few years ago, at Daventry, a couple were charged with neglecting their ten-year-old son. It was stated that the child was in the habit of smoking a pipe and drinking beer, supplied by the father. A doctor stated that the boy was a perfect savage. He was undersized and threatened to be an idiot or a criminal. The boy was sent to the workhouse while the mother and father, described as "mentally weak," were sentenced to one day's imprisonment and are now free to bring forth _sui generis_. Another recently reported case which I noted was that of a partly paralyzed old man who applied for out-relief to the Oulton Guardians. He has had thirty children and the youngest, a girl, is described as "practically an imbecile." From her, doubtless, and from others of the brood, the terrible strain will proceed. Mr Amos W. Butler, speaking at the American Association for the Advancement of Science, gave particulars of the descendants of a feeble-minded woman. She was the mother of two daughters, who were free to marry because, like their parent, they were not actually insane. One of them, Rachel, has married twice, and borne eleven children, three of whom are dead. One of the survivors is a criminal and the others are degenerates. The other daughter, Kate, has four children, all feeble-minded, two of them illegitimate. One of them became the wife of a feeble-minded paralytic and has had five awful children. The direct descendants of the woman first mentioned number twenty-nine, and in ten years twelve of them have spent an aggregate of twenty-two years in asylums and orphans' homes.

These details may be nauseating, but of what use to shirk them? It is only when we realize that such propagation is going on unchecked that we see our duty clear in the matter. We then also see that segregation of the unfit would not increase our burdens, but decrease them.

Segregation recognized as a painful duty, it would no longer be necessary to make any reservation when speaking of the hope that lies in the child. Our 1,200,000 new births per annum would soon regenerate the race. _During the next twenty years about 25,000,000 children will be born in the United Kingdom._

[Footnote 41: See evidence before the Physical Deterioration Committee.]

[Footnote 42: Cd. 2175, p. 117.]

[Footnote 43: In this connexion it should be observed that there are 28,000 surgeons, physicians and medical practitioners in the United Kingdom. The number (one to about 300 families) is probably larger than the nation needs, but even to organize the whole of them as public servants, and to make the medical service entirely free, would cost only about £10,000,000 per annum, allowing for salaries ranging from £250 to £1,000.]