Even simpler is the question of infant mortality.[1] In computations dealing4 with this matter it is not necessary to make use of the figures of the general census5, for the calculations are based simply upon the recorded births and deaths. The calendar year in which the birth took place does not come directly into the question at all. What we record is the rate per thousand at which, in or during a particular year, say 1909, infants have died before attaining6 the end of the first year of their life; some of these will have been born in the year 1909, others, of course, in the year 1908.
Nearly 30 per cent. of all deaths are infant deaths; about 10 per cent. of all deaths are those of children of ages one to five years; about 50 per cent. of all deaths are those of children from birth to fifteen years. The least dangerous section of human life is between the ages of ten and fifteen years. Child mortality, extremely heavy during the year of infancy7, diminishes greatly after the completion of the first[18] year, and diminishes enormously after the completion of the fifth year. In the civilised countries of Europe, at the end of the nineteenth and the beginning of the twentieth century, of every 1000 infants, from 100 to 300 die, on the average, every year. The attainable8 minimum of infant mortality, under conditions practically realisable to-day, may be regarded as about 70 per 1000. In families in which exceptionally favourable9 conditions prevail, the infant mortality rate is even lower than the figure just stated; in the families of the higher aristocracy and among the royal houses it is as low as one-half, and even as low as one-third, of this “practicable minimum” of 70 per 1000.
Since the middle of the eighteenth century there has, in nearly all the countries of Europe, been a decline in infant mortality, in the case alike of boys and of girls; this fall in the infantile death-rate is greater than the fall in the general death-rate. Although the data available justify10 this general statement, it is necessary to point out that authentic11 statistical data bearing on the question exist only in the case of small and isolated12 areas, such as individual towns; national registration13 of such particulars is of much more recent date than the middle of the eighteenth century.
Certain Contributory Causes.—The influence upon infant mortality of certain causes commonly regarded as important is in fact small. Statistical data prove beyond dispute that local and climatic factors exercise no direct influence at all upon the infantile death-rate; such influence as these factors do exercise is an indirect one, operating through the effect which climate and locality may have upon social conditions. The same qualification applies to the influence of race and of religion upon infant mortality. There are differences in the infantile death-rates as between Teutons and Slavs, and as between Christians14 and Jews; but these differences are in no way directly dependent upon the differences in race or in religion, and they must be ascribed to the differences in social conditions. Fertility is well known to exert a decisive influence upon infant mortality; but variations in fertility are not the direct effect of any differences in race or creed15; they are a consequence of the varying social conditions in which those of[19] the respective races or creeds16 actually live. Thus it is only in certain social conditions that Slavs are more fertile than Teutons, and Jews more fertile than Christians. The constitution of the parents exercises a considerable influence upon infant mortality; but the parental17 constitution must be regarded as largely dependent upon the social environment in which the parents themselves have grown to maturity18.
The Chief Causes of Infant Mortality.—Among the commonly enumerated19 conditions affecting infant mortality the following are conspicuous20: the proportion of infants reared by artificial feeding instead of being suckled; work for wages by the mothers of infants; the general intelligence of the lower classes of the population, and their knowledge of the care and management of infants; the general state of the public health, including such conditions as the degree to which the general population is enabled to avail itself of the medical knowledge of our time (in all the countries claiming to be “civilised,” bald official statistics prove beyond dispute that a large proportion of the children dying before attaining the age of one year die without having ever received any medical treatment whatever); the number of illegitimate births, &c. But all these conditions are in essence nothing more than social conditions. Thus we are practically justified21 in saying that the determining factors of infant mortality are social conditions and nothing else. With striking unanimity22, those who have made a special study of this question formulate23 the conclusions summarised in the following paragraph.
The infantile death-rate is higher among the lower classes than it is among the upper. Within the limits of those making up what are termed “the lower classes,” the infantile death-rate is higher in proportion as the social conditions are unfavourable. The figure attained24 by the infantile death-rate depends above all upon the social circumstances and the earning capacity of the parents. Inasmuch as an infant does not possess the faculty25 of spontaneous change of place or of other spontaneous activity, since it is unable even to express its needs in an intelligible26 manner, its fate depends upon the soil in which it grows—its very life depends upon its environment. Such, from the social standpoint, is the essential[20] characteristic of the age of infancy. The infant born of well-to-do parents has better chances of life than the infant born of poor parents, for the former lives in more favourable circumstances, and receives in every respect a better upbringing. It is a demonstrable fact that most children that die succumb27, not from inherited weakness, but owing to the errors and defects of their upbringing.
