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U. S. DEPARTM ENT OF LABOR
W. B. WILSON, Secretary

CHILDREN’S BUREAU
JULIA C. LATH RO P. Chief

INFANT-WELFARE WORK
IN EUROPE
AN ACCOUNT OF RECENT EXPERIENCES
IN GREAT BRITIAN, AUSTRIA, BELGIUM,
FRANCE, GERMANY, AND ITALY
By

NETTIE McGILL

COMMUNITY CHILD-WELFARE SERIES No. I
Bureau Publication No. 76

WASHINGTON
GOVERNMENT PRINTING OFFICE
1921


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CONTENTS
Page.

6
7

Letter of transmittal................ ......................................................................................................
Introduction......................................................................................................... ............................
Great Britain..................................................................................................................................
Introduction....................................................

15-51
15

Infant-welfare work before the war...................................................................................16-20
Legislative groundwork.............................................................
Voluntary work.......................................................................................... . . . ..............

16
18

In f ant-welfare work during the war....................... ........ ..............................................20-24
Promotion of grant-aided schemes.........................................................................
H ealth visiting..................... ............... ........................................................ .................

20
23

Growth of welfare centers............................................. ............................................

25

Lying-in accommodations and nursing.....................................

28

M idwifery service..................................................................................................... j .
B aby weeks and exhibitions.....................................................................................
Teaching of mothercraft..........................................................................................
Training of volunteer workers........... ........................' ......... ...................................
Provisions for nutrition........................................................................................... .
Financial p r o v is io n s ........... . .............................................................

30
32

33
34
35
36-37

Separation allowances..........................................................
M aternity benefits........ ........................................

36

Protection of mothers in industry....................
Establishment of day nurseries and nursery schools.....................................
Government appropriations........ .....................................
Grants from private sources..............................
Infant and maternal mortality rates..............................................................................
Sum m ary...................................................................................................................... ............
Austria........................................................................
Introduction........................

37
37
39
42
44
44
48
53-70

53

Inf ant-welfare work before the war...................................................................................54-56
Legislation........................................................................................
54
Private and municipal work.....................................................................................

55

Infant-welfare work during the war.............................................. ................................ 57-67
Growth of infant-welfare centers.............................................................................
57
Training of workers..............................................................

60

Exhibits and courses for m others...............

61

Provisions for nutrition......................................................

62

Government measures..................................................................................., ............

63

Public financial a id ............................................... ................................ '.................... 65-66
Maternity insurance............ ......................................

65

Separation allowances..................................................

66

Establishment of day nurseries and centers................................... ...................

67

Infant mortality rates.............................................................................................

68

Summary.....................................................................

69

Belgium ............................................................................................................................................... 71-79
Introduction............................................................................ ......................'........................
Infant-welfare work before the war............................

71
71-74

Legislation and Government aid.............................................................................

71

Private and municipal activity.............................

72
3


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CON TEN TS.

Belgium — Continued.
Page.
Infant-welfare work during the war.............. ....................... ..................................... .. 74-78
Organization under the national commission for food relief
..................
74
Infant feeding.............. 1..................... .............................. ..............................................

75

The m ilk supply............................... ...............- ...........................................................
The feeding of mothers..............................................................................................

76
76

Crèches........................................... ....................................... ......................................... >'

77

Appropriations.. . .............................................................................. * ------ .................
Creation of national children’s bureau................................................................

77
77

Infant mortality rates.................................. .....................................- .................................
Summary................................................................................................................................. ..

78
78

France.................................................................................. - ...............................- ...........- .............81-108
Introduction.......................................................................... - ..............................................81
Infant-welfare work before the w a r ......................................... - - > ..............................

81-87

Government provisions........................................................................

81

Private and municipal work........................... ... 1 ..................................................
84
Infant-welfare work during the war............................
88-103
In Paris...........................................................

—

88

In the provinces.......................................................................................................
Midwifery service......... .............................. ................. - .............- - ........ ........ . . . . .

91
92

B a b y weeks and exhibits..................................................

92

Training of workers.................................................................................................... - .

93

Teaching of infant hygiene.................................................... - ................... . ...........

93

Financial provisions for mothers.............................. ................. - .......................... 94-96
Maternity benefits and nursing p rem ium s...............................................
94
Separation allowances...................
•
96
Protection of factory workers and their children................ ................. ........ 96-103
Increase in employment of w om en..............................................................

96

Discussion in the A cadem y of M edicine....................................................

97

Voluntary action of em ployers.......................................................... .......... ..
Governmental measuresof protection........................

99
100

Official investigations......................................... ........................- ......................
Government appropriations................................................................................. . ;

102
103

Infant mortality rates.................................. ..........................•-...........................................

104

Sum m ary..................................................................................

106

Germ any............................................................ ........ .......... ................................ ......................109-136
Introduction....................................... - ............................ - ................... ...........- - - - .............
Infant-welfare work before the war........................
Organization...................................................................................
Types of work............................................................................................. —

109

109-113
109
.........

I ll

Infant-welfare work during the war................................... ............... ................... .... 113-131
E arly experience............................ ..................... ................. - ...............- •- •------- - New organizations and appropriations........................................... : ...................

113
114

T h e war sponsorship m ovem en t..........................
Infant-welfare centers and home visiting..........................................................

116
116

Training of workers............ ....................................................................- ...................

118

Prenatal ca re............ ............................ ..................... .. - - - - - ......... ..........................
Midwifery practice................................................ ................................... - - - .............
Lying-in accommodations........................................................ - - . ............... ..

H8
119
120

Special food regulations.......... .................................................. - - - .................. ..

120

Extension of work to rural districts............................................................... ..
Education of mothers and young girls in infant care....................................

121
122


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CON TEN TS.
Germ any— C ontinued.
Infant-welfare work during the war— Continued.

Page

P u b lic financial assistance....... .................................... ............................ 123-127
Separation allowances.........................................................................
323
Imperial m aternity grants.....................................................................
Protection of mothers in industry....... ..; ....... ..........................................
Establishment of day nurseries and nursing rooms......................... ........
Infant m ortality rates............ .............................
Sum m ary...........................................................................

124
127
128
131
133

I ta ly ............. ..............................- - .................. ....................... ................................. 137-149
Introduction................................. . .............................._...............
23«
Infant-welfare work before the war...............................*................................. 13S-143
Legislation....................................................................................
13g
Municipal and private work....................................... ................................

139

Infant-welfare work during the war........................... ......... . . . ....... ............ 143-146
Promotion of infant h y g ie n e ....... .........................................
I43
Protection of mothers in industry.................. ........................ ...... .........
Proposed b ill for the national protection of infants..................................
Infant m ortality rates........................................................
Summary................................................................ .................... *...........
Sources consulted............ .......
I n d e x ........ ......................................................................


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145
447

248
451
261

LETTER OF TRANSMITTAL.

U n it e d St a t e s D e p a r t m e n t o f L a b o r ,
C h il d r e n ’s B u r e a u ,

,

Washington February 16, 1920.

Sir : I transmit herewith a report on infant-welfare work m eertain European countries, with special emphasis on the work done
during the course of the war.
The material for this report is such as was available October l, iy iy.
It is based on official records, parliamentary debates, newspaper
reports, current literature, and such other material as could be secured
by correspondence or was obtainable in American libraries. A con­
siderable body of material which would otherwise have been at hand
did not, owing to war conditions, reach this country, if at all, in time
to be used in the report. This is true especially of vital statistics,
for in countries closest to the theater of war the work of statistical
bureaus was to some extent disorganized and customary publica­
tions were in certain cases suspended. Hence the report, based as
it necessarily is on unofficial accounts, can in no sense be regarded as
complete, particularly in the case of Austria, Germany, and Italy.
Information was complete and satisfactory only for Great Britain.
Fragmentary as the report undoubtedly is, it nevertheless serves to
show the importance which in recent years has been attached to the
protection of maternity and infancy and to indicate certain general
tendencies in infant-welfare work, differentiating between what is
merely local in application and what has proved universally accept­
able and successful.
. ,.
.
,
The research work for the report was under the general direction of
Miss Anna Rochester, at that time director of the Publication Divi­
sion of the Children’s Bureau. The English readmg was done by Mrs.
Frances Hawes and by Miss Nettie McGill; the readmg for the Aus­
trian, Belgian, French, German, and Italian sections was done by
Miss Anna Kalet, who also read the manuscript and suggested inter­
pretations of the original material. The report was written by Miss
McGill.
Respectfully submitted.
F

J

Ju l ia

C.

