Part 6

Every mother should, therefore, endeavour to take plenty of nourishment, so that she may be able to feed her child as long as possible. In order to be successful, a quart of rich milk should be taken daily; there will be no difficulty in digesting this, so long as she continues to nurse. Beer and stout, however, have been proved to be unnecessary and often harmful for the creation of pure milk. To show how important it is to nurse babies, it is only necessary to state that in London alone during the summer 200 infants die every week from “hot weather” diseases, in most cases propagated by flies which poison the milk.

The second cause of boy-mortality is the widespread, and often ignored, necessity for circumcision. Every male infant should be circumcised within the first week of its birth. If properly attended to, the child does not feel the slight operation, and naturally no anæsthetic is used. Circumcision is an insurance against many troubles later on. It is cleanly and a real safe-guard to morality from early boyhood upward. Every child thus attended benefits thereby, and it is especially desirable for children of neurotic or tuberculous parentage. It has been remarked that the Jews rear a much larger percentage of boys than do Christians, and there can be no doubt that the circumcision universally practised among them is one of the chief causes of this smaller mortality.

Anæsthetics must be resorted to if this operation is performed later on, and this, in itself, always entails a slight risk. Otherwise I hardly know a single case where any serious degree of trouble has arisen from circumcising an infant. On the contrary, I have seen great relief afforded by the operation. The number of cases is increasing yearly, and facilities should be extended to all classes for obtaining this necessary surgical treatment for their babies. Public opinion should be educated as to the great necessity of this operation, and, just as vaccination is compulsory, so should circumcision be looked on as necessary to the physical welfare of the male child.

With the advent of women into public life it was realised that their special profession of motherhood had not been adequately assisted or safe-guarded. Even before the war broke out, Government help was offered in the form of a grant to defray the expenses of local health work. As a result, England is now saving 50,000 babies a year, who would formerly have died. In other words, we are losing one in eight instead of one in seven, and the death-rate is proportionately lower.

During the great war England lost, every hour on the battle-fields abroad, ten men. At home every hour twelve babies under one year of age die. We could not save the men abroad, but we may well save as many of the infants at home. And it is the patriotic duty of every woman to help preserve the babies—the nation’s greatest asset.

PREMATURES

“There is no true potency, but that of help; nor true ambition, but ambition to save.”—RUSKIN.

There existed long ago in Paris, in the Boulevard des Capucines, an institution called “La Couveuse,” where, on payment of a franc, one could see an exhibition of babies, domiciled in incubators for the period of time requisite for their complete development. I do not know if the same place is still in existence, but when I saw it, it was a long room divided by a corridor with half a dozen incubators on either side.

Each of these was tenanted by a wee premature baby, which had made its appearance at least two or three months before it was expected. More than half of these infants (they were mostly boys) had enjoyed an embryo existence of just six months. They had, as Shakespeare puts it,

“come into the world Full fourteen weeks before the course of time.”

These babies were fed by three or four “nourrices,” who lived on the premises and supplied each little incubated person with a drop or two of human milk administered in a teaspoon, as none could suckle until the end of the seventh month.

Among these infants a little pair of red-haired twins, born at twenty-six weeks, were especially attractive. Their name was Smith, and they certainly had a familiar John Bull-like expression of countenance. Their native vigour proved itself in their obstinate battle for life. Two years later I was able to see those same twins in the best of health and spirits, and to all appearance as bonny specimens of humanity as any parent might desire.

Hitherto incubators had been regarded solely as a means for hatching chickens. It was in France that Dr. Tarnier for the first time applied the system to the rearing of weakly babies. At the Maternity Hospital in Paris, and in various other places in France, “couveuses” have now been employed, for over twenty-five years, with the greatest success. It seems a pity that in Great Britain the incubator is not more widely used. Perhaps on account of the antipathy shown in that country to the wet-nurse system, artificial feeding is a stumbling block. It certainly is almost impossible to rear an infant born at six months on anything but human milk. Wonderful results have been obtained, thanks to the incubator and human milk combined, while many thousands of invaluable boy-lives have been sacrificed for the lack of combined artificial warmth and proper feeding.

