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and I wanted to know about those still-births: what is the movement of the figures? For instance, it would interest me profoundly to be able to discover, assuming that other things were constant, the relation between the reduction of the convictions of women for drunkenness and still-births; as it interested me profoundly to know that in Paris, as I said in my lecture last year, when the sale of spirits to women was entirely prohibited, the still-births fell to the lowest on record. This morning Sir Bernard Mallet and Dr. Stevenson told me that they work under a statute dated 1836. Under that law a stillbirth is nothing, non-existent; and they told me, further, that the whole English-speaking world, the whole British Empire, and the United States have based their procedure on ours, and that to this day you will get nothing about still-births. A new volume which has just been published in America, the first official document ever published there with regard to natality statistics, contains no allusion to stillbirth. I wonder what Dr. Ballantyne and Dr. Routh think of that? Let us hope for better things when our Chairman, Lord Rhondda, gets the Ministry of Health which I asked for, as an urgently needed War measure, in 1915, and which he so powerfully championed during his wonderful term of office at the Local Government Board last year; and when Sir Bernard Mallet gets the reforms in vital statistics, through a General Register, which he desires. But, already, we know to-day that the infant mortality curve is only the second half of a curve which was going on before it, and which was higher still. As for the neo-natal mortality, it is largely the result of mortal injury effected in the ante-natal period, leading to a fatal issue some time after birth. As long as the infant is within its mother it has unique advantages, not only in regard to nourishment, but also as regards disease. One of the great killing diseases of infancy, we have seen, is syphilis. The infant is infected by syphilis through its mother before birth. Frequently it is killed and born dead; but frequently it does not die nor even show symptoms till after birth, and then it dies. The remarkable fact emerges that the record of our best new anti-syphilitic drugs for infants after birth is one of almost absolute failure. But those same drugs, used before birth, give splendid results. There is something at work before the infant is born which makes for its health and makes for the mother's health. Each helps the other: salvarsan given then is worth more to both than given to either afterwards. Similarly, though the mother will eventually die from tuberculosis, as long as she is carrying the infant the disease holds its hand. The relation between
mother and infant is not, as is often said, and as superficially appears, a parasitic one. There is a symbiosis between mother and infant; the clinical facts of syphilis and tuberculosis can mean no less. They still further confirm the assertion that our problem, even in its immediately medical aspects, is really a social problem of motherhood. I insist on that for a special reason. Since Baby Week last year a good deal of nonsense has been authoritatively published on this subject. A distinguished student of State Medicine has written a book in which he comes to the conclusion that the main factor of infant mortality is urban smoke. The Medical Research Committee of the National Health Insurance Commission, which has done splendid work in connection with special medical problems, have published a report on infant mortality which, being a quite unofficial person, I will call gravely mischievous-except that it could not deceive anybody who had ever been in contact with the problem at all. Suffice it to say that they decry the importance of the maternal and the ante-natal factors. As for smoke-which no one hates nor has more constantly arraigned as an enemy of the public health than I-take just two instances. Compare the Jewish infant mortality with the non-Jewish infant mortality in any dirty city, say London or Manchester. Roughly speaking, both breathe the same air, yet the mortality among Gentile infants is in general about twice that among the Jewish infants. Second, go to a city like Munich. It is situated very high above the sea; running through it is the very rapid stream whose name we learnt at school, "'tis Iser rolling rapidly." The Iser produces electricity to run the whole city of Munich, which is absolutely clean, with pellucid airParis is dirty in comparison; all the public buildings and statues in Munich always look as if they had just been washed. Or, if you are not quite satisfied with that, go on through Verona to Venice, which enjoys an almost absolutely dustless air, thanks to its unique position in the sea. The infant mortality in both those cities is disgraceful, their wonderful air notwithstanding. The infant has an environment nearer to it than the air it breathes-Closer is She than breathing, and nearer than hands and feet; and if you want to understand and resolve all the paradoxes and antinomies of infant mortality, you will do so in Her and in Her alone.
