THE MIDDLE-CLASS BABY’S HANDICAP

Ladies' Mirror, Volume 3, Issue 12, 1 June 1925, Page 29

THE MIDDLE-CLASS BABY’S HANDICAP

<sy MARION MACKENZIE

Laugh and the world laughs with you ”

<fA delightful ‘fßaby Study *fßy SK. S. Cottrell

0 NE ’ S experience of babies, when a medical student, was entirely with the sick baby who has already been damaged, usually by bad management. To prevent such damage was never taught. Even attendance at “Sick Kids”—as we colloquially called the Children’s Hospitalwas not compulsory. Many medical students have not the luck to have a “Sick Kids” where they can attend if they choose, but become fullyfledged doctors before they realise that the treatment of babies is not quite so simple as to enable them to deal with them as immature adults. True, there was a formula by which the dose of a drug could be made to fit a baby by some abstruse mathematical calculation; but either one’s mathematics were at fault, or the baby had an inconvenient way of resenting such treatment. Sometimes he would tolerate a drug in a way which was out of all proportion to his size; perhaps, on the other hand, he would almost “walk out” on a dose which should have suited him admirably. Such a simple thing as castor oil given too early in life would annoyingly upset his digestion for the rest of his days. So it became the fashion to “leave it to the nurse,” and then, when the baby became ill enough to deserve our. attention, we resorted with a sigh of relief to the inevitable bottle of medicine, which had the advantage of being somewhat of a mystery, and at any rate made us feel we were doing something. In our salad days we had diets for infants of different months framed and hung in our consulting rooms. But, alas ! the babies were not machines, and refused to tolerate being treated as such. True, if we were lucky—and there are some babies who will stand anything— came across a baby who would thrive on a standard diet, but they are so few as to be negligible. Then we thought we had got the right thing at last, a standard not of age, but of weight; and by dint of more mathematical brain strain, and by taking the weight of a baby and multiplying it by so much food Become a Subscriber Fill up a Form TO-DAY

per pound of weight, the right standard was arrived at. But, alas! if the baby was of a genial, placid turn of mind, and gained weight rapidly, you found the increase of food required to be so alarmingly large that you feared an explosion was inevitable ! And you proceeded to curse the system, or want of a system, which omitted to put you wise on these matters, and left you to learn in the hard school of experience after you had been licensed to kill, instead of before. True, we had been taught to recognise the physical signs of bronchitis, for example, and its treatment, but no one taught us how to prevent it in babies. However, we might bear it with equanimity till it came to our own babies’ turn. Then it was a different matter, and one’s indignation was great that the teaching of the treatment of the normal baby should be left so much to chance. In the case of the writer’s first baby, in spite of the, fact that both parents were doctors, the baby bade fair to depart this life, as nothing seemed to suit him, till we wrote to ask the advice of one of the doctors at the Infant Welfare Centre at Huddersfield. The baby never looked back, and from a fretful, crying child became happy and healthy. Huddersfield at the time had reduced its infant mortality to less than half what it had been previously. Dr. Moore, their Medical Officer of Health, had been inspired by the success of a French town, Villiers le Due, whose infant mortality, previously about 200 per 1000 born, had been brought towards vanishing point by the efforts of a mayor who was also a doctor. The then Mayor of Huddersfield, Mr. Broadbent. at the instigation of Dr. Moore, took an active interest in the Huddersfield babies, with the above result. Now what can be done for workers in industrial areas can more certainly be done among the middleclass. It is a crying shame that only the babies of the poorer classes should be helped, when help is often so much needed by the better-class

mother. In 1922, in Leeds, in an industrial part of the city, the infant death rate was 300 out of every 1000 babies born— is to say, almost one-third of the babies died who did not attend the Welfare Centre but of those who attended, only 76' per 1000 died. In other words, they had as good a chance of life as the middle-class baby not attending a Centre, in spite of overcrowding, filth, lack of air and sunshine, and all the hundred and one things # which militate against a baby’s chance of life. It must be remembered that these statistics include the indifferent mothers, who simply come for what they can cadge, and probably only attend a few times. Imagine what could be done with the more fortunatelyplaced mother with leisure to carry out directions. Every baby who is artificially fed should be under medical care, and most babies fed naturally are the better for it. This is where the poorer mother scores. In towns, at any rate, she has always the benefit of a trained health visitor’s advice, and can take her baby to infant clinics, if she cares to. There the baby is weighed weekly, and seen by the doctor every week if necessary, sometimes several times a week, even every day at times, but at least once a month. Any mother may go if she chooses. It is not enough to think your baby is doing well, but to make sure. Weight is not everything, but it is a very good indication of progress, and unless a baby is gaining steadily, neither too much nor too little, there is usually something wrong. Even the baby fed naturally needs supervision, especially when the. time for solid food arrives. One of the greatest benefits an infant clinic can and does bestow is the prevention of artificial feeding before the normal time, and then the giving of the right sort of diet. In many cases where the baby has been on a bottle for as long as a couple of months it may be safely got back on to natural feeding. Recently a mother brought a baby to

