THE

MATERNAL MANAGEMENT

OF

CHILDREN.

Introductory Remarks on the Great Mortality of Children, and the Lessons which this Knowledge teaches.

1

In the Supplement to the Thirty-fifth Annual Report of the Registrar-General 1 we find it stated that one child out of every six that are born dies within the first five years of its birth, even in the healthy districts; and that in Liverpool, which serves to represent the most unfavourable sanitary conditions,' ' nearly half the number born die in the five years following their birth.' It can be seen also, by reference to the elaborate tables of mortality, that more than one-half of the entire number of the deaths takes place during and within the first year of life.

Dr. Farr, in referring to this subject, says: "The mortality of infants evidently depends, to some extent,

Published by Messrs. Eyre and Spottiswoode. London, 1875.

on the midwifery of a country: on the way the children are fed by the mothers; on the water; and on the cleanliness observed, as well as on the other sanitary conditions.'

Now these observations are founded on actual statistics, compiled by order of the Government, and can be consulted by anyone who feels inclined to doubt their accuracy. It is exceedingly probable that this rate of mortality (which is computed for the whole of England) is higher than that which actually occurs in the class of people who care to consult such a book as this. But although certain social and sanitary conditions surround the children of this class which undoubtedly tend to lessen the mortality, it is yet only too evident that much remains to be accomplished, and that the conditions which alone render a child vigorous at its birth and enable it to live through the most critical period of its life are either misunderstood, neglected, or ignored. To show what these conditions are, and how they may best be carried out, and above all, to prove that they cannot be neglected with impunity, is one of the objects of this little work. Whatever be the mortality in any given class of the community-small or great, it may be greatly diminished. The distress of witnessing a suffering infancy cut short by an early death just as the child is beginning to reward all the parents' care and anxiety, may be prevented in multitudes of cases. But the early death of offspring is not the only penalty that must be paid. For, what is still worse, they survive only to struggle with all the consequences of weak constitutions, and to perish just as they begin to fulfil all the hopes of their friends. Or, if this do not happen, they carry through life, as long as it lasts,

a state of health which deprives their minds of elas ticity, their tempers of serenity, and their duties of enjoyment.

Since the diligent observance of what is to be recommended to her involves so great a reward, and its neglect so painful a retribution, no appeal to the mother's sense of duty can be needed. It is true she must be content to take the representations here given on trust, unless she extend her studies beyond these pages. If she is alive to her responsibilities, she will not withhold her earnest and conscientious attention, until she has mastered the evidence on which the medical profession urge compliance with all the means of ensuring health.

The causes which affect the health and life of offspring fall under two heads: those which have reference to the state of the parents before the birth of the child; and those which act directly upon the child after the commencement of its independent existence.

The first class includes, of course, those tendencies to disease which are derived from both parents at the time of conception, and those which act through the medium of the mother's system alone, and which are especially under her control-viz., her state of health and conduct during pregnancy. Of the influence of those which operate at the time of conception, the most striking contrasts are met with in different families. Amongst the wealthy of the land, where the nurture of the body is sedulously pursued, and under the greatest advantages, it is sometimes found to be difficult, and in many instances impossible, to rear the children to maturity. Consumption, or strumous disease in one or other of its manifold phases, or some other hereditary disorder, carries off