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CHILD WELFARE AND THE WAR. By II. MACNAUGHTON-JONES, M.D., M.Ch., M.A.O., F.R.C.S.J.,
It is obvious that the reply to any question as to how this world war, in which humanity and inhumanity are engaged in deadly struggle, will affect the coming generation, must be of a doubtful and speculative character. Still, there are several most important issues associated with the well-being of children which intimately affect the conduct and attitude of all who have a share in the guardianship and training of the young that cannot be considered too early or too carefully, and foremost amongst these is the influence that the War will have on the religious beliefs of those whose early years are spent under conditions widely different to any the world has hitherto known.
Already we see striking changes which are likely to remain permanent. Prominent among them are the earlier development in independence of individual action; greater precocity, especially in young lads who have had no guiding and restraining paternal influence, and whose early employment in various occupations (as is also the case with girls) has deprived them of school training, and brought them into exceptional social relationships. The opinions and conversation of those with whom they come in contact must largely determine their views on religion. In face of this it behoves all parents, school teachers, and those whose parochial duties bring them into touch with youth to keep a careful watch over their instruction and companionship, in order to counteract the effects of such conversation and criticism as might tend to undermine the tenets of the Christ-faith and to lay the seeds of agnosticism or atheism.
It is pleasant to turn from such reflections to other effects and influences of this War. There are the millions of instances of glorious self-sacrifice and self-denial and of an ardent patriotism calling forth dauntless courage and heroism. All this service is manifested in order that the will of God may be done and seen in a changed world, in which a military despotism shall not prevail, or ruthless "culture" take the place of reliance upon God's laws; a “culture” in which the first elements of humanity are ignored, and where Might outbalances all consideration of Right. So also has love, in its highest sense, and in countless ways, been the ever-present principle evoked in each phase of the struggle in trench, in hospital, and home relationship. True, there has been grief
“ Griel too deep for language, grief too deep for tears,
Grief that knows no solace in the long, long lapse of years."
But grief has wonderful elements that tend to ennoble the mind and elevate the soul. It calls for intensity of love, self-sacrifice, devotion to duty at any cost, and regard for the suffering of others. This War has developed these ennobling traits in the highest degree, and all will have their effect on the youth of this generation--can we doubl for their good?
When the settling day arrives and the freedom of the world is established, then will come changes in the social relations of various classes, and these influences will make those who accommodate themselves to them more ready and willing to help in the work of reconstruction. Truly, not without influencing permanently for good a proportion of the children who are growing up during this struggle between humanity and inhumanity will this War have been allowed for a Divine purpose! How assiduously, then, should all who either directly or indirectly have the training or guardianship of child welfare at heart use every endeavour to counteract the mischief of evil contamination or pernicious companionship-surely one of the greatest dangers to the child of the present day.
ABSTRACTS AND EXTRACTS. Under this heading are gathered thoughts from literature, both ancient and modern, which seek to
provide information likely to be of assistance to students of child life and practical workers for child welfare. It is hoped that our readers will co-operate in making this section both suggestive and serviceable.
SCOTTISH MOTHERS AND
CHILDREN. The Carnegie. United Kingdom Trust, the headquarters of which are at East Port, Dunfermline, have rendered incalculable service to the cause of maternal and child welfare by providing means whereby it has been possible for comprehensive reports to be prepared and issued in a form which make them documents of national importance and such as will prove reliable sources of information and stimulus for workers for human betterment in all parts of the British Isles. With the recent publication of Dr. ll. Leslie Mackenzie's monumental volume on “Scottish Mothers and Children, being a Report on the Physical Welfare of Mothers and Children in Scotland,” the foundation work of the Carnegie Trustees is well and worthily completed. The first two volumes dealt with England and Wales, and were issued under the names of Drs. E. W. Hope and Janet M. Campbell (see notice in THE CHILD, June, 1917, vol. vii, No. 9, p. 495). The volume relating to Ireland was prepared under the direction of Dr. E. (oey Bigger (see notice in THE CHILD, vol. vii, So. u, p. 587). The complete set of these authoritative reports furnishes the most instructive publication on the question of maternal and child welfare in these islands which has ever been issued. We hope it may be possible to arrange for the preparation of supplementary volumes which shall deal with the subject as it presents in Britain Overseas, so that in due course we may have available an authoritative work dealing with the question in all parts of the Empire. And we venture to suggest that some adequate means should be provided whereby the rapid progress which is being made may be fully recorded and rendered available for the assistance of all organizers, administrators and practical workers. THE CHILD attempts to keep its readers