me who had been put on to a bottle and, fortunately, was even more ill on it than when previously nursed by her. I pointed out the risks of bottle-feeding, and showed her that her failure was due entirely to overfeeding (every two hours), not, as she thought, to her having insufficient milk or to it disagreeing. It took me just over half an hour to examine her baby, get its history, habits, etc., and instruct the mother; but that half-hour may mean a healthy citizen, instead of, conceivably, a dead baby or a chronic dyspeptic. By means of test feeds—that is. weighing the baby before and after a feed—we were able to assure her that she had sufficient, with the result that though the infant had been on a bottle some weeks, it is now a peaceful, happy baby on fourhourly feeds, allowing the house-

hold to sleep in peace. The mother told us naively that she never dreamt that she could come to such a place as an Infant Welfare Centre. Why should middle-class babies run so much graver risks than the poorer ones? That they do is obvious from the statistics in a mixed district, where it has become the fashion for the better-class mothers to attend the clinics. If the babies not attending, the infant death rate is 110 per 1000 fairly low for an industrial town; but of those babies who attend, only 27 per 1000 die. In this district there is no doubt that the kindly co-operation of one of the leading doctors is a help, as he always advises the mothers to bring their babies to us. One of my first cases sent by him was a small mite weighing about 341 b., whom he sent with the assurance that if anything could be done we should do it. We worked hard, and eventually, after despairing several times, we got another mother to give of her abundance an occasional feed. The baby slept six hours the first time, and never really looked back. Dr. Truby King got some marvellous

results in his efforts to ensure successful feeding. In one case, a mother, being unable to nurse her own baby, was enabled not only to do so, but to help altogether about twenty other infants. Dr. King came over from New Zealand during the war in order to help the “Babies of the Empire.” Previously a mental specialist, he came to the conclusion that he would do better work by beginning with the babies and their mothers, and getting thus a sound mind in a healthy body. In spite of its hot summers, New Zealand had at one time, and, as far as I know, has now, the lowest infant death rate in the world, after previously having about the highest. What New Zealand has done, we can do; but it is up to us to see that it is not only the derelicts of society that arc saved to propagate the race. The child is the father of the man, but

the baby is as certainly the grandfather. The great middle class threatens to be squeezed out of existence by the high price of living, the shortage of houses, etc. Their families tend to become smaller. At any rate let us conserve what we have got. Surely the middle-class baby is as well worth saving as his poorer brothers, and Infant Welfare Centres should be started for the middle-class mothers and babies, where they would have the advice of a trained staff. The objection is raised that we are taking away work from the general medical practitioners. Speaking as a general practioner of ten years' standing, I hold this is untrue, except in the sense that we keep the children from getting ill in a great many cases when they otherwise would. It is much more dramatic to do a big surgical operation than it is to prevent the necessity for it ever arising. One can conceive a Utopia in which doctors and dentists will no longer exist, much less surgeons. In general practice, mothers will not bring their babies to us as a

rule till there is something wrong. Now the aim of pediatrics is to keep the healthy baby healthy, not to treat . the diseased baby. Take such an apparently simple thing as sickness. In an infant usually it is amenable to treatment, if seen early and treated seriously directly it occurs. But let it go on and it becomes most intractable. It should be a sine qua non that the “nation’s babies” should have the same right, whether rich or poor, to benefit by the Centres. In many Centres this is the case, but there are still others where the betterclass mother is looked at askance. One journalist whom I know personally told me the doctor at the Centre said she could afford to go to a private practitioner. If every mother were to do so with healthy babies, he would have little time for anything else! And it’s the healthy babies we want — keep them so. Though there is no doubt that infant welfare is still in its infancy, and that there is much to learn, at any rate it begins at the root, which is a step in the right direction. We found many of our conscripts were C 3 men, and traced their ill-health back to childhood; then it was found that children were already defective when entering schools. Hence began a big campaign to start with the babies, which had already been initiated by people of vision, mostly lay women who were baby lovers and appalled by the unnecessary deaths and suffering. It was given a great impetus by the War; Lord Long

said it was the best war-work women could do. Men saw that it we were to survive as a nation, we must have healthy babies, but the mistake was that only the poorer babies were catered for. At the moment it is only the middle-class mother with a lair amount of “nerve” who brings her baby regularly to the Centre. There is an' impression that they are only for the poor. This impression is not confined to the mothers themselves, but many doctors will say the same, and resent it it their patients attend. Even our own staff arc known to say, “I should think they could afford to go to their own doctor,” which shows how little they appreciate the spirit of the work, and makes me think with gratitude of the Centre that came to out rescue. Just as surely as Mother Shipton’s prophecy that men would fly like birds has come true, so will preventive medicine in time wipe out most of the diseases of the earth. But if the middle-class is to survive it is up to us to see that there arc Infant Welfare Centres in middleclass districts—it is up to the middleclass mother to see that she takes advantage of them. It is a disgrace that middle-class infants’ death rate should be no lower than that of the slum babies attending a Centre. Antenatal work should also be a sine qua non —for the safety of mothers and babies. “The race marches forward on the feet of little children.”