L athrop,

Chief.

Hon. W. B.

W il s o n ,

Secretary o f Labor.
6

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INFANT-WELFARE W ORK IN EUROPE
INTRODUCTION.

“ Excessive mortality in infancy implies excessive mortality in
later life,” says the well-known English authority on infant mor­
tality, Sir Arthur Newsholme,1 and he adds: “ There can be no rea­
sonable doubt that in the countries having a high infant death rate
there is— apart from migration—more sickness and a lower state
of health in youth and in adult life than in countries in which the
toll of infant mortality is less.” 2 The environment which, because
of bad housing, bad sanitation, domestic or municipal, a low degree
of social progress in general, reacts unfavorably on infant life, is the
environment responsible for a low state of health and vitality in all
classes of the population. Moreover, those children who because of
superior resistance do live to maturity are often seriously impaired
in health. The infants who are injured by the unfavorable en­
vironment into which they are born number two or three times
as many as those who die. The survivors of infant mortality, it
has been declared, bear in their bodies the marks of its causes and
conditions. Weak in body or mind, or both, they become the
fathers and mothers of the next generation, and social regeneration
is indefinitely delayed. Thus infant mortality figures have come to
be called “ the most sensitive index we possess of social welfare and
of sanitary administration.” 3 For the last 15 years or so there has
-been in the more highly civilized countries a growing recognition of
this fact, and a growing anxiety on the part of statesmen and leaders
in social reform to lower the infant mortality rates.
But to the popular mind it is only within very recent years, and
partly as a result of the war, that the significance of infant mortality
has come home. The war brought to every belligerent country not
only an unparalleled destruction of life on the battle field but an
alarmingly lowered birth rate, which seemed to menace national
existence itself. As the nations saw their young men cut down
1 Local Government Board, Thirty-ninth Annual Report, 1909-10, Supplement to the report of the
medical officer containing a report on Infant and Child Mortality. Cd. 5263, p. 35.
2 Local Government Board, Forty-second Annual Report, 1912-13, Supplement in continuation of the
report of the medical officer of the board for 1912-13, containing a second report on Infant and Child Mor­
tality. Cd. 6909, p. 47.
3 Local Government Board, Thirty-ninth Annual Report, 1909-10, Supplement to the report of the
board’s medical officer, containing a report on Infant and Child Mortality. Cd. 5663, p. 74.

7


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EUROPE.

without issue, a new and pressing necessity for saving infant life was
revealed to them.
The object of modern infant-welfare work, to which the war lent a
particular stimulus, is the preventive care of all children. Up to the ;
end of the nineteenth century such work had dealt chiefly with sick
or dependent children, or with those who because of the employment
of the mother were virtually deprived of a home. Thus infantwelfare work had concerned itself with the establishment and main­
tenance of hospitals, asylums, and day nurseries. 'B u t with the
growth of preventive medicine emphasis in infant-welfare work
shifted somewhat from remedial measures for sick and dependent
children to measures to secure for all children the best home care,
largely through teachihg mothers the proper way to rear their babies
in order to keep them healthy.
In the words of Sir Arthur Newsholme, the object of this work is
tl to insure that each parent has within reach accurate counsel as to
the hygiene of childhood, and as to the general and domestic con­
ditions necessary for insuring its maintenance. From the stand­
point of medicine this implies such advice as will conduce to the
prevention of minor ailments, to their prompt discovery, and to
that early treatment which is essential for the prevention of
more serious disease.” 4
One of the most successful means of maintaining this supervision
over normal babies has been found to be the infant-welfare center,
or infant consultation. First established in France, the infantwelfare center has spread to every civilized country. It has tended
to replace the earlier milk station, where pure milk was given or sold
to the mothers of young babies, but where in general no regular
medical supervision was exercised over the babies who received the
milk. The infant-welfare center, on the other hand, gives each baby
a physical examination, weighs and measures him periodically,
keeps an accurate record of his development, and gives the mother
expert advice concerning his food, clothing, and daily care. While
these are the fundamental activities of all centers, a number have
instituted in addition infant-welfare exhibits, courses in infant care
for mothers or young girls, instruction in sewing and cooking, and
home visiting among the babies attending the center.
More and more, too, as the emphasis on the preventive side of
infant conservation has increased, the centers have endeavored to
keep watch over the health of the baby’s mother, until, in very recent
years, widespread attention has been given to prenatal care. The
importance of periodical physical examinations of pregnant women
has been everywhere recognized by opening the center to the expec4
Local Government Board, Forty-second Annual Report, 1912-13, Supplement in continuation of the
report of the medical officer, containing a second report on Infant and Child Mortality. Cd. 6909, p. 90.


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IN T R O D U C T IO N .

9

tant mother. Certain days have been set apart for pregnant women
for consultations; in some cases, special centers have been opened for
tbeir use. Home visiting where it is well established, as in England,
has been extended to include visiting expectant mothers. The estab­
lishment of preconfinement homes and rest houses, as well as an
extension of hospital service to pregnant women, has taken place in
seVeral countries. This aspect of prematernity service was well
developed in a few French cities before the war. In England
by 1918 public grants for infant welfare became available for
the provision of rest homes for mothers awaiting confinement.
In Germany and Austria provision in this respect is not so gen­
eral as in England and is almost entirely in the hands of volun­
tary agencies. Mothers’ canteens, providing free dinners for all
expectant mothers, have been established in France and Belgium
under Government subsidy. Not only is the expectant mother
given nourishing meals at these canteens, but she is also placed
under medical supervision and is given helpful hygienic advice.
In Great Britain the feeding of mothers has been undertaken at a
number of welfare centers, which during the war became eligible for
government grants.
The importance of good obstetrical, as well as prenatal, care has
been increasingly recognized. Within the last few years the stand­
ard of midwifery practice has been raised by law in several countries.
The period of training for English midwives was doubled in 1916,
and more adequate compensation was guaranteed the midwife
through the extension of Government grants to cover midwives’ fees
where necessary. In 1918 a new midwives’ bill providing among
other things for more efficient supervision of midwives was passed in
England. Both Ireland and Scotland during the war passed bills
providing for the training and supervision of midwives. Municipal
mid wives have increased in Great Britain to a considerable extent.
In France the second-class midwife of inferior education was abol­
ished in 1916; henceforth only those who have completed at least a
portion of the high-school course are eligible for training. Prussia
has pending a midwives’ bill which provides for continuation courses
and periodical examinations for midwives already in practice.
Berlin, in 1915, passed similar regulations to insure better mid­
wifery. In several countries there has been an effort to enlist the
cooperation of the midwife in infant-welfare work. In England she
is urged to bring her prospective patient to the maternity center
and to be present at the physical examinations. In many places in
Germany and Austria midwives receive a fee, usually from local
public health bodies, for every mother whom they persuade to breast
feed her baby. In Italy similar attempts have been made to use the
midwife in the work of infant conservation.

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EUROPE.

Lying-in accommodations, except in large cities, are universally
regarded as unsatisfactory. There has been a constant demand for
the public provision of obstetrical care. In England late in the war
grants became available for hospital accommodation not only, as
before, for complicated cases of childbirth but also for normal deliv­
ery. These#grants also included payments toward the establishment
and maintenance of rest homes for women after confinement. Such
convalescent homes have for some time been common in France.
In Germany, as well as England, domestic assistance has been
extended to women after confinement, in the former country gen­
erally through the work of the sick-benefit societies, in the latter
through both public funds and private organizations. In England
in 1918 home nursing in confinement was aided by the grants for
infant-welfare work.
All infant-welfare work emphasizes the importance of maternal
nursing. In France, Germany, and Austria nursing premiums are
given from both public and private funds to mothers who breast feed
their infants. In Belgium and Italy assistance in kind is given out
by the centers to nursing mothers. The experiences of both France
and Germany showed that the number of women unable to nurse
their babies, for a few months at any rate, is very small indeed.
Lunch rooms for nursing mothers have been extensively developed
in the world-wide campaign for breast feeding. Italian child spe­
cialists consider it the most successful of all methods of inducing
mothers to nurse their babies and to bring them regularly to a
welfare center. Such canteens have proved very successful also in
France and Belgium. Providing nourishing meals for nursing
mothers has now become a regular part of English infant-welfare
work, where it is regarded as a benefit not only to those women
otherwise unable to obtain sufficient food but also to numerous
mothers who, after preparing a meal for the family, have no appetite
for it themselves. Mothers in England in many cases pay a nominal
sum for thé meal.
Welfare centers furnishing milk to these mothers who can not
breast feed their infants tend to replace milk stations providing modi­
fied milk for weaned children; or, the milk stations themselves tend
to become consultation centers through the regular attendance of a
physician and trained workers who supervise the children receiving
milk. In either case modified milk is not distributed until evéry
assurance has been given that the mother is unable to feed her child
in the natural way. In England, in contrast to the continental cus­
tom, there has been comparatively little distribution of milk since
the early years of infant-welfare work in that country, before the
consultation center was well established.