The materials available in proof of this proposition are ample and incontrovertible. Whatever the place, the time, and the other conditions submitted to investigation28, and whether the investigated materials be large or small, we are led invariably to the same conclusions. In the bourgeois29 (middle and upper) classes, only 8 per cent. of the children die during the first year of life, but among the proletariat the infantile death-rate is 30 per cent. Even more significant, if possible, are the following facts. The infantile death-rate is higher among illiterate30 wage-earners than it is among literate31 wage-earners; it is higher among casual labourers than it is amongst wage-earners permanently32 occupied. In the strata33 of the population above the manual workers, we find that the infantile death-rate is lower as we pass from strata in which social conditions are comparatively bad to strata in which they are comparatively good. The infantile death-rate and the income of the parents vary in inverse34 ratio. The differences in the infantile death-rate as we pass from the poorer quarters of our towns to the richer quarters tell always the same tale.
The Great Number of Children.—The chief cause of high infant mortality and of high child mortality among the lower strata of the population is the great size of their families. The number of conceptions, pregnancies35, and births varies directly as the infantile death-rate. If out of a certain limited income more children have to be maintained, the share of each in the commodities purchasable out of that income necessarily diminishes. The income of the manual worker is so small that, even if his family is quite a small one, it is exceedingly difficult for him to provide out of that income what he and his wife and children need for the satisfaction of elementary vital needs. With every additional child comes a[21] further limitation of supplies for each individual member of the family. Not only does this have a directly unfavourable influence upon health, inasmuch as each child receives a smaller share of dwelling36-room, food, &c. In addition, as more and more children are born, the worth of the individual child in the eyes of the parents diminishes.
The mother’s health is apt to suffer from the rapid succession of conceptions, pregnancies, and deliveries. For various reasons this is disadvantageous to the children. A woman thus affected37 will subsequently bring more weakly children into the world; the mother whose health is poor is unable to give as much time and pains to the rearing of her children as she would if she were well and strong; many women whose health has been broken by unduly38 frequent pregnancies die during a subsequent pregnancy39 or delivery.
But may it not be that the relationship between a large number of births and a high infantile death-rate is the reverse of that which we have suggested? Is it not possible that the great mortality among children may be the cause of an increase in the number of conceptions, pregnancies, and births? It is true that certain purely40 psychological factors may contribute to such a causal sequence. To a certain degree a high infantile death-rate has such an effect. For if a woman gives birth to a diseased or a still-born child, or if one of her children dies, the parents are more likely than would otherwise be the case to desire to have another child, and the wife will be more ready to undertake the troubles of another pregnancy and the risks of another delivery.
The most important means for the diminution41 of child mortality is to improve the conditions of working-class life. It is indisputable that the more prosperous members of the working class have fewer children on the average than those who are not so well off; that in any region in which an improvement has taken place in the conditions of working-class life a fall in the birth-rate has ensued; that the poorer the condition of any stratum42 of the proletariat, the larger is the average family. An increase in the average working-class income will lead to a proportionately greater decline in the death-rate of infants and young children. For this increase[22] in income will operate in two ways: in the first place, if the number of children remain the same, the rise in income will ensure for each child a larger share of the necessaries of life; and, in the second place, with the rise in income the size of the average family will diminish, and this will reduce the child mortality. Inasmuch as the height of the infantile death-rate depends mainly upon the great infant mortality among the lower strata of the population, every effort at reform in this direction must begin at the lower end of the social scale.