If these conclusions are sound, we will beware of all the old teaching to devote our attention to the material factors primarily, and we will beware of all the solutions of the infant mortality problem which omit the mother, even although they give us a temporary substantial
success. We will regard the crèche and the sterilized milk dépôt as only tolerable faute de mieux. Indeed, though they save babies, they only interfere with the real solution of the problem. Napoleon said that, in war, the moral factor is to the material as three to one. I will say, without vouching for the figure, any more than Napoleon could, that in our great campaign of peace, for Saving the Future, the maternal, which is the primal moral, factor is to the material as ten
One more illustration. The city of Bradford presents the most remarkable problem in infant mortality in our country at the present time. It has long been a very prosperous city, and has never been so prosperous as it is to-day, owing to the importance of wool. It has a very remarkable man in the Chairman of the Public Health Committee, Mr. E. J. Smith, and an admirable medical officer of health in Dr. Buchan. On each visit I pay to their city I learn more from these great practical exponents of infant welfare. The city, of some 300,000 inhabitants, spends £20,000 a year on infant mortality work, under the direction of these devoted and masterly students of the problem. No other place in these islands can compare with Bradford for the magnitude and thoroughness and science of its effort, in all the chief essentials, but one. The infant welfare department is a very model of its kind. Yet the figures are still deplorable. The infant mortality last year was 132, the general death-rate being 14'6, and the birthrate 132. Thus, apart altogether from its losses at the Front, Bradford is dying out. There are fewer babies born, the babies die fast, and all this in spite of wonderful effort, perfectly co-ordinated, well devised and splendidly executed-now including extensive ante-natal provision. There is a splendid system of free feeding for expectant mothers, but the mothers have so much money now that they do not patronize their feeding centre, which has been converted into a National Kitchen. Yet look at last year's dreadful figures, under conditions of unexampled prosperity. What they would be without Councillor and Dr. Buchan one does not care to think.
Now let us go to Ireland, to Connaught, where there are poverty and not merely ignorance, but the people's heads full of nonsense, and always ready for more-a much more serious condition than mere ignorance; medical resources, nursing and ante-natal resources, standard of obstetrics, of housing, of public effort, all best left undescribed. The birth-rate is a trap for the unwary, a very low, crude birth-rate; but, examined in terms of women of reproductive age—
which is the only way to understand a birth-rate-it is extremely high. In other words, there are very few women of reproductive age in the province, but they have very large families, and thus the corrected or standardized birth-rate is actually no less than 45. It is a fact in general that large families and a high birth-rate usually go with a high rate of infant mortality. In Connaught, under these conditions, what are the figures? Everything-but one thing, which is everything is against the infant, and yet the infant mortality for Connaught is about 50 as compared with 132 in Bradford, with all its municipal devotion and resources and its very small families. In County Roscommon the infant mortality in 1916 was 35. Poverty, ignorance, a plentiful lack of everything that knowledge and civilization can provide, swarming families, but Roscommon's infant death-ráte little more than one-fourth that of wealthy, generous Bradford, with its rare babies. But the Connaught babies have healthy mothers, with an extreme minimum of syphilis, who stay at home and feed them as no science can feed them, and the babies live. Though the material environment is as wrong as it can be in almost every particular, the maternal environment is right. True, the mothers are ignorant; if they were not, the infant mortality would be practically nil, I suppose, as it is amongst Quakers in England. And in Bradford, you see, practically all the mothers in Bradford go out to work; I think nearer 90 per cent. than 80 per cent. now. That is the fundamental sin against the laws of life. I do not use the word in a theological sense, for I am not a theologian; but here it suffices to be a biologist and a mammal.
I think I have now proved my case. For practical purposes we may say that, other things being equal, or unequal, according to the maternal environment, ante- and post-natal, so is the infant's chance of life. But you may say that this is to omit the father. This is not to omit the father, because the father can determine the maternal environment. Thus, if he goes away from the home and brings back syphilis, and ruins the maternal environment, the child will very likely die. The paternal environment conditions, in large degree, the maternal environment. The determining, immediate factor of infant life or death, compared with which all others are relatively trivial, is the maternal factor. Hence, the paradox that poverty kills babies and prosperity kills babies. If poverty is going to damage the maternal environment because, for instance, the mother is starved, then the baby is starved. If the mother is prosperous, per contra, because she leaves the home, cannot be
bothered with the baby, and abandons it to the "care" of others, who feed it on "humanized" milk, whilst she makes plenty of money, as in Bradford, then prosperity is going to kill babies. And the moral is, Whom Nature hath joined together, let no man put asunder. Not Baby Week, really, but Mother-and-Baby Week. Le lait et le cœur d'une maman ne se remplacent jamais. Poy's cartoon is very jolly and English and modern, but my verdict is still with Botticelli.