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A marked increase in centers has taken place in many countries.
The increased work in Austria and in Germany during the war gen­
erally took the form of opening new centers. In Belgium there were
10 times as many centers in 1918 as there had been in 1914. English
welfare centers probably doubled in number during the same period.
Expert and regular medical direction is now considered an essential
of every center, in spite of the shortage of doctors caused by the war.
A higher standard of training for workers also is generally being
demanded. In France training schools have been opened in the
largest cities. In Prussia and Saxony infant-welfare workers must
have a diploma from a State training school. In Austria, in 1915,
the imperial institute for the protection of infancy was established
chiefly for the training of infants’ nurses and child-welfare workers.
The English health visitor must be two of three things—sanitary
inspector, qualified midwife, trained nurse. Even volunteer workers
are encouraged to prepare themselves through training for their work,
and a number of centers offer courses for the training of both pro­
fessional and volunteer workers.
Home visiting is now regarded in a few countries as a part of the
regular work of a center. The greatest development of home visiting
has been in Great Britain, where it has followed the requirement by
law of early notification of births (notification-of-births act, 1907, and
notification-of-births extension act, 1915). France is giving in­
creased attention to this phase of infant-welfare work. In Austria
and Germany wherever it is systematically practiced it is frequently
an outgrowth of the visiting of illegitimate children, who are under
public supervision.
■
The general education of the mother in hygiene and infant care
is in some countries a function of the welfare center. This is espe­
cially the case in England, where the welfare center, or “ school for
mothers,” as it is generally called, holds regular classes in sewing,
cooking, and infant hygiene, and was, until recently, aided by grants
from the board of education. In Germany and Austria, on the other
hand, instruction in baby care is usually given by public-health
officers or bodies in a series of lectures for mothers and young girls.
In France a few courses for mothers and young girls have been
opened, usually by private societies or individuals. In Italy instruc­
tion in the care of babies is given in some normal schools, schools of
midwifery, and domestic-science schools, and by infant-welfare
agencies.
That the medical supervision and care at the center should not
cease with the passing of infancy is becoming universally recognized.
Almost every country has made efforts to secure continuity of childwelfare work not only by beginning with the child before birth but


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EUROPE.

also by continuing care throughout the preschool age, or until a child
is placed under medical supervision in school. In England special
stress has been put upon this neglected period, and health visiting
has been extended to include systematic oversight of the “ toddler.”
The development of the English nursery school is a further indication
of the interest in that country in the welfare of the child between
infancy and school age. In Germany centers were opened especially
for the child of from 1 to 5. In France consultation centers received
the older child, and some mothers’ canteens fed the “ ex-baby,” as
well as the expectant or nursing mother. In Belgium special can­
teens were opened for children over 3, the consultation centers and
milk stations caring for babies up to that age. In Austria regret was
expressed that funds did not in general permit the extension of
welfare work to children of preschool age.8
The mother and child in rural districts present a problem in every
country, despite many and increasing efforts to meet it. In England,
the grants of the local government board for supplementing the earn­
ings of midwives have had the effect of providing more adequate
midwifery service for some parts of the country previously suffering
from a lack of trained midwives. In England, too, a few rural centers
have been opened since the war began and the grants became avail­
able. Lying-in accommodations for rural areas are still a pressing
need in that country as in all others. The education of the country
mother in the care and management of her baby has been attempted
in France and in Germany by the extension of the work of a city
center to the surrounding rural region. In Germany the visiting of
babies up to 9 months has been carried on in some remote districts
by midwives who assisted at the births, the midwives in most cases
receiving a fee from public funds for the service. The German vac­
cination doctor, also, exercises some supervision over babies outside
urban confines and gives medical and hygienic advice to the mother,
who is required to bring her infant for vaccination. In France, in
the last few years, motor trucks equipped as inf ant-welfare centers
have visited the smaller towns and villages. Italy, through school­
teachers trained at the infant-hygiene schools, carries on infantwelfare propaganda in small towns and villages and remote districts
in the mountains. Austria has a number of traveling centers. The
distribution of pamphlets and leaflets on infant care is general and
traveling exhibits have proved their value both on the Continent
and in the British Isles.
The child of the working mother also furnishes a special problem,
particularly acute since the beginning of the war. Day nurseries
have increased in every country, with the exception of Belgium,
6 However, according to a report for 1919 of the Children’s Bureau of Lower Austria welfare work in that
part of the country has been since early in the war gradually extended to children beyond the age of infancy.


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IISTTRODTJCTION.

13

where industry has been at a standstill. Factory nurseries and nurs­
ing rooms have also been established, especially in France. In France
a law passed in August, 1917, obliges certain employers of women
to permit nursing mothers time off during the working day to nurse
their infants and may oblige them to maintain nursing rooms on the
premises. Government regulation and supervision of day nurseries
have come about in England as a result of public grants to nurseries.
A higher standard in staff, premises, and equipment is everywhere
apparent, with a tendency to incorporate the day nursery into munic­
ipal and national schemes of child welfare. Protests are still raised,
on the other hand, against even the best of day iiurseries, and there
are many who argue with Prof. Adolphe Pinard, of the University of
Paris, that not only is the day nursery dangerous but that the cost
also is at least as great as would be involved in subsidizing mothers,
in the absence of adequate family income, in order to keep them at
home to nurse their infants.
Practically every important European country has made some pro­
vision for financial assistance to mothers, either at confinement or
during the nursing period, or both. This provision has usually fol­
lowed a law requiring at confinement a period of rest from industrial
employment. In England, the national insurance act (1911) granting
maternity benefit to insured women and wives of insured men was
extended during the war to include a greater number of women, since
all men in service were obliged to be insured. In France the amount
of maternity benefit was raised after 1914 and more women were
included. In Germany a system of imperial maternity grants was
inaugurated in December, 1914, and covered many classes of women
not covered by the prewar insurance code. Austria in 1917 amended
its insurance law to make the provision of maternity benefit more
generous. Italy, during the war, raised the amount of maternity
benefit. The universal experience with regard to maternity benefits
and nursing premiums is that in general they fail to provide the max­
imum of care for the mother and her baby unless they are accompanied
by such expert advice and help as the home visitor and the infantwelfare center can furnish.
The nationalization of child-welfare work is taking place in the
chief countries of Europe, Many governments have indicated their
awakened sense of responsibility toward maternity and infancy by
aiding with public funds those organizations that have already done
successful work for mothers and babies, and, where necessary, by
undertaking work on a national scale. The most striking develop­
ment of State work has been in England. There, in July, 1914, Par­
liament voted to make grants of 50 per cent of approved expendi­
ture on infant-welfare work done by either voluntary agencies or
public authorities. These grants were administered through the

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I N F A N T -W E L F A R E

WORK

IN

EUROPE.

local government board and to a lesser extent through the board of
education. Year by year the scope of these grants has been enlarged
until practically every aspect of infant and maternity welfare is cov­
ered, and the grants were in 1918 at least ten times as great as they
were in 1914. In France, subsidies up to 20 per cent of approved
outlay have for a number of years been given to infant-welfare organ­
izations by the National Government, and laws of June and July,
1913, on maternity benefits and nursing premiums, and an extension
of these laws during the war, have greatly increased State appropri­
ations for maternity and infancy. The German Empire and the fed­
erated States regularly appropriated considerable sums for the pur­
pose of combating infant mortality. The imperial maternity grants
represented the most important national act of recent years for further­
ing the protection of infants in Germany. In Austria two new min­
istries were formed in 1918, both of which dealt with some aspect of
child welfare. Subsidies from the State became available in 1918
also for places with an unusually high infant mortality, and a pro­
gram of infant welfare was put forth by the ministry of the interior.
In Belgium the National Commission for Food Relief granted during
the war 50 per cent of approved expenditure on consultation centers,
milk stations, mothers’ canteens, and other infant-welfare measures;
and a bill to provide a national children’s bureau to do similar work
was passed in 1919 by the Belgian Chamber of Representatives.
Italy also has before its Chamber of Deputies a bill proposing radical
measures in favor of infancy and providing for State subsidies and for
national regulation of the work.
The universal tendency is expressed in the words of an Austrian
writer: “ Before all, coordination of all efforts in this sphere [child
welfare] and complete child-welfare work by the Government are the
ultimate aims of modern child-welfare work.” •
• Das Osterreichische Sanitatswesen, Nos. 9-12, March, 1916, p . 369.