Child Mortality in the Towns.—A connection appears to exist between density43 of population and the death-rate: if the other conditions remain unchanged, the death-rate increases pari passu with increasing density of population. The question whether in the towns child mortality is higher than in the country districts has not yet been decisively answered; and it is equally uncertain whether from the hygienic standpoint the existing rural conditions are better than the urban. It appears probable that child mortality is higher in the towns than in the country districts; it is more doubtful, however, if the same can be said of infant mortality. The statistical data available on this question must be subjected to a stringent44 critical examination. The infant mortality which truly belongs to the towns appears smaller than it really is, for the reason that a proportion of the infants born in the towns are placed in the care of foster-parents living in the country, and some of these die in the country. It is equally true that many people from the country die in hospitals and other institutions in the towns; but this applies much more to adults than to children.
The proletariat constitutes a large majority of the inhabitants of the urban districts; the proportion of artificially reared children is greater than in the country, the housing conditions are less favourable, there is less opportunity for open-air life, venereal diseases are more prevalent, and fertility is lower. But against these considerations we must set the fact that the urban population is more intelligent, and for this reason better understands the various methods of artificial feeding of infants; the fact that charitable institutions are more[23] effective in the towns, and the fact that in the towns better hygienic conditions prevail. The sanitary45 improvement of the towns by better cleansing46 of the streets, an improved water supply, better methods of disposing of sewage and refuse, &c., has led to a reduction not merely of the general urban death-rate, but also of the infantile urban death-rate; whereas in the country districts these rates have remained stationary47, or have even undergone an increase. In wealthy towns the death-rate is lower than in poor towns; like differences are observed as between the rich and the poor quarters of one and the same town. Wealth has so marked an influence in lowering infant mortality that in the wealthy villa48 quarters of large towns the infantile death-rate may be as low as from 10 to 20 per mille.
The Effect of Housing Conditions.—The infantile death-rate is very closely connected with the character of the housing conditions. The rate of infant mortality in any particular dwelling varies directly with the number of inhabitants, and varies inversely49 with the number of rooms available per family. Those living in the upper stories of tenement50 houses have a higher death-rate than infants living in lower stories and basements. This influence of bad housing conditions in producing a rise in the infantile death-rate is only to be expected. The habitation exercises its influence upon the infant by day and by night, and through every detail of the infant’s life. To give one instance, there is an intimate connection between the quality of the dwelling and the quality of the infant’s food; in a suitable dwelling milk may be more readily kept cool, preserved from contamination, sterilised, &c.
The Effect of Age.—The degree to which bad conditions of life endanger health varies inversely with the age. The maximum danger to health from such conditions is incurred51 by infants. The younger the infant the greater the danger that bad conditions will prove fatal; and most of the environmental factors unfavourable to the maintenance of infant life come into operation immediately after birth. The younger the infant, the less resistant52 it is to external influences. Therefore the younger the infant, the more carefully does it need to be watched and safeguarded. Physicians and statisticians lay[24] great stress upon the degree to which the infant’s chances of life depend upon its age in days and months.
Time of Birth, Seasons, and Meteorological Conditions.—Is it possible to demonstrate the existence of any connection between the time of birth and the temporal variations in the infantile death-rate? In the months in which the number of births is high, the infantile death-rate is probably also higher than at other times. This is true more especially of the very cold months, when infants cannot be taken freely into the open air; it is true also of the very hot months. It is well known that the annual curve of births exhibits two notable elevations—one in February and March, and the other in September; this depends on the fact that most conceptions take place, on the one hand, in the spring-time—that is, at the time of the general awakening53 of nature; and, on the other hand, in December, when nature reposes54, and agricultural labours are at a standstill. But owing to the fact that the factors influencing infant mortality are so numerous and variable, it is not possible to demonstrate any definite relationship between the times of maximum births and the times of maximal infantile death-rate.
The seasons and the meteorological conditions exert an influence upon infant mortality through the intermediation of their effect upon various social conditions. The infantile death-rate is highest during the summer, the rate in the months of July, August, and September greatly exceeding that in the other months of the year. During the hot season, contaminated and decomposing55 milk gives rise to fatal illness on all sides. When we compare different years, we find that the height of the infantile death-rate varies directly with the heat of the summer. This influence of the hot season is exerted almost exclusively upon artificially reared infants, and especially on those in whom the technique of artificial feeding is improper56. It is an established fact that the children of the well-to-do largely escape a similar fate, simply because that in their case it is possible to keep the milk artificially cool, and to prepare it more carefully in other ways.