Personally I know of no less than eleven little six-month prematures who could have lived and thrived, had an incubator been available. One case in particular was heart-rending, as the tiny creature cried pitifully for nearly twenty-four hours on end, as if begging to be saved. Born at six months from the last day of period, he was well made, with a voice as strong as any full-time infant’s. Unfortunately it was bitter January weather, and no amount of hot water bottles could keep the cold air from his little lungs. He died the following day, literally perishing with the cold, and worn out with his struggle for life. Here was a case where an incubator would have solved the problem of rearing successfully a perfectly healthy atom of humanity, thrown into the world before its time, owing to the fact of its mother being elderly and not of a very robust nature.

A medical friend of mine told me recently that, had he been able to procure an incubator, he was sure his own seven-month baby girl could have been reared. Twenty-five years ago an attempt was made to introduce them in England, and I know personally of two mothers who made use of them with success. In one case a very tiny seven-month girl was put in an incubator for two months, and has grown up to be a fine healthy young woman. The other did equally well, and is, I believe, still a woman of strong constitution.

Why the use of incubators did not become more general was evidently because they were difficult to procure and expensive to hire. Then the question of food without the wet-nurse system renders them very difficult to use privately. But there seems to be no reason why these difficulties should not be overcome in hospitals and private “Homes” where so many premature, or difficult, lying-in cases are to be found. Wet-nurses doubtless could be obtained, and, if this were not possible or desirable, humanised milk or some patent food administered, with effective, if not equally excellent results.

As a rule I do not hold with the wet-nurse system; it has been tried for generations and found wanting. The moral question is at the bottom of the failure. Perhaps also the eugenic point of view had something to say about the transmission of hereditary taints through the milk of a foster-mother, quite frequently drawn from the lowest stratum of society. In the last generation, of course, the use of wet-nurses was an habitual occurrence with the well-to-do. But then it was a common question whether the child did not often become similar in ways and even looks to its foster-mother.

My own mother, who had ten children, of whom four had wet-nurses, used to remark in her latter days how much these children partook of the robust health and nature, and even looks, of those who had nurtured them. In the case of one of my brothers this was especially marked, and it was also certainly noticeable in one of the girls.

In France, where many children are put out to nurse, the disadvantages outweigh the beneficial results of human lactation. The nurses hold such a sway over the mothers, and in many cases abuse the power they control to such an extent, that the mother’s care is discounted; her maternal instincts are blunted, and the child, once weaned, becomes the defenceless victim of ignorant incompetence and wrong feeding. Meanwhile, the nourrice returns to her native village to find the child she left as often as not a puny weakling, suffering all the evils of maternal neglect.

Nevertheless, if a wet-nurse were immediately available, she would accompany the promptly forthcoming incubator when required, and many thousands of premature male lives could be saved. I say male advisedly, for the reason that a six-month baby is nearly always a boy, whereas the rare five-month miscarriage is generally a girl. In April, 1915, at Sunderland, England, a Mrs. Pallion, the wife of a soldier, gave birth to premature boy-triplets. They were immediately conveyed to the Children’s Hospital and placed in incubators. They have all survived and done well, and were duly christened Kitchener, Jellicoe and French. The public can hardly realise the enormous number of children lost to the nation as a result of still or premature birth.

As a rule no fœtus is born viable before twenty-six weeks, though according to Scotch law, an infant may be viable at six lunar months or 168 days. A Mr. Tait reports a case in which the mother gave birth to a girl at five months and twenty-seven days. It lived four months. Dr. Keiller recorded particulars of a case in which a child of about four months intra-uterine life lived for about an hour. It weighed 9½ ozs.

Under ordinary conditions it is almost hopeless to try and save these mites; but, if the greatest care is exercised, it is nevertheless possible to rear a goodly proportion, in spite of the many difficulties. Here is a case in point from my own experience: A Scotch woman, over forty and very stout, gave birth to a seven-month girl, her first-born. She reared it with trouble owing to her inability to nurse it. Nine months later she became pregnant of a boy, which was born barely over the six months. A day after its birth, when weighed, it turned the scale at 1 lb. 10 ozs. The doctor present did not think it would survive. It seemed impossible to keep the infant warm, as it had no powers of suction.