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GREAT BRITAIN.
INTRODUCTION.

The social reasons for protecting babies have been repeatedly
emphasized in Great Britain. Again and again in official reports
British medical officers have shown that in a particular community
a high infant mortality goes hand in hand with ill health and a high
general death rate. “ A high infant mortality,” says Sir Arthur Newsholme, at that time medical officer of the Local Government Board
of England and Wales, “ implies a high prevalence of the conditions
which determine national inferiority” ; and also “ Right up to adult
life the districts suffering from a heavy child mortality have higher
death rates than the districts where infant mortality is low.” 1
According to Sir George Newman, one-time chief medical officer of
the board of education,2 “ the conditions which kill * * * children,
maim and disable many of the survivors, and these swell the numbers
of those who die in early childhood, or survive with greater or less
degree of defect or disability.”
The declining birth rate, too, has for years caused comm pint, and
uneasiness. In the opening years of the war this decline became
more marked than ever and attracted wide attention. “ The need
for increased effort to save child life is shown,” asserted Sir Arthur
Newsholme, “ by the markedly lower natural increase in population
in 1915 than in 1914.” 3 The birth rate in England and Wales for
1915, the first complete year of war, was 22 per 1,000 of the popula­
tion,4 in Scotland, 23.86,5 and in Ireland, 22,® each figure the lowest
ever recorded in the respective countries.
Table I shows how much greater the fall was than for any other
single year since 1905.
Table
- Country.

I .—Number o f live births per 1,000 o f the population.a
1905

1906

1907

1908

1909

1910

1911

1912

1913

1914

1915

England and W ales........ 27.3
Scotland.............................. 28.61
Ireland................................. 23.4

27.2
28.56
23.5

26.5
27.70
23.2

26.7
28.07
23.3

25.8
27.32
23.4

25.1
26.18
23.3

24.3
25.65
23.2

23.9
25.90
23.0

24.1
25.49
22.8

23.8
26.11
22.6

22.0
23.86
22. Ö

0 “ Cor? 1P1.le<! frop Seventy-eighth Annual Report, Registrar General, England and Wales, 1915, Cd.
8484, T a b l© 3,p . 5. Sixty-first Annual Report, Registrar General, Scotland, 1915, Cd. 8339, Table 2 n
L X V n . Fifty-first Annual Report Registrar General. Ireland, 1914, Cd. 7991, p. V . Fifty-fourth Annual
Report Registrar General, Ireland, 1917, Cd. 9123, p. V .
i Local Government Board, Thirty-ninth Annual Report, 1909-10, Supplement to the Report of the
Board’s Medical Officer containing a report by the medical officer on Infant and Child Mortality Cd 5263
pp. 74-75.
5 Annual Report Chief Medical Officer, Board of Education, 1914. Cd. 8055, p. 26.
* Local Government Board, Forty-fifth Annual Report, 1915-16, Supplement containing the Report
of the Medical Officer. Cd. 8423, p. I V .
■Seventy-eighth Annual Report of the Registrar General of Births, Deaths, and Marriages in England
and Wales, 1915. Cd. 8484, p. X I V .
6 Sixty-first Annual Report of the Registrar General for Scotland, 1915. Cd. 8339, p. L X V I I .
* Fifty-fourth Annual Report of the Registrar General for Ireland, 1917. Cd. 9123, p. V .

15


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EUROPE.

Early in the war the infant mortality rate apparently rose. Sir
John Byers, professor of midwifery and of diseases of women and
children of the Queen’s University of Belfast, declared that “ while 9
men belonging to British forces are dying in the war, 12 babies under
1 year are, in the same time, perishing in the United Kingdom,
while losses during the antenatal period are responsible for a similar
reduction in population.” 7
INFANT-WELFARE W ORK BEFORE THE W AR.
LEGISLATIVE GROUNDWORK.

Although the war brought to England a sharpened realization of
the national importance of maternity and infant care, there existed
when the war began a firm and broad foundation for the more com­
prehensive infant-welfare work that was to follow. The growth of
sanitation and the improvement in general public-health measures
had provided the basis for a reduction in child mortality. Legisla­
tion to control the milk supply, to prevent the spread of infectious
diseases, and to regulate housing had had an important bearing on
the life and health of young children. Moreover, legislation directed
specifically toward maternity and infant welfare embraced about
half a dozen acts.
The factory and workshop act (1901) forbade the employment of
a woman within four weeks after the birth of her child.
Those women who, in accordance with this act, were refused
employment received no financial indemnification until after the
passage of the national insurance acts of 1911 and 1913. By their
provisions the wife of every insured man is entitled to a maternity
benefit of 30 shillings. If she herself is insured, she is entitled to
an additional 30 shillings. If an employed woman, she must abstain
from remunerative work for four weeks after confinement in order
to draw the second sum. A number of married women, unless
insured themselves, receive no maternity benefit, owing to the fact
that certain classes of men, in spite of small earnings, are not eligible
for insurance. These classes include small employers, many Govern­
ment and municipal workers, and men working on their own account—
such, for example, as hucksters or peddlers.
The mother’s right to better care in confinement was recognized by
the midwives’ act (1902). Before 1902 a woman without any special
qualifications might practice midwifery at will. No midwives had
been licensed, registered, or supervised. By the midwives’ act of
1902, the central midwives’ board was created, whose duty it was to
prescribe the character of training for midwives, certify training
schools, give examinations leading to certification, and make rules
1 The British Medical Journal, Oct. 27, 1917.


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GREAT B R IT A IN .

for and supervise midwifery practice. Training was both practical
and theoretical and lasted three months. A midwife might receive it
in a hospital, in a poor-law infirmary, or through associations recog­
nized as suitable by the central midwives’ board; or she might train
in actual practice under the supervision of an approved practicing mid­
wife and receive her theoretical instruction from lecturers approved by
the board. In any case, before taking the examination given by
the board and receiving her certificate, she was required to have
undertaken at least 20 cases, with the nursing involved, and to have
received instruction in the management of labor, the care of the child
at and afterbirth, and the recognition of complications. The midwives’
act of 1902 required the midwife to summon a physician in any com­
plication or emergency. Thus the act provided for the prohibition
of practice for gain of unqualified women, for the training of mid­
wives, for the regulation of their practice, and for skilled care in
complicated cases of childbirth.
The notification-of-births act (1907) was a further step in maternity
and infant care. For a number of years, in a few cities, the visiting
of infants by sanitary inspectors or other municipal officers had been
undertaken. Several towns, realizing the importance of reaching
the mother as soon as possible after the birth of her child, had adopted
also a system of birth notification.8 In Salford, for instance, volun­
tary notification was made by midwives. In Huddersfield, notifica­
tion of births within 36 hours had been made compulsory in 1906.
The notification-of-births act (1907) requiring the notification of
every birth within 36 hours— in addition to the registration which
might be made within six weeks— enabled all authorities to send the
assistance of a health visitor to give hygienic advice and aid to the
mother at the earliest possible moment. “ This act is a most impor­
tant one,” said Dr. E. W. Hope, medical officer of health for Liver­
pool, “ for it provides for much more than the compulsory notification
of the birth. Under it the powers of the public-health acts may be
exercised in following up the information received and in promoting
the care of mothers and young children.” The adoption of the act
was, however, optional with local authorities, and many communities
either failed to adopt it at all or were very slow in doing so. B y
March 31, 1914, action had been taken in districts which comprised
65 per cent of the total population of England and Wales.9 It was
not until the war was well under way that the notification-of-births
extension act of 1915 made notification compulsory everywhere.
Infant-welfare measures undertaken as a result of the earlier act
were furthered by the Local Government Board of Great Britain and
8 Report on the Physical Welfare of Mothers and Children, Carnegie United Kingdom Trust.
p, 88.
• Local Government Board Forty-fourth Annual Report, 1914-15, Pt. III.

173389°— 20------2


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Cd. 819, p. 27.

Vol I,

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I N F A N T -W E L F A R E W O R K I N

EUROPE.