acquainted with the developments of child welfare work, but it is manifest that to secure detailed records of all departments the resources of the State must be available, or some such wealthy and patriotic body as the Carnegie Trust. In any case it is to be hoped that the good work so admirably begun under the auspices of the Carnegie Trustees will be continued and extended in many directions. We gather from Dr. Leslie Mackenzie's introduction that the Carnegie Trustees contemplate the establishment in Scotland, and presumably in Edinburgh, of “an Institute for the Organization of Study, Research, Conference, and Propaganda.” We trust that this is indeed the case. It may be hoped that a similar institute for England and Wales will be set up in London, and, if possible, one for Ireland in Dublin. No more permanently patriotic service in the highest interests of the great British Commonwealth could be possible. In the present notice we desire to direct attention to the fine study of Scottish mothers and children prepared by Dr. W. Leslie Mackenzie and his numerous coadjutors. Dr. Leslie Mackenzie, as Medical Member of the Local Government Board for Scotland, occupies a unique position, which has enabled him to secure the services. of many of the best trained and most experienced workers in the Northern Kingdom and to procure all necessary evidence of a scientific and trustworthy character. Mrs. Leslie Mackenzie has rendered her husband invaluable aid in the preparation of the volume and in the conduct of much of the investigation work on which the Report is based. Miss Bertram Ireland has acted as Secretary, and has much facilitated the work by her exceptional tactfulness and untiring industry. We have nothing but admiration and praise for this notable Report. No mere notice can in any way do it full justice. We trust it may be possible to
arrange that a copy is available in every reference library throughout the British Isles, so that all classes of students and workers may have ready access valuable a mine of information. The book consists of 660 pages, with 24 pages of illustrations, and there are
no less than 58 chapters. Some slight indication of the wide scope may be indicated by an enumeration of the titles of some of the chapters : “ Distribution of the Scottish People," "Provision for Prematernity : The Expectant Mother," " Provision for Maternity : The Nursing Mother," " Maternity Benefit : Its Working and Effects," “ Provision for Mother and Child under the Poor Law," “ Provision for the Unmarried Mother," "The Unmarried Mother's Child,” “The Employment of Expectant and Nursing Mothers," "Provision for the Feeding of Mothers and Children," “ The Housing of Mother and Child," “ The Provision for the Protection of Infant Life,” “Scottish Travelling Exhibition of Maternity and Child Welfare Work,” “The Birth-rate," “ The General Case for the Medical Supervision of the Pre-school Child," “ Death and Deathrates of Pre-school Children,” “ Principal Causes of Death of Pre-school Children," "Provision for the more Common Infectious Diseases,” “Provision for Tuberculosis," "Provision for Sick Children's Hospitals,” “ Provision of Hospital Convalescent Homes,” “Provision of Homes for Cripple and Invalid Children," vision of Holiday Homes : Fresh-air Fortnight," Recuperative Schools," "Rest Homes," Miscellaneous Institutions for Children,"“ Day Care of Children : Crèche or Day Nursery,'
" “ The Toddlers' Playground," "Play Centres,” “Playgrounds and Open Spaces," “ Correlation of the Pre-Five and Post-Five Play Centres and Playgrounds," "Open Spaces in the Large Cities and Mining Counties,” “Educational Aspects of the Day Care of Children,” “ The Kindergartens,” “Provision of Nurses in Scotland," “ Medical Service in the Highlands and Islands," “ The Position and Duties of the Health Visitor," “The Training of Health Visitors,"
Special Regional Studies," “ Schemes of Maternity and Child Welfare,” “ Practical Proposals for the further Promotion of Maternal and Child Welfare." Such an enumeration shows it to be hopeless to
attempt more than an abstract of so encyclopædic a volume. In Scotland there are 4,760,904 people, according to the last Census, scattered through 33 counties, with 312 public health districts and 874 civil parishes. Of the total population of Scotland 3,139,824 live in the burghs and 1,619,621 in the extra-burghal portions of the country. Scotland, in any single year has at least 110,000 expectant mothers. In 1916, when the birth-rate had fallen lower than in any year since 1863, the children born alive numbered 109,935.
The annual loss of children probably exceeds 20,000, including those who died at birth and the unknown numbers that by accident, or disease, or crime, died before birth. In the five years, 1911 to 1915, congenital causes account for the deaths of 23,481 infants under 1. In 1915, 4,615 children under i died of congenital causes. Roughly some 4,600 children die in Scotland every year from congenital causes. From these causes alone 46,000 children are lost to Scotland every ten years. In a normal year Edinburgh alone has considerably more than 6,000 expectant mothers; and in a normal year Glasgow has nearly 30,000 expectant mothers.