When asked to take over the baby, my first care was to wrap him in cotton-wool and flannel, discarding the cotton shirt in which Highlanders invariably swathe their shivering offspring. I next secured a rubber hot water bottle, filled it with warm water, and baby and bottle were rolled up together in a blanket. The next problem was how to feed it. The mother, happily, had plenty of milk this time, and by means of a teaspoon I drew off a few drops at a time and fed the baby every half-hour. He stopped crying and slept for hours on end. The bathing difficulties were great, as he was so tiny as to fit into my hand, and his little legs were about as long and fat as my finger.

After seven days of this system, in which I was helped by the devoted and painstaking mother, the infant had gained 6 ozs. and began to look almost like a real baby. At the end of three weeks, during which time we just managed to keep the mother’s milk-supply going, the child was able to suckle all he required for the nourishment of his minute frame. By that time he weighed 3 lbs., and had acquired a good hold on life. For three months he lived and slept with the hot-bottle, and at the end of that time he weighed 7 lbs. At one year he weighed 20 lbs.—well above the average weight—and, as I write these words I recall that he has grown so big as to need “breeching,” much to the satisfaction of his excellent Highland mother.

The moral of this story is that if a hot-bottle and mother’s-milk could save such a “puir wee loon” as that recorded above, thousands of babies in similar plights could be saved yearly. The whole care consists in the proper warming and feeding of these premature infants who need to be literally coaxed into remaining with us in this cold and hungry world. In New Zealand, state and voluntary efforts have united to provide what is, judging by the results, the most perfect system for the care of maternity and infant welfare that the world has ever seen. A voluntary society has management and control of the whole work. No money grant is made, but aid is given in skilled attendance, advice, and teaching. In five years the infant death-rate has fallen from 80 to 35 per 1,000, whereas in Australia it still stands at 71. It is significant that this marvellous superiority in the numbers of children reared in New Zealand dates from the time that women were given the vote.

In England in 1914 the death-rate was as high as 108 per 1,000 births. In 1924 it was only 69 per 1,000. In twenty-five years it had been reduced from no less than 150 per 1,000 to 69. There are now 2,200 infant welfare centres in the country, and 2,650 women employed on infant-welfare work. In Germany, France and Italy, the death-rate of infants is terribly high, and in modern Greece only one child in three survives to its first birthday. The reasons alleged for this state of affairs are the sudden changes in the fickle winter weather, and the amount of soft fruit with which babies are generally fed in summer-time.

As regards the death-rate from causes connected with maternity, there has been a great improvement in England since the passing of the Midwives Act. There are now 135 maternity hospitals and homes, and, whereas 20 years ago, five mothers died for every 1,000 children born, the rate has now been reduced to less than four. With the advent of the new method known as “Twilight Sleep” or painless childbirth, and the numerous other means of ameliorating the condition during confinement, no woman need dread the ordeal of childbirth, but can look forward with unmixed joy to the advent of the child of her desire.

The excess of boy-births over girls has been recorded in Germany, France, and England for more than 200 years as being at the rate of 106 boys to 100 girls; but against this we have to reckon with the greater mortality of males already described, which, of course, does not include the death-rate causes connected with men’s several callings, e.g., the army, the navy, mines, colonial pioneering, etc. I have enumerated the many ways in which we can help enormously to reduce male infant mortality, and that surely is the first and most important step. In 1916, it was calculated that in Australia, 72 babies died out of every 1,000 born before reaching twelve months of age; in Norway 72, in Sweden the same and in Holland 99, in the United Kingdom 109, in France 120, in Germany 170 and Austria 205. But in New Zealand, where women take an active part in public life, only 35 babies die out of every 1,000 born. These figures tell their own story. Where women have most power, the infants have the best chance of living.