Wales. The local government board had for some years interested
itself particularly in infant mortality, as the special reports on the
subject by its medical officer bear witness. It was just on the eve of
war (July 31, 1914) that Parliament voted to grant financial aid to
such local schemes for maternity and infant-welfare work as were
approved by the local government board. Such grants were to
amount to not more than 50 per cent of the total approved expendi­
ture, and were to be made to voluntary agencies as well as to public
authorities. The act empowering the grant is practically, as well as
actually, prewar legislation, not only because it resulted from prewar
interest, but because it was to cover expenditure beginning March 31,
1914.
., .
Of the prewar laws mentioned above, all except the midwives
act applied to Scotland, and all except the factory and workshop act
and the midwives’ act applied to Ireland. It was not until after the
war began that midwives’ acts were passed for those countries. The
notification-of-births extension act of 1915 applied to both Scotland
and Ireland.
VOLUNTARY WORK.

With the exception of home visiting, a large part of the direct work
for mothers and babies was carried on before the war by voluntary
agencies.
Between 1900 and 1905, inspired by the success of the gouttes de
lait in France, a number of larger cities of the British Isles estab­
lished •milk depots, the purpose of w hich was to provide suitable
milk for infants whose mothers were unable to feed them at the breast.
They offered little if any opportunity for instruction to the mothers
whose children received modified milk.
Somewhat more akin to the modern infant-welfare center was a
milk depot set up in 1904 by the social workers’ association in Fins­
bury, the object of which was not only to supply milk for young
children, but also, like the French consultation des nourrissons, to
advise mothers where necessary in the care of their babies. Fol­
lowing application for milk, babies were brought to the depot to be
examined by a physician and weighed. A record was kept of each
child’s physical history and progress. In order to obtain the supply
of milk, the infant had to be presented periodically for examination
and weighing. Each child was visited by an agent of the center, and
in this way it was possible to take to the mother advice and instruc­
tion about her own child’s needs. Milk depots, however, never
became popular in England.
Welfare centers, infant consultations, babies’ welcomes, or schools
for mothers, as they are variously called, the chief object of which
is to encourage breast feeding, gradually replaced milk stations and
were established in many places where no milk depot had ever existed.


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GREAT BRITAIN".

19

The St. Paneras School for Mothers in London, founded in 1907
entirely through private funds and initiative, is a typical example of
the centers. In time it came to include the following activities:
Infant consultations; dinners for nursing mothers;- classes in sewing,
cooking, and hygiene; a provident maternity club (to encourage
thrift in the expectant mother); prenatal consultations; home visit­
ing; fathers’ evening conferences.
In 1907 the Government recognized the educational work of the
St. Paneras School and a number of other schools for mothers in Eng­
land and Wales by grants in aid given through the board of educa­
tion. These grants, given under the regulations for technical schools,
presupposed regular attendance and classes of a specified size and
duration, so that it was not easy for schools for mothers to comply
with the requirements. In 1913 the number of schools receiving aid
was about 150.10 About that time it was stated that “ the board fully
appreciate the difficulty of obtaining a regular and punctual attend­
ance and realize that the total amount of grants which can at present
be earned will often be small. At the same time they hope that as
many schools as possible will avail themselves of the limited official
recognition which can now be given.” 11 After the war began public
grants for such work were materially increased. The Women’s Coop­
erative Guild, an organization composed of the wives of working men,
was active in pressing the necessity of maternity and infant care upon
Government authorities in England and Wales.
In Scotland, local school boards in some cities assisted schools for
mothers.
Previous to the war, day nurseries also were established and main­
tained by voluntary agencies. Some of them had been in existence
for as long as 30 years. They varied widely in every particular; but
in 1906 an effort was made through the foundation of the National
Society of Day Nurseries to standardize them. Those nurseries
affiliated with the national society were obliged to maintain certain
standards in premises, staff, and equipment; and to those certified
a grant of 2 guineas a year was made by the society. Further assist­
ance also was extended to such nurseries as were in special need. A
similar association aided day nurseries in Scotland. These day
nurseries or crèches were fairly numerous before 1914, but they were
not invariably situated where they could be of the most use. “ They
[day nurseries] have been dependent on local energy and good will,”
said Dr. Janet M. Campbell, of the board of education, “ and their
number and distribution have been determined by that rather than
the actual requirements of the country as a whole. All existing
i« Annual Report, Chief Medical Officer, Board of Education, 1913. Cd. 7730, p. 31.
u Annual Report, Chief Medical Officer, Board of Education, 1912. Cd. 7184, p. 336,


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IN F A N T -W E L F A R E W O R K I N

EUROPE.

nurseries are probably needed, but there are many places which have
no nursery, where one would be of the greatest valu e/’12
Their establishment depended not so much on the absolute need
for them as on the generosity and initiative of local volunteers.
INFANT-WELFARE W ORK DURING THE W AR.
PROMOTION OF GRANT-AIDED SCHEMES.

Such was the situation before the war. Just at a time when it
was inevitable through conditions incident to war that work of vol­
unteer societies should suffer, the Government had come forward,
as it happened, with a measure that provided a powerful and effective
instrument for creating new activities, both public and private, and
encouraging such as already existed. On July 30, 1914, the Local
Government Board of England and Wales, anticipating the Par­
liamentary grant, put forth a memorandum prepared by its medical
officer, Sir Arthur Newsholme, on maternity and child welfare, in
which was described the following complete scheme13 for such work:
1. Arrangements for the local supervision of midwives.
2. Arrangements for—
(1) A n antenatal clinic for expectant mothers.
Antenatal<

(2) The home visiting of expectant mothers.
(3) A maternity hospital or beds at a hospital in which complicated cases
of pregnancy can receive treatment.

3. Arrangements for—
(1) Such assistance as may be needed to insure the mother’s having skilled
and prompt attendance during confinement at home.
Natal

(2) The confinement of sick women, including women having contracted
pelvis or suffering from any other condition involving danger to the
mother or infant, at a hospital.

4. Arrangements for—
(1) The treatment in a hospital of complications arising after parturition,
whether in the mother or in the infant.
(2) The provision of systematic advice and treatment for infants at a baby
clinic or infant dispensary.14
Postnatal/ (3) The continuance of these clinics and dispensaries, so as to be available
for children up to the age when they are entered on a school reg­
ister.
(4)

*

The systematic home visitation of infants and of children not on a
school register as above defined.

While it was stated that local conditions must determine the ex­
tent and character of the program, this outline was suggested as a
standard, and the wisdom of taking only such measures as could later
12 Report on the Physical Education of Mothers and Children, Vol. II, p. 115, Carnegie United Kingdom
Trust.
« Local Government Board, Forty-third Annual Report, 1913-14. Supplement containing the Report of
the Medical Officer. Cd. 7612, p. X X I I .
M ¡ ‘ Baby clinic” is here identical, it would seem, with “ infant-welfare center.”


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GREAT B R IT A IN .

21

be incorporated into a more comprehensive scheme was pointed out.
The letter accompanying the memorandum emphasized the impor­
tance of home visiting as well as the maintenance of infant-welfare
centers. It urged the desirability of continuing the work for young
children up to school age, pointing out that owing to the centering
of interest on the infant the older child had generally been neglected
in the past. It recommended especially the establishment of mater­
nity centers for the expectant mother and the provision of proper
obstetrical care.
To encourage the adoption of schemes by local authorities, the
Local Government Board of England and Wales was at that time pre­
pared to pay grants in aid of approved local expenditure, whether
by local authorities or voluntary organizations, for the salaries of
health visitors or other officers engaged in child-welfare work, and
for clinics, dispensaries, or other institutions providing medical and
surgical advice and treatment to mothers, and children up to the age
of 5 years.
From time to time during the war the scope of the work covered
by the local government board grants was greatly extended, especially
with respect to prenatal care and the care of children between 1 and
5. In 1916 grants became available for the expenses as well as sala­
ries of health visitors and nurses ; for salaries and expenses of inspec­
tors of midwives; for the provision of a midwife to necessitous women
or in regions where there was no midwife practicing; the provision of
a doctor in confinement where the woman was unable to pay; the
maintenance of a center; hospital treatment provided or contracted
for by a local authority in complicated cases of confinement, or in
complications arising from parturition either in mother or child, and
treatment of infants in hospitals.15 B y 1918 the grants were ex­
tended to cover food for expectant and nursing mothers; “ homehelps” ; maintenance of older children away from home during the
lying-in period; maternity homes accommodating expectant mothers;
hospital accommodation of children between 1 and 5; convalescent
homes for mothers after confinement, and for children after illnesses;
home nursing of mother or child during illnesses, especially where
hospital accommodation is unavailable; and crèches. An item of
the new regulations that permitted still further elasticity was the
promise of grants in aid of experimental work.16
In 1916, the Local Govérnment Boards for Scotland and for Ireland
issued regulations for maternity and child welfare schemes similar
to those suggested by the Local Government Board of England and
15 Local Government Board, Maternity and Child Welfare, collection of circulars and memoranda
1914-16, p. 8.
*
is Local Government Board, Forty-seventh Annual Report, 1917-18, Supplement containing the Renort
of the Medical Officer. Cd. 9169, p. X L I .