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1
statistical
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| adj.统计的，统计学的 | |
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thoroughly
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| adv.完全地，彻底地，十足地 | |
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complicate
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| vt.使复杂化，使混乱，使难懂 | |
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dealing
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| n.经商方法，待人态度 | |
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census
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| n.(官方的)人口调查，人口普查 | |
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6
attaining
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| （通常经过努力）实现( attain的现在分词 )； 达到； 获得； 达到（某年龄、水平、状况） | |
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infancy
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| n.婴儿期；幼年期；初期 | |
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attainable
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| a.可达到的，可获得的 | |
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favourable
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| adj.赞成的，称赞的，有利的，良好的，顺利的 | |
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justify
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| vt.证明…正当(或有理)，为…辩护 | |
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authentic
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| a.真的，真正的；可靠的，可信的，有根据的 | |
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isolated
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| adj.与世隔绝的 | |
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registration
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| n.登记，注册，挂号 | |
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Christians
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| n.基督教徒( Christian的名词复数 ) | |
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creed
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| n.信条；信念，纲领 | |
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creeds
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| （尤指宗教）信条，教条( creed的名词复数 ) | |
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parental
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| adj.父母的；父的；母的 | |
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maturity
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| n.成熟；完成；(支票、债券等)到期 | |
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enumerated
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| v.列举，枚举，数( enumerate的过去式和过去分词 ) | |
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conspicuous
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| adj.明眼的，惹人注目的；炫耀的，摆阔气的 | |
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justified
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| a.正当的，有理的 | |
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unanimity
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| n.全体一致，一致同意 | |
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formulate
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| v.用公式表示；规划；设计；系统地阐述 | |
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attained
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| （通常经过努力）实现( attain的过去式和过去分词 )； 达到； 获得； 达到（某年龄、水平、状况） | |
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faculty
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| n.才能；学院，系；(学院或系的)全体教学人员 | |
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intelligible
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| adj.可理解的，明白易懂的，清楚的 | |
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succumb
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| v.屈服，屈从；死 | |
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investigation
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| n.调查，调查研究 | |
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bourgeois
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| adj./n.追求物质享受的(人)；中产阶级分子 | |
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illiterate
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| adj.文盲的；无知的；n.文盲 | |
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literate
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| n.学者；adj.精通文学的，受过教育的 | |
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permanently
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| adv.永恒地，永久地，固定不变地 | |
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strata
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| n.地层（复数）；社会阶层 | |
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inverse
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| adj.相反的，倒转的，反转的；n.相反之物；v.倒转 | |
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pregnancies
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| 怀孕，妊娠( pregnancy的名词复数 ) | |
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dwelling
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| n.住宅，住所，寓所 | |
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affected
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| adj.不自然的，假装的 | |
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unduly
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| adv.过度地，不适当地 | |
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pregnancy
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| n.怀孕，怀孕期 | |
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purely
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| adv.纯粹地，完全地 | |
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diminution
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| n.减少；变小 | |
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stratum
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| n.地层，社会阶层 | |
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density
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| n.密集，密度，浓度 | |
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stringent
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| adj.严厉的；令人信服的；银根紧的 | |
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sanitary
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| adj.卫生方面的，卫生的，清洁的，卫生的 | |
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cleansing
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| n. 净化(垃圾) adj. 清洁用的 动词cleanse的现在分词 | |
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stationary
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| adj.固定的，静止不动的 | |
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villa
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| n.别墅，城郊小屋 | |
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inversely
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| adj.相反的 | |
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tenement
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| n.公寓；房屋 | |
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51
incurred
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| [医]招致的，遭受的； incur的过去式 | |
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resistant
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| adj.(to)抵抗的，有抵抗力的 | |
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awakening
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| n.觉醒，醒悟 adj.觉醒中的；唤醒的 | |
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reposes
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| v.将（手臂等）靠在某人（某物）上( repose的第三人称单数 ) | |
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decomposing
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| 腐烂( decompose的现在分词 )； （使）分解； 分解（某物质、光线等） | |
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improper
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| adj.不适当的，不合适的，不正确的，不合礼仪的 | |
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