INFANT MORTALITY.

Evening Star, Issue 12982, 19 June 1908, Page 3

INFANT MORTALITY.

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By Db W. E. Smith. At the present time, when so much attention is being given on the part of all interested in the national progress to the question of the physical condition of the rising generation, it is of interest to go to the root of the whole subject, and endeavor to seek an explanation of those causes which tend not only to the maintenance of our high infantile death rate, but which indirectly lead in a large proportion of those who survive to a debilitated constitution from which it may take years to recover. The deaths of infants in relation to a community is grouped by a form of death-rate known as\he infantile mortality rate. Infants are children under one year of age, and the infantile mortality rate is the proportion which the deaths of such infants bear to every thousand children born. In some places this rate is low, being only eighty deaths to every I.OCO births: in other places it is high, being some 200 to 250 deaths to every 1,000 births, the rate in large urban districts being higher than in rural localities. As the present conditions of life in a community become more healthy, as a rule the general death-raie declines, and also that of the more preventable diseases, and under such conditions it would appear reasonable to expect that the infantile death-rate would follow a similar course, but this is not the case, for the broad fact remains that whilst during the past fifty years, thanks to the growth of science and the recognition of the principles of preventive medicine, the general death-rate has declined and life has been prolonged, the infantile death-rate remains una'tered, infants still die in the same numbers as they did formerly, indeed in many places in greater numbers, and apparently more readily than in the past, but if children thus die in infancy by thousands it means a very serious lass to a nation's prosperity; and, this is not the only harm done, for of those who survive this critical period of tife many trrow up stunted in mind and injured in" body. —Statistical Evidence.— If we take the year 1905 we shall find there were 120,000" deaths of infants alone in England and Wales, which represented nearly one-fourth of the total deaths occurring for the same period : in 1904 there were 549,784 deaths, of which 137,392 were infants; and in 1903 there were 514,628 , deaths, of which 124.718 were infants. And if we look still further back at the statistical records we shall find that in t the period from 1832-1850, the average infant mortality in Entrland and Wales was 153, and in 1841-1850 the general death- ' rate was 24.8 and the infant mortality rate 157. So that by these figures it is brought home to us that there is yearly an emormous sacrifice of human life,"and "that no improvement is apparently taking place. If we study the statistical re- ' turns for England and 'Wales for the last fifty years we find that, taking the population at thirty-four millions, there are nearly a million births every year, more than half a million deaths every year, and of these deaths at least 120,000 of them aye of infants under one year of aa;e. We also learn something else—viz., that the birth-rate is decreasing. a>nd it is if interest to note that if the birth-rate to-day were the same as in the last century there woold be some 60,000 more infants born. Again we note the reduction in the general death-rate, the decline being 14 per cent, in males and 19 per cent, in females for the decennial period 1851-1860 and the quinqnennial period 1896-1900 whilst the infant mortality remains at the same rate. Now, there can be no doubt that this great prolongation of life, consequent upon the decreased general deathrate, is in great measure, to bo attributed 'to the more scientific treatment of disease, hut mainly to the enormous improvement which has taken place in the general management of all Public Health questions under the more enlightened policy of the many sanitary authorities, and to" the higher standard of comfort of the people; and it is therefore a most striking fact that the deaths of infants should remain as before, one in six dying before the age of one'year is reached, and this clearly shows that it is not to defective sanitation that we must look for the cause. And what is true of England and Wales in this Tespect is found to be the case also in many European countries of first-rate importance ; in Austria and Russia the figures are even higher than in Great Britain. —The Critical Period.— It now becomes of interest to know at what period during this first year of infant life the mortality is the greatest, as we shall thus be the better able to draw deductions as to its causes. Since 1888 the Registrar-General has published returns of infant deaths in three periods—the first three months, the second three months, and the last six months. From .hese returns we find that in Manchester •here has been a marked increase of infanile deaths in the first three months—in ;895 42 per cent, of all the infant leaths occurred in the first three .nonths, in 1904 . 45 per cent., in 1905 47 per cent; whilst in Glasgow, comparing the figures available for the years 1870-72 with those of 1900-02. those for the first three months remained the same, for the second three months there was a reduction of 16 per cent., for the last six months 30 per cent., and of this total mfant mortality 15 per cent. Tn London in the year 1906 tliere were 16,385 Heaths of infants, and of this number 4,657 riecurred in the first month, and of this bitter number 2,683 were in the first week. 707 in the second, 722 in the third, arid J 5-15 in the fourth. Prom this additional information, therefore, it is gathered, that the mortality in the first year of life is not uniformly distributed, but that it falls on the first three months, and that whilst there is a decrease in the incidence in the last six months and of the second three months the incidence on the first three months remains practically what it was many years ago. and if the returns for the first 'three months and of the first month be examined it will be found that the rise has been in the first month, and within this month in Ihe first week, and of these deaths mor» are of boys than of girlS: We are thus brought home to the fact that a large iraml>er of infants start life handicapped from the first by being literally in a dying condition before they axe born, and of those who survive many are in such a poor physical state that they are unable to successiu'Jy cope with the unfavorable influences to which they will l>e exposed in later yeaw. And what bus been said applies with more force i<i illegitimate children, for with these the infant mortality 7s much greater than with the legitimate. * —The Chief Causes.— °