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E U R O P E.

Wales, and promised grants in aid up to 50 per cent of approved
expenditure. In 1917 the scope of grants was increased in Scotland
as in England.17
In general up to 1918 grants in Scotland and Ireland were legally
available for a greater variety of infant and maternity welfare work
than in England and Wales. The right of any local authority to
take the direct special measures indicated above for the protection
of infancy rested upon powers conferred by the notification-of-births
extension act, which was passed in 1915. The notification of births
within 36 hours was made compulsory throughout the British Isles,
and local authorities were empowered to follow up notification by
measures to promote the welfare of mothers and young children.
Under the act the local authorities of Scotland and Ireland were
permitted to “ make such arrangements as they think fit (and as may
be sanctioned by the local government board of each country) for
attending to the health of expectant and nursing mothers, and of
children under 5 years of age,” 18 whereas the local authorities of
England and Wales were allowed only such powers for the promo­
tion of infant and maternal welfare as a “ sanitary authority has
under the public health acts of 1875 to 1907, or the public health,
London, act, 1891.” 19 According to the local government board in
1917, the work in England was “ hampered by the fact that the
powers of local authorities in England and Wales are more limited
than the powers of local authorities in Scotland and Ireland.” 20 The
maternity and child welfare act passed on August 1, 1918, was in
effect an amendment to the notification-of-births extension act, 1915,
removing the restrictions thus placed on the local authorities of
England and Wales, and bestowing powers of far-reaching character.
The president of the Local Government Board of England and
Wales, on August 9, 1918, issued a circular letter to bring to the
notice of the local authorities the provisions of the new act.21 In
this letter much importance was attached to the proper provision of
suitable midwives and their supervision. “ The board consider that
an inspector of midwives should, if possible, be a qualified medical
woman.” 22 They strongly advocated an increase in the number of
centers, until there should be one for every health visitor’s district.
They made a special point of hospital treatment for children up to
5. 1 Initiative still rests with the local authority, who may take any
or all of these steps but is not compelled to do so, or with voluntary
committees who may take up the work and receive grants from the
board.
it

Scotland Local Government Board: Twenty-third Annual Report, 1917, Cd. 9020, pp. V I I I - X .

is Chitty’ s Annual Statutes, 1915, p. 843.
w Ibid., p. 842.
so Bocal Government Board, Forty-sixth Annual Report, 1916-17, P t. I l l : Cd. 8697, p . 39.
si Local Government Board, Maternity and Child Welfare, Circular 4, A ug. 9,1918.
*2

ib id ., p . 4.


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GREAT B R IT A IN .

23

From the very beginning of the Government grants, the work was
taken up with considerable enthusiasm by the local authorities. Véry
few failed to initiate some sort of scheme. A small minority, from
motives of economy, proposed to postpone consideration of the ques­
tion until after the war, but the local government board insisted that
of all war-time economies, economy of babies was one of the most
fundamental. The board spoke of the work as “ second only to that
arising out of war conditions,” and as a “ measure of war urgency,”
and warned the country that “ although we have enjoined on local
authorities the necessity of the strictest economy in public expendi­
ture, we have urged increased activity in work which has for its
object the préservation of infant life and health. We are glad to
say that the great majority of local authorities have realized the
value of continuing and extending their efforts for child welfare at
the present time.” 23 Even the more inert communities were encour­
aged to adopt a plan of baby saving. These plans involved one or
more of the features suggested by the board and ranged from the
appointment of a part-time health visitor to the establishment of a
complete system of home visiting backed by an elaborately equipped
center, directed by skilled obstetricians and experts in child welfare.
By the end of March, 1916, “ nearly half the County councils and
almost all County Boroughs had prepared schemes, and most of
them,” stated the Local Government Board of England and Wales,
“ are in actual operation.” 24
By the end of 1917 Scotland had adopted schemes for districts
with 22 per cent of the population of that country, while plans
covering 49 per cent more of the population were under considera­
tion.25 In Ireland, 26 urban and 2 rural districts had undertakén
schemes embodying many of the recommendations of its local govern­
ment board.26
HEALTH VISITING.

The Local Government Board of England and Wales urged every
County council to adopt a comprehensive scheme of health visiting
for the whole County, as in that way the rural districts in the County
would be covered, while its Boroughs or towns with larger demands
for infant-welfare work could adopt separate plans of their own,
including separate health visitors. In cases where health visiting
had already been initiated by the local sanitary authority, as it was
in many districts following the notification-of-births act, 1907, it
was recommended that this work should as a rule be merged into
that of the general County scheme, when a scheme was prepared,
53 Local Government Board, Forty-fourth Annual Report, 1914-15, Pt. f f i , Cd. 8197, p. 28.
Local Government Board, Forty-fifth Annual Report, Supplement containing the Report of the
Medical Officer, 1915-16, Cd. 8423, p. X X X V .
« Local Government Board of Scotland, Twenty-third Annual Report, 1917, Cd. 9020, pp. V I I I - I X .
m British Medical Journal, Mar. 23,1918, p . 354.
**


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E UROPE.

in order to avoid duplication of effort. As a result of the stimulus
thus applied by Government funds, the Local Government Board of
England and Wales could report in March, 1917, t h a t A l l the 29
metropolitan Boroughs except Camberwell, all the 82 County Bor­
oughs except Gateshead, 51 of the 61 County councils outside Lon­
don, and 360 County districts have some provision for health visit­
ing.” 27 Only 1 important County district remained in which no
health visiting had been provided for.
The passage of the notification-of-births extension act, 1915, was
of great assistance in carrying out the programs for health visiting.
Whereas in March, 1914, only 600 health visitors were employed by
local authorities in England and Wales, by the end of 1915 their
number had increased to 812, and by the end of February, 1917, to
1,024.28 This was an average of 1 health visitor to every 800 regis­
tered births;29 so that, though the number fell short of the minimum
standard set by the Local Government Board of England and Wales
of 1 for each 500 births, the progress toward this goal was encour­
aging. In 1918, in view of increased work with expectant mothers
and with children between 1 and 5, the board raised the standard,
suggesting 400 as the largest number of births that could con­
veniently be taken care of by onehealth visitor.30 By 1917 there
were in England and Wales 2,555 health visitors, and in 1918, 3,038.®
Only such health visitors as are approved by the local government
board as competent may be paid from Government funds. While she
need not be a trained nurse, a certified midwife, and a certified sanitary
inspector, the health visitor should have training in at least two
of these branches, and some knowledge of all. While her principal
function is to give advice to the mother in the home, in some dis­
tricts she acts as an inspector of midwives, and in all cases is expected
to aid the local sanitary inspector by reporting on the sanitary con­
ditions of the homes into which she goes. There are training insti­
tutes for health visitors throughout the country, and special advanced
courses for them are provided in many of the large centers. The
board repeatedly urged the payment of a salary sufficient to attract
trained women to the service and stressed the importance of a pleasing
personality in the success of the health visitor. No other depart­
ment of infant-welfare work was more emphasized by the authorities
than that of health visiting.31
a Local Government Board, Forty-eighth Annual Report, Supplement containing the Report of the
Medical Department, 1918-19, cmd. 462; p. 115
« Local Government Board: Maternity and Child Welfare, 1917, pp. I I I - I V .
M Ibid., pp. V I I I - I X .
» Local Government Board, Forty-fifth Annual Report, 1915-16, Supplement containing the Report of
the Medical Officer, Cd. 8423, p. X X X I V .
so Local Government Board, Maternity and Child Welfare, Circular 4, Aug. 9,1918, p. 6.
si Local Government Board, Forty-fourth Annual Report, 1914-15.
of the Medical Officer. Cd. 8153. pp. 1-3.


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Supplement containing the Report

GREAT B R IT A IN .

