Изображения страниц

help in ages past,' followed, of course, by God save the King' and three cheers for our brave airmen. And then? Threequarters of an hour's play. As a result

of our experience we are making the following music arrangements for next term (1) Each class twenty minutes' modulator, sight-reading, &c. (2) Classes combined to make choirs of 100 children -forty-five minutes per week. These will take classical and other music suitable to

their age. (3) One lesson per week;

whole school for songs that all can sing.' Here are wise suggestions which many will do well to follow.


"The Baby Book," issued by Messrs. Joseph Nathan and Co., the Proprietors of Glaxo, 155-157, Great Portland Street, W., is an artistic and informing volume of 136 pages with numerous illustrations which all maternity and child welfare workers should possess. It contains data and directions, hints and guides, tables and records, and much information particularly practical and serviceable relating to all matters connected with a baby's well-being.

The history of the "The Star-Spangled Banner," originally composed by Francis Scott Key, has been written and printed for the Free Public Library of Newark, New Jersey. It gives in concise attractive form the history of the evolution of the poem and an account of Key's life, together with notes on war music and national songs and suggestions for the teaching of the poem to children and to foreign-born Americans. This great patriotic song of the United States of America is reproduced in full.

Mr. John Buchan, with wonderful industry and real genius, is pushing on with his remarkable "History of the War." The work is now in its eighteenth volume, and is being published at frequent intervals by Messrs. Thomas Nelson and Sons, Ltd., of Edinburgh and London (price is. 3d. per volume). The current volume deals with the period from the commencement of the German overtures for Peace to the issue of the American Declaration of War. There are also illuminating sections on "The End of the Rumanian Retreat," "The Clearing of Sinai and the Fall of Bagdad," and the

"Situation in Austria." The fine descriptions of the Russian Revolution, the New Government in Britain, and the Breaking of American Patience make vol. xviii a notable one. Every British patriot should read these striking chapters. The work is plentifully supplied with maps. The appendices are of particular interest, for they reproduce documents connected with the German and American Peace Notes, and President Wilson's Message to Congress, and also contain valuable information regarding the clearing of the Sinai Peninsula and the Fall of Bagdad. "Nelson's History of the War" should have a prominent place in every home and school in the British Dominions.

"Christ and the Public Schools," by Malcolm Venables, published by Mr. B. H. Blackwell, Broad Street, Oxford (price is. net), merits the careful consideration of the head masters of our public schools for boys. The title is somewhat misleading; "Our Public Schools for Boys and the Church of England" would be a more accurate designation. It is the plea of a Churchman for serious and systematic preparation of boys during their school days for the responsibilities of Churchmanship. The tract raises many points of great importance and it will doubtless arouse criticism, and we hope will lead to helpful discussion.

[ocr errors]

"More than this World Dreams Of," by Coulson Kernahan, published by the Religious Tract Society, 4, Bouverie Street, E.C.4, bears the explanatory subtitle, "A Little Book for Human Needs in Wartime." It is a sincere, unconventional, and beautifully expressed exposition of the purpose and power of prayer. The author has written it "for the men at the Front, and for the men and women at home, who, in such terrible anxiety and suspense, pray for their safe return." Infantile Mortality: An Inquiry into its Causation, with Suggestions for Preservation of Infant Life," by Dr. W. S. J. Peiris, of Colombo, is an informing brochure dealing specially with the ques-tion as evidenced in Ceylon. There are a number of carefully compiled tables giving valuable statistical data. The publication is one which should be widely distributed throughout Ceylon, for it very forcibly expresses the need for child welfare work in this important part of the British Empire.


In this section are inserted records of the progress of Child Welfare Work as carried out by various State Services dealing with Health, Education, Industry, Delinquency, Defectiveness, and other questions relating to the care and control, of the young. We shall be glad to receive copies of reports and all other official publications as soon after issue as may be possible.