The chief causes of death in the first •*-etk of life «-vre immaturity, atrophy, and want ;>f breast-milk, and congenital defects, tho deaths in the first week bcin.' nearly 58 per cent, of those dying in rhe first month. Tho 6triking fact that 50 per cent, of the deaths of infants in this country are due to immaturity ciearlv show* that there mutsi bo something more than external conditions, or food or mancement at work; indeed .a coneideratiwi of those influences which play a part upon the life of the child before birth is necessary, and thifi obviously includes the personal health of the parents both before and after marriage, the stock from which they are derived, their hereditary tendencies, and the diseases from which they are known to have suffered, and amongst these of primary importance are alcohol* m syphilis, and tuberculosis, indeed the whole question of —Fitnees for Marriage—is involved One may test one's own knowledge to realise how very little attention is ever given to this point; indeed, the unfit appear to marry more readily than the lit. It may appear impossible to arrange

a marriage purely on the ground of phyei- < cal fitness, yet'it would obviously be desirable in view of the fact that such ie the frequent cause of infantile deaths or disease of the offspring, that much more serious attention should be given to the matter ; for just as every woman brings into her pregnancy the results of her past medical history, so the new-born child brings with him into the world at his birth the effects of any morbid condition which may have attacked him, such conditions may result in the child's- being " still-born," or they may cause a premature birth, in which case the child may live but a few days, or for a period of weeks or years, or tuey _ may cause the child' to bo in 6tich a condition that physically it is seriously handicapped in the race for life. —The Effect of Alcoholism.— .Alcoholism in the mother acts most perniciously upon the offspring both before and after birth, for it has been proved beyond doubt that alcohol as such mav pass from the mother to the unborn child in considerable quantities, and the evidence of prison surgeons, workhouse medical officers, and others, is all in the same direction—viz., that the percentage of dead children born of drunken mothers in the first two years of life is much greater in the same period than those born of sober mothers; and, further, it ie found that tl*re is a progressive death-rate in the families of alcoholic consumers, the number of "still-boms " or of those dying in the first two years increasing as time goes on. There can be no question that alcohol circulating in the mother's blood Teaches the unborn child, and either injures the tissues, or arrests its proper development, and may cause its death or miscarriage, but that is not all—the after-effects on the child are serious, resulting, it mav be, in an unstable nervous system, which may drift into insanity or such a low physical condition that the struggle for existence will be great. Again, an alcoholic mother will yield a milk of poor quality or a milk actually containing alcohol, with the result that the child may be starved or made to take alcohol. Its development will thus be arrested, and its power of growth, of resistance to ills to which it may be exposed, weakened or lost. It is impossible in a short article to enter fully into the details of the question, which is at the root of the physical well-being of the children of the nation, but I think I have said enough to prove from this great infant mortality which exists that urgent and stringent measures are necessary to cope with the evil, if we are as a nation to hold our own. The wastage of life ie appalling, the necessity for a race of healthy, welldeveloped, and mentally strong men and women was never more pressing, if we are to hold our own as an Empire of first-rate importance. It behoves us, therefore, to look the facts in the face, and take all prudent measures to arrest the evil which is rampant in our midst.