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W itt regard to visits, the board recommended 32 that the first be
paid within two or three days of the notification of birth, so that
the health visitor could consult with the midwife. It suggested
eight visits a year as the standard average for each child. Health
visiting should, the board urged, continue up to school age, and
should be extended to include visits to expectant mothers wherever
possible. This extension took place in some districts, especially
through the efforts of the centers. The board recommended in 1918,
after four years’ experience in regulating grant-aided work, that
when health visiting was engaged in by volunteer workers, as it
was to some extent, their activities should always be under the
supervision of trained and paid officers.33
GROWTH OF WELFARE CENTERS.

Home visiting, closely related as it is to the notification-of-births
act, was generally undertaken by the Government. The work of the
center, however, with its multiform activities, devolved during the
early days of the war almost wholly upon voluntary bodies. The
Government’s call to action in defense of infant life found many
well-established and organized centers needing only the funds that,
the Government was prepared, to give to extend their labors most:
effectively. The lack of funds was widely felt by volunteer childwelfare organizations almost from the beginning of the war; also, at
that time, many volunteer workers were withdrawn, so that there
was no prospect for an expansion in private as in official work for
child welfare. However, a provision of the notification-of-births
extension act, 1915, permitting the formation of committees to include
persons who were not members of the authority furthered effective
cooperation between private and public agencies. The efforts of
the municipal or county health visitor, moreover, brought recruits to
the centers, and the centers, through the variety of their contacts with
the mothers and babies, were enabled to offer valuable guidance to
the official health visitor. In a large proportion of voluntary centers,
the official health visitor in cooperation with voluntary workers “ ran”
the center when no doctor was available. It was recommended that,
wherever practicable, the health visitor’s district should be served
by one center.
In spite of a decrease in voluntary work, voluntary centers con­
tinued somewhat in the majority, noticeably in London, even as late
as 1917. While the municipal authorities of the metropolitan
Boroughs supported only 19 centers, voluntary societies supported
125, either wholly or aided only in part by Government grants. The
difference as regards County Boroughs and County districts, though
82 Local Government Board.
** Local Government Board.


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Forty-fourth Annual Report, 1914-15. Cd. 8153. p. 3.
Maternity and Child Labor. Circular 4, Aug. 9,1918, p. 8.

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IN F A N T -W E L F A R E W O R K I N

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much less marked, was in favor of the public-welfare center,, there
being 377 centers in the hands of local authorities and 321 under
volunteer agencies. At the beginning of 1917 there were about 850
centers in England and Wales.31 By July, 1918, the number had
reached 1,278. One of the aims in the increase in centers was to
bring the center within easy reach of the mothers, in order to en­
courage them to attend regularly and often.35 Of the 1,278 centers,
700 were municipal and 578 voluntary,35 an indication of the out­
stripping of independent voluntary enterprise during the war by the
work of local authorities.
The lack of doctors militated somewhat against the opening of new
centers and the development of prenatal work. Sir Arthur Newsholme, quoting Prof. Budin, the eminent founder of infant consulta­
tions in France, had said that “ An infant consultation is worth
precisely as much as the presiding physician.” 38 But early in the
war the local government board found it necessary to point out that
a center receiving occasional visits from a doctor was better than no
center at all. A trained nurse could supervise the weighing of babies
and give advice on subjects of hygiene. Warning was given, how­
ever, that even under war conditions a center should arrange that
each child at some time should come under medical review, and
that mothers in attendance should be examined. The board approved
centers with doctors in attendance only once a month instead of at
each session of the center, the usual procedure in normal times.
Although exact figures for Ireland and Scotland are lacking, welfare
centers were fairly numerous in Dublin and Belfast, and in the four
largest Scottish cities. In Belfast, for instance, there were six cen­
ters in 1916. In Edinburgh as early as 1915 weekly clinics for ex­
pectant mothers were instituted in connection with the Edinburgh
Royal Maternity Hospital. Under the new scheme these clinics
were to be held twice a week in a new building near the hospital,
which opened in May, 1917. The attendance at Edinburgh centers
almost doubled in 1916 as compared with 1915.37
In Glasgow a children’s clinic was opened in connection with a
hospital in October, 1917. Together with a nurses’ training home
it formed a unit in the Glasgow child-welfare scheme. Prenatal care
was given in the training home, while children up to 5 were looked
after in the new clinic.
Over all this work the local government boards of the several
countries exercised constant supervision.38 Medical inspectors from the
Local Government Board. Maternity and Child Welfare, 1917, p. X . 35 Local Government Board. Forty-seventh Annual Report, 1917-18. Supplement containing the Re­

34

port of the Medical Officer. Cd. 9169. p. X X X V I .
36 Local Government Board. Forty-fourth Annual Report, 1914-15.

_
Supplement containing the Report

of the Medical Officer. Cd. 8153. p. 14.
37 Report on the Physical Welfare of Mothers and Children, Vol. I l l , p. 560.
Trust.
»»Local Government Board. Forty-fifth Annual Report, 1915-16, P t. III.


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Carnegie United Kingdom

Cd. 8332 p. 14.

GREAT BRITAIN".

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English board, for example, paid frequent visits to local authorities
and voluntary agencies. They assisted in the forming of new
schemes and gave advice as to the extension of work already existing.
Local bodies met frequently in conference for these purposes with
members of the medical staff of the local government board in its
own offices, or in the locality concerned. With applications for
grants, descriptions of the work undertaken had to be presented,
along with a detailed expense account, certified by the officer of the
local authority in charge of the accounts. A voluntary agency
might apply either directly or through the local sanitary authority,39
except in Scotland, where the grant was paid to the local authority,
who distributed it to approved agencies.40
In 1916 the Local Government Board of England and Wales issued
a detailed memorandum on standards of work, staff, and equipment
to be maintained at a center.
The work of centers varies widely in details, but the essential pur­
pose of every center is to provide continuous medical supervision
for mothers and children. Each mother or child is examined regu­
larly by the physician in attendance, the health visitor being present,
if possible, in order to advise and help the mother later in carrying
out the doctor’s directions. The chief advantage of this frequent
examination is the early discovery of illness and physical defects.
This preventive work is especially valuable in connection with
pregnant women. In the larger cities, usually in close cooperation
with maternity hospitals, a very well-defined system of prenatal care
was developed, which endeavored to interest for their mutual benefit
the midwives of the district. In order to extend the benefits of the
work to as large a number as possible, there was some agitation for
the notification of pregnancy, but this has been considered, on the
whole, impracticable, and the prenatal or maternity center relies for
its clientele upon the opportunities of the home visitor to learn of
pregnancy, and upon the cooperation of local midwives and doctors
and of the charities which supply midwifery assistance. Thorough
physical examinations of pregnant women are given at the maternity
center from time to time, with the result that many conditions which
might, if neglected, result fatally are discovered in time to be easily
remedied. Through these examinations, too, the doctor and mid­
wife learn whether or not to expect a difficult confinement and are
prepared for complications if any arise. The preventive work is of
paramount importance in this connection, since 40 per cent of the
total number of infant deaths in England and Wales occur within a
83 Supplement containing the Report of the Medical Officer.
Annual Report, 1913-14. Cd. 7612, p. X X I .

Local Government Board, Forty-third

<° Report on the Physical Welfare of Mothers and Children, Vol. I l l , p. 560, Carnegie United Kingdom
Trust.


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month after birth41 and are traceable to the mother’s health before
the birth of the child or to imperfect midwifery. The early detection
of dental caries, for instance, one of the most frequent troubles in
pregnancy, was found to be so important in safeguarding the health
of expectant mothers and their offspring that the Government in
1917 agreed to defray half the cost of approved dental clinics,42 and
by 1918 a large extension in this work had taken place.43 Encourage­
ment of breast feeding and preparing the expectant mother for this
function constitute one of the most essential parts of the work of
supervision. To encourage and assist maternal nursing, many cen­
ters provide dinners, free or at cost, for expectant mothers. In
addition to these fundamental activities, the main features of the
more highly developed centers follow very closely those described in
the account of the St. Paneras School for Mothers, which was founded
before the war.44 They provide not only medical supervision and
advice, but also various specifically educational opportunities.
In rural communities the physical and financial obstacles to the
establishment of a center were difficult to overcome. The great need
was, however, recognized, and increasing efforts were made to extend
to rural areas the medical and educational benefits of the welfare
center. In a number of small places centers were started after the
war began; in some cases municipal, in others under private direc­
tion. Town halls, school and church rooms were used as premises
for centers in sparsely populated districts. The local medical officer
of health in many cases acted also as the medical officer of the center.
Every center receiving grants had a nurse in charge specially trained
in infant care, who weighed the babies and gave advice in hygiene.
These centers were open usually only once in two weeks, as the
number of mothers was small and the expense of daily meetings
prohibitive. In East Sussex there were, in 1916, nine schools for
mothers. By the end of 1916 the County Councils of Hertfordshire,
Monmouthshire, and Denbighshire had instituted a system of centers
throughout their Counties. Every effort was made to organize such
centers under the County health authorities, the County nursing asso­
ciation, or some other responsible body, in order to control the gen­
eral management and at the same time to give freedom to each center
to make such arrangements as suited its particular needs and
conditions.
LYING-IN ACCOMMODATIONS AND NURSING.