War has quickened our realization of the value of child life. Throughout the greater part of this turbulent world the lives of adult combatants and workers are counted lightly. Amidst the passing of thousands the disappearance of individuals is scarcely noted. And yet the loss of the very flower of maturity is teaching the nations to value the life and service of those of advanced age and to conserve the still more precious potentialities of the children. No question is of more vital importance than that of child welfare. No subject deserves and demands fuller study. We welcome every form of inquiry which throws new light on the problems of child life. The Medical Research Committee of the National Health Insurance Commission, 15, Buckingham Street, Strand, W.C.2, under the chairmanship of the Hon. Waldorf Astor, M.P., have just issued, as No. 10 of their "Special Report Series," a collection of studies bearing on "The Mortalities of Birth, Infancy and Childhood." The publication can be obtained from H.M. Stationery Office, Imperial House, Kings'way, W.C.2 (price IS. net, post free Is. 2d.). A philosophic and somewhat academic introduction points out our relative ignorance regarding "infant mortality," under which we seek to include the influences of a great variety of complex and separate factors. On the one hand, we have to analyse and separate the physiological qualities, whether of the mother or the babe, and the separate physiological stages through which the growing infant passes in succession towards the full establishment of healthy childhood-and our knowledge even of this normal physiological progression is still highly imperfect. On the other hand, we have to detect and classify the attacks made upon these stages of normal life by conditions of improper environ

ment and by the infective parasites of disease. It is very properly urged that our knowledge of the separate factors which lead to illness or death at this or that stage of the physiological progress through which the infant rapidly passes in its normal development is most incomplete. Clearly co-ordinated schemes for research are needed. The Medical Research Committee have already made some progress in initiating such work. Inquiries into the causation of disease or death before or during birth, infancy, and in childhood fall into two main groups: (1) Analyses of the external conditions associated historically and topographically with different mortality rates. (2) Investigation of the particular physiological and pathological processes of the unborn babe, the infant and the child, conducted so as to show what external conditions at each stage are most likely to exercise unfavourable influences. The memoirs here presented throw some light on these points of view. The volume opens with some interesting quotations from the reports of the late Dr. Farr, a former Registrar-General; and Dr. A. K. Chalmers, Medical Officer of Health for the City of Glasgow, contributes a suggestive Historical Note." His concluding paragraphs merit quotation, for they admirably express the views held by most medical officers of health: "The difficulty in defining the ultimate line of cleavage between ante-natal and true post-natal causes of death in early infancy is but one of many questions that may be answered by direct appeal to clinical and laboratory observation. Meanwhile the very. serious loss of life during infancy and the conviction that much of it is preventable, has appealed to the philanthropic instinct of the nation, and in 1906 the first of a series of National Conferences on Infant Mortality was held in London, and did much to stimulate public interest

[ocr errors]

therein. Since then legislative sanction has been granted to local authorities to undertake wide schemes for the welfare of infancy and childhood. It is certain that these will receive the most careful consideration before adoption, but it may be well to anticipate the possibility of disappointment if they come to be regarded as in any sense substitutionary for fundamental reform in many of the conditions of home life." And now as to the monographs which compose the major portion of this suggestive publication. The first, on "The Relative Importance of Pre-natal and Post-natal Conditions as Causes of Infant Mortality," is an original study by a medico-legalist and lecturer on forensic medicine, Dr. William A. Brend, Barrister-at-Law. The subject is expounded under three heads : Infant Mortality in relation to Environmental Cause, Infant Mortality in relation to Pathological Cause, and the Decline of Infant Mortality and Mortality in Early Childhood. Well-arranged data. numerous statistics, and many extracts from official and other publications are effectively marshalled and logically discussed. The general conclusion arrived at is as follows: "It appears, then, that under the term infant mortality' we are classing together two radically different types of deaths which are brought about by different causes and are governed by different influences. The first type consists of deaths due to developmental factors which vary but little from place to place, year to year, and class to class, and appear to be caused by fundamental influences which we do not fully understand, and at present seem unable to control. The second type consists of deaths mainly due to respiratory diseases and enteritis caused by influences in the postnatal environment, most prevalent in crowded, smoky, industrial and mining districts, and probably entirely preventable. These two types of deaths overlap in time, but the end of the first month gives us a fairly sharp line of division. Some 75 per cent. of all deaths before that time are due to developmental conditions, though the proportion among miners, textile workers, and unskilled labourers is rather less. On the other side of the line the proportion of deaths due to developmental conditions is small.