At the 1911 Census there were in Scotland 1,145,745 women of ages from 15 to 45, that is, the period of potential or actual motherhood. In the year 1915 there were born alive 114,181 children. Of the mothers of these children 698 died from puerperal conditions. In 1915 among women of all ages from 15 to 45 the deaths amounted to 6,574. With regard to the working of the modern system of so-called "maternity benefit,” the following general conclusions are presented : (1) The general effect of the system has been to raise the standard of attendance on maternity. (2) On the whole the money benefit is spent on the purposes for which it was intended, namely, the improvement of maternity service. (3) In the course of administration, the tendency to limit the individual's choice of doctor or midwife has asserted itself in various forms-sometimes as payment in “kind"; sometimes as special provision of a nurse; sometimes, and this is the most important, as an arrangement with a maternity institution for the special attendance of its maternity nurses. The general drift of administration seems
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to be towards the provision of medical and midwifery service rather than towards an increase of the individual's freedom of choice. (5) But the most striking development is the arrangement for more institutional accommodation and treatment, indoor and outdoor. In the five years 1911 to 1915 the total number of illegitimate children born was said to be 43,491. In the five years from 1901 to 1905 the number was 43,046. The annual average may be put approximately at 8,600. This means a yearly illegitimate birth-rate
13 for every 1,000 single and widowed women between the ages of 15 and 45. Reckoned in the same way, the 112,000 legitimate births would mean, roughly, a birth-rate of 230 per 1,000 of the married women between the ages of 15 and 45. The legitimate birthrate has been falling with some consistency. In 1901 it was 269 per 1,000 married women between 15 and 45; in 1911 it was 231; in 1914 it was 236; and in 1915 it had fallen to 216. Reckoned in the same way, the illegitimate birth-rate for 1901 was slightly over 13 per 1,000 single and widowed women between 15 and 45. In 1911 it was 14; in 1912 it was almost 14; in 1915 it was about 12. With regard to the intricate problem of the feeding of mothers and children, the opinion is expressed that it “demands prolonged investigation." A particularly valuable section is devoted to the question of the housing of mother and child, and the conclusion is expressed that “among the one-room population there are many other evil influences operative besides the physical dangers of overcrowding the lives of women and children necessarily suffer deterioration from life in one room ... the Scottish nation cannot any longer afford to keep up so many one-room houses; they mean too great a waste of the nation's real wealth-the mothers and their children." After a careful consideration of provisions for the protection of infant life, the following view is expressed : The field is now occupied by so many statutes and public bodies that, if merely as an economy of energy, some readjustment is necessary. .. It is certain that the provision for children tends to suffer from the multiplicity of administrative authorities responsible. I do not suggest that all
those authorities can be reduced to one; but I do suggest that there is room for a re-investigation of the whole machinery for dealing with children from the standpoint of health, education, and crime. It is not so much a question of legal powers as of administrative correlation." An interesting account is given of the Scottish Travelling Exhibition of Maternity and Child Welfare Work. study of national welfare the birth-rate deserves a foremost place. Scotland has Special need to consider this problem. The decline from the year 1876 is, on the whole, continuous. “Whether the birthrate be declining rapidly or not, the fact remains that the children actually born are not all well provided for in housing, or in food, or in general nurture. Even if the birth-rate falls as much in the next twenty years as it has fallen in the last, the infants born will present problems that nothing short of national organization can solve." In Scotland, the child
ters a public school when he completes his fifth year, but “the school child, as he appears at school, has already lived through a long and adventurous history." Large numbers of these young scholars start their school life seriously handicapped by physical defects. Some 81,900 entrants are submitted to medical examination annually. As regards teeth, 70 per cent. of all entrants are defective, and at least 25 per cent. have teeth in a very defective condition. This would mean for the whole of Scotland that at least 57,000 children begin school life every year with their teeth in a defective state, and that 20,000 of them have more than five teeth in decay. Vermin of the head are met with in 8 per cent. of town and county children, and 2 per cent. of the school entrants are verminous in body. Cases of malnutrition form 10 per cent. Approximately 4 per cent. have marked enlargement of tonsils or adenoids; this means that every year over 3,000 Scottish children begin their school life with nasopharyngeal obstruction requiring surgical treatment. Approximately 2,000 entrants have some form of inflammation of the eyes or their appendages, and something like 1,700 children are the subjects of squint or other disturbance of their seeing mechanism, quite apart from the number of simple cases of defective vision. About