It is desirable that the mother should not be over burdened by physical or mental tasks in the months preceding the child's birth, but a blanket injunction against wage-earning would not yet be warranted, because it seems to be difficult to determine just what forms of employment are injurious and at what point the injury begins. That a woman should not be employed in a steam laundry or an ordinary factory, or in any other occupation making similar demands on her strength, in the weeks im mediately before confinement is generally agreed, and legislation to this effect should be extended, even though there is probably no considerable number of American women in danger of subjecting themselves to such risks. It is in the first year of the child's life, however, rather than before its birth, that the problem of the wage-earning mother is the most serious. John Burns once referred, in his picturesque way, to countries "where industries flourish, where mothers labour, and where babies decay "; and it is not an accident that textile workers in England show an infant mortality rate exceeded only by that among miners and unskilled laborers,* nor that Fall River and Lowell, New London and Willimantic have much higher rates than New York and Boston. Any work—pro fessional, industrial, or unclassified—which inter feres with the nursing of the child by its mother, either because it exhausts her power or because it keeps her away from home, is condemned from the point of view of the child's welfare. Day nurseries attached to factories in which the work is not ar duous and the sanitary conditions are good might be a genuine advantage to mother, child, and em * Forty-third Annual Report of the Local Government Board, p. xxix.
ployer. Day nurseries which receive babies a week or ten days old at seven o'clock in the morn ing and hand them back to their mothers at seven o'clock at night may well consider whether they are not blindly working against the very thing they have most at heart—the child's welfare.
Employment of the mother is only one of the factors in home life which has an influence on the survival and the health of babies. All the adverse conditions which go to make up a low standard of living are unfavorable to health at any age, and they are most unfavorable in the delicate and sensi tive stage of infancy. In any of our cities it is the poorest and most crowded districts in which the babies die fastest—unless it happens, as in New York, that there is some complicating factor, like race, to interfere. It is not possible to pick out the various elements in a low standard of living and determine just what effect each one has on infant mortality,—or on any other social problem,—but the general connection is undeniable. Ignorance and dirt, the baby's worst enemies, are the natural accompaniments of poverty. The Children's Bu reau found in Johnstown that the infant mortality was five times as great in the poorest ward as in the section containing the homes of the well-to-do; that, in general, it fell as the earnings of husbands rose and the proportion of wage-earning wives de clined; that it was considerably lower in dry, clean homes containing a bath-tub, than in damp, dirty homes with no water-supply in the house; that of the babies who slept at night in a well-ventilated room (nearly half of them did, by the way) only one died in proportion to every six whose mothers carefully kept the windows shut tight; that babies had a better chance to live if their mothers could read some language and could speak English and had been in the United States more than five years —not so much because of the direct and intrinsic advantage to the individual baby of a literate mother who has had the privilege of residence in this country, as because these items, like the bath tub, happened to be in Johnstown convenient in dexes to the general economic status of the home.
The welfare of the baby, we have tried to em phasize, depends primarily upon its home, and within the home primarily on its mother, but we must not entirely overlook the contribution of the government, especially the municipal government, toward making the home what it should be and giving the mother an opportunity to meet her obli gations. Home conditions depend more and more, in our cities, upon general sanitary conditions, which the most intelligent and best-intentioned father of a family can affect only slightly. A minimum standard of housing, with respect to safety, decency, water-supply, and ventilation; an adequate drainage system for all parts of the city; an abundant supply of pure water for drink ing and household purposes; an efficient street cleaning service; supervision of the milk supply; maintenance of small parks at frequent intervals— these are some of the main features of municipal housekeeping which are prerequisite to family housekeeping of a kind favorable to babies. The local Department of Health has its special responsi bility for infectious diseases and the opportunity, if taxpayers will furnish the funds, to extend its supervisory and educational work for mothers and children.
Still another element in the saving of babies and the improvement of the physical basis of the in dividual's life is further advance in medical knowl edge of children's diseases and of their causation. All social measures and all individual measures to this end must rest on the teachings of science, and it is the skill and insight of the individual physician that determine again and again whether a particu lar baby shall live or die. Higher standards of general medical education, the including in the general curriculum of a larger amount of specialized instruction in the diseases of infancy (all groups of medical specialists urge this in regard to their specialities, and rightly) and encouragement of advanced study in this difficult and elusive field, are technical and scientific problems of general social interest.