Some three-quarters of mortality in the first month represents a bedrock loss of life which we have hitherto failed to reduce, and may continue so to fail indefinitely. Mortality after the first month is part and parcel of the general mortality of childhood, due apparently to the same causes, and demanding for its reduction the same measures. The use of the term infant mortality-applying only to deaths in the first year is apt to be misleading, since it tends to concentrate attention upon that year, and obscure the fact that the same influences are acting upon all young children after the first month and producing the same variations and tendencies. It might be an advantage to drop this term and speak of those in the first month as 'birth mortality,' and those from the end of the first month to, say, the end of the third year as the 'mortality of early childhood.' The great centres of deaths in infancy and early childhood are overcrowded industrial cities, and the measures which will benefit all classes of the community-clearing of slum areas, provision of open spaces, segregation of factories, as at Letchworth, and prevention of atmospheric pollution -are also those which will reduce infant mortality." The second essay, which is to be viewed as a preliminary communication, on "The Causes of Infant Mortality," is by a clinician, a specialist in pediatrics, Dr. Leonard Findlay, of Glasgow. The subject is discussed under the following heads: The Effects of Infant Welfare Schemes on Infantile Deathrate; The Influence of Wages; The Zymotic Diseases; Housing Conditions; Prematurity and Marasmus; and the following conclusions are formulated: (1) The apparent periodicity in the death-rates from the various zymotic diseases, which seem to explain not only the variations in the death-rate from year to year, but in different parts of the country at the same time. (2) The importance of environment (housing, &c.), as a factor in causing the present high infantile mortality. (3) The necessity for a more thorough study of that class of case called prematurity or congenital defect.' (4) The need for a more scientific investigation of the results following schemes of infant welfare to determine their true effects." The concluding essay on "The

Changes in the Physiological Processes of the Developing Child as shown by its Response to different Diseases," is by Dr. John Brownlee, the Director of the Statistical Department of the Medical Research Committee. After an introductory exposition and a note on the Graduation of Statistics by Mathematical Formulæ, the main matter is grouped under the heads of Growth in Childhood, Convulsions, Wasting Diseases, Diarrhoeal Diseases, Scarlet Fever and Measles, Pneumonia and Bronchitis. There is

also a section on Healthy and Unhealthy Surroundings and their Influence on the Death-rate of Ages up to 10 Years. The following conclusions are reached : "First, it has been shown that the growth of the child is a continuous process from a period at least six months prior to birth to the age of about 4 years, a process not interrupted either by the act of birth or by the act of weaning. Second, with regard to convulsions, it has been shown that the death-rate from this condition diminishes in a perfectly definite manner from the age of 2 months to the age of 4 years. Convulsions are usually considered as a symptom of disease, and there is no doubt that this is true. This statement, however, as usually interpreted, lays too little stress upon the fact that the essential factor is the nervous instability of the child. Thus, I have never been able to satisfy myself that there is any clinical distinction between convulsions associated with pneumonia and convulsions associated with enteritis. It is not only with regard to the tendency towards convulsions that changes take place in the growing child. The growing stability of the nervous system during the first few years of life is shown in many ways; for instance, the tendency in children towards paroxysmal rage disappears with age in the same kind of manner. In view of these facts I feel inclined to believe that convulsions are more a pathological entity than they are commonly regarded at the present moment. Third, it has been suggested that in the group of premature births and wasting diseases some considerable saving of infantile life is possible. This saving of life may be expected from better care at certain critical stages of development. Fourth, the group of diar

rhoeal diseases has been found to be a homogeneous statistical group, and as these diseases undoubtedly include several definite specific infections, it seems obvious that the reasons for the frequency of these diseases at the ages of life at which they are found must be sought for in the development of the child and not specially in the type of parasite. This is rendered more probable as it has been seen that the variation of the death-rate from tuberculous peritonitis with age bears a very close correspondence to that from diarrheal diseases. Fifth, with regard to scarlet fever and measles, it has been remarked that as the second half of the first year of life is reached both the infectibility by the parasite of the disease and the susceptibility to death are markedly higher. In both these instances the curve of the death-rate can be represented by the same curve as that which has been used to graduate the death-rate in diarrhœal diseases. The evidence for this has not been given, as the data are not sufficient to do more than offer the suggestion that this is the explanation. There is no doubt, however, about the manner in which the death-rates decline in these diseases with increase of age. For this change it seems to me most useful to seek the explanation from the side of physical chemical, and to assume that some substance in the body which predisposes to a severe attack of the disease develops rapidly and then gradually disappears during the growth of the child. This explanation seems more probable than the complementary explanation, namely, that the increase of the severity of the disease at the age of 6 months is due to a loss of one protective substance, and that the recovery of the protection is due to the development of a second protective substance. This is, however, a matter in which direct animal experiment might be made once a suitable disease were found. The final solution of this question will be obtained either in the laboratory or by direct observation in one of the larger fever hospitals. Sixth, it has been shown that the statistics of bronchitis and pneumonia suggest that these are two diseases of different etiology: the one, bronchitis, an infantile disease; and the other, pneumonia, a disease causing the greatest

number of deaths during the latter half of the first year of life. With regard to the broncho-pneumonia of measles and true broncho-pneumonia, the view has been advanced that these are two separate diseases, though the pathological and bacteriological findings have been hitherto considered almost identical. The clinical differences are quite sufficiently marked to warrant the conclusion that there is an etiological difference. Lastly, the general conclusion is advanced that the physiological processes of the growing child offer a great field for study, and that systematic inquiry resulting in the correlation of the evidence obtainable by the physiologist, clinician, and the bacteriologist would lead to very valuable results." In fairness to the writers of these suggestive, and in many ways controversial essays, as well as in the interests of our readers, it has seemed only just to present the authors' conclusions. It would be easy to raise many points for quotation, criticism and discussion if space would allow. The chief advantages of these communications, will be that they will require further investigations for their more complete elucidation. This "Special Report" raises old problems in new forms. We have to discriminate between pre-natal and post-natal factors. The relative influence of seed, soil, and general environment calls for fullest consideration. The problems of Nature and Nurture must if possible be expressed in statistical terms. The possibilities of prenatal and post-natal prophylaxis must not be neglected. Mere theoretical conceptions cannot be allowed to inhibit the progress of practical hygienic developments. Research must not confound or confuse administrative issues. Important as are innate powers for healthy growth and resistance of pathological processes, the influence of environment for good or ill must not be overlooked or discounted. It is doubtful if "urbanization" is necessarily pernicious, and it is certain that in rural districts conditions of "pollution may be greater than those existing in cities. In all investigations relating to the very complex subjects of child growth and child welfare generally it is essential that while concentration of aim is necessary, a sense of proportion must be maintained. The Medical Research Com

mittee are to be congratulated on having originated researches touching various aspects of child welfare, and the reports of the results of inquiries carried out by capable investigators will stimulate scientific investigations among individual workers. We trust. it may be found pos sible for the Medical Research Committee to initiate and to maintain researches by trained and experienced investigators, and also to undertake collective inquiries in different parts of the country relating to the many problems, touching child welfare, which await solution.



"The Report of the Committee of the Privy Council on Education in Scotland, 1916-1917” [Cd. 8648], issued by H.M. Stationery Office, Imperial House, Kingsway, W.C.2 (price 2d.), contains much valuable information regarding educational work in Scotland during war days. The Report expresses the opinion that no one who is interested in the welfare of children can view without deep concern the fact that some thousands of pupils are leaving school at present with an educational equipment the defects of which will never be made good." The difficulties to be faced are stupendous. Of the eligible teachers more than half are now on military service. Of the others, the great majority have been found unfit for general service and only a few of those regarded as eligible have been retained as necessary to carry on educational work. The continuance of the War has made it necessary to bring Scottish School Boards into line with other public bodies so far as the postponement of elections is concerned. The training centres for teachers have continued to feel the effects of the War in the reduction of numbers, both amongst students and staff. So far as the general welfare of children is concerned, efforts have been made to continue medical inspection and treatment as well as circumstances will permit. While, however, the physical well-being of the children has on the whole improved, and no effort is being spared to prevent intellectual loss due to the War, the Report expresses regret for the apparent break in what

« ПредыдущаяПродолжить »