The complete scheme for maternity and child-welfare work as pro­
mulgated by the local government board included hospital accom4* Local Government Board, Maternity and Child Welfare, Collection of Circulars and Memoranda,
1914-16, p. 17.
42 Local Government Board, Maternity and Child Welfare, i917, p. X I .
43 Local Government Board, Forty-seventh Annual Report, 1917-18, Supplement Medical Officer. Cd.
9169, p. X X X I X .
44 See p. 19.


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modation for complicated cases of pregnancy, for unusual confine­
ments, and for children needing special care. Most centers are
affiliated with some local hospital for the receipt of such patients.
Many centers maintain maternity beds or wards in hospitals. A
few, as in Bradford, instituted a small hospital of their own for
infants or me thers, or both, usually making over and refitting some
neighboring house for the purpose. However, the lack of sufficient
lying-in accommodations continued to be felt during the whole
period of the war. “ One of the most urgent requirements of the
present time,” wrote the medical officer of the Local Government
Board of England and Wales, in 1918, “ is hospital accommodation.” 45
Outside the urban districts there were few, if any, hospitals with
maternity wards within easy reach of the women. Many towns,
such as Nottingham, Stoke-on-Trent, Swansea, had no lying-in
accommodations except poor-law infirmaries.46 Even in London,
where the hospitals were sufficient for the number of cases, they
were said to be badly distributed.47
In 1916 the Local Government Board of England and Wales stated
that grants would be available for the support, by local authorities,
of hospital beds for complicated cases of parturition; and in 1917
the board gave grants to 11 local authorities for this provision, £628
of which went to Bradford, £504 to Birmingham, £294 to Leeds,
£243 to St. Helens, and £142 to Sheffield.48 But this covered only
a part of the field, for what lying-in facilities' there were, were generally
available only for abnormal cases. Normal casés, however unsatis­
factory the home conditions might be, had no resort except to the
poor-law infirmaries.
By 1918 the Local Government Board of England and Wales had
decided to extend its grants to include the provision of hospital
treatment for normal obstetrical cases. Because of the pressing
need for accommodation of this character, local authorities were
advised to contract for beds in hospitals rather than wait for new
hospitals to be built. Following the announcement of the new grant,
municipal action was taken in 15 or 20 towns. Beds for ailing
infants and children, either with or without their mothers, were also
provided to some extent in both London and the provinces, usually
in connection with welfare centers. In announcing grants for this
purpose the board advised that hospitals maintained by centers be
on a small scale (not more than eight cots) ; that a full-time nurse
should be in charge day and night; that the nursing staff should be
45
Local Government Board, Forty-seventh Annual Report, 1917-18, Supplement containing the Report
of the Medical Officer. Cd. 9169, p. X X X V I I I .
« Report on the Physical Welfare of Mothers and Children, Vol. II, p. 62. Carnegie United Kingdom
Trust.
*i Local Government Board, Forty-sixth Annual Report, 1916-17, Supplement containing the Report
of the Medical Officer. Cd. 8767, p. X X X V I I .
« I b i d ., Cd. 8767, p. X X X V I .


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different from the regular nursing staff of the center; that the prompt
attention of a doctor be available; and that acute illnesses and
infectious diseases be excluded.49
It was found that mothers in some cases were unable to work and
had no place to go while awaiting confinement. Others, discharged
the first possible moment from hospitals, went back to heavy duties
much too soon for either their own or their babies’ welfare. Experts,
therefore, urged the necessity in any scheme of State-aided welfare
work for mothers and children of the provision not only of lying-in
hospitals but also of prematernity homes and maternity rest houses.
A number of the larger cities made such provision in their schemes
for maternity and child welfare. A rest home opened in Liverpool
in July, 1916, was said to be so successful that in six months it
received 106 pregnant and nursing mothers.50
Not only do the domestic circumstances of many mothers call for
the establishment of prematernity homes and maternity rest houses
but also in many cases these aids have to be supplemented by some
sort of domestic assistance. In 1918 came the décision of the board
to extend the scope of its work to include the provision of “ home
helps” during the lying-in period.51 The board also was prepared
to encourage by grants expenditure for the maintenance of older
children away from home during this period, in order to insure the
mother a measure of rest and freedom from care.
A number of the centers organized a system of “ home helps” and
provided training for them at the center. The central committee on
women’s employment had already (1915) arranged for the training
of young women as “ household helps,” and a grant in aid had been
made for the purpose.52 Mothers paid what they could afford toward
the wage of the helper. A graduated scale of payment based on
the family rent was common.
MIDWIFERY SERVICE.

The midwife plays an important rôle in Eng” h obstetrics. Before
the war she was the only attendant in approximately 50 per cent of
all births.53 During the war this proportion increased, and by 1918
almost three-quarters of the births in England and Wales were in
charge of midwives.54 By March 31, 1916, 30,54355 midwives
49 Local Government Board, Forty-seventh Annual Report, 1917-18, Supplement containing the Report
of the Medical Officer, Cd. 9169, p. X L ,
61Report on the Physical Welfare of Mothers and Children, Vol. I, p. 16, Carnegie United Kingdom Trust.
si Local Government Board, Forty-seventh Annual Report, 1917-18, Supplement containing the Report
of the Medical Officer, Cd. 9169, p. X L I .
62 Local.Govemment Board, Forty-fourth Annual Report, 1914-15, Appendix. Cd. 8195, p. 66.
s* Local Government Board, Maternity and Child Welfare, 19Ï7, p. X I I I .
94 Local Government Board, Forty-seventh Annual Report, 1917-18, Supplement medical officer. Cd.
9169, p. X X V .
ss Local Government Board, Maternity and Child Welfare, 1917, p. X I I .


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trained in hospitals and universities offering courses approved by
the central midwives’ b'oard were certified in accordance with the
law of 1902; but as less than one-fifth of this number gave notice of
their intention to practice and these were, moreover, very unevenly
distributed over the country, there existed a serious shortage, felt
most acutely in rural districts, especially in Wales. In many rural
areas there was no midwife at all. As it had been impracticable at
the time of the passing of the law to exclude altogether all midwives
whose training was derived solely from actual experience, a number
of so-called “ bona fide” midwives, often very ignorant women,
remained in practice, and the average level of intelligence and
training remained correspondingly low. This condition was accentu­
ated by the fact that many trained midwives did not practice but
preferred, because of the greater remuneration, to go into institutions
to teach or supervise. The midwife’s income, small and uncertain,
presented serious obstacles to the obtaining of suitable women for
the work. This was particularly true of sparsely settled areas,
where the births were too few to occupy the full time of the midwife,
who had to depend on some other income or else desert the region
for a more populous one.
In 1916 the local government board offered grants in respect to
the provision of a midwife in areas inadequately supplied. Bradford,
a pioneer in many of the measures of infant conservation, was among
the first to appoint municipal midwives. At the same time in
necessitous cases a grant was allowed of half the fee paid to the
doctor who must be called in in case of emergency, a responsibility
that previously had had to be met by the individual midwife, by
midwives’ associations, or by poor-law authorities. The period of
required training was raised in June, 1916 to six months, except
in the case of a trained nurse, who need have only four months in
addition to her previous training. This is generally recognized as
too little, a year being the minimum advocated.
There has been a tendency in schools for mothers to provide
lectures on subjects of interest and profit to midwives. In Liverpool
and Bradford and at the North Islington School for Mothers in
London, for example, such postgraduate courses were given, and
they were occasionally held by hospitals and trained nurses’ and
midwives’ associations. The London County council also has
provided several courses, including bedside as well as classroom
lectures. Attempts were made here and there to keep the midwife
in touch with her profession through a supply of Government reports,
medical books, and journals dealing with midwifery. This work
was sometimes undertaken by the inspector of midwives.
Midwifery service in rural districts is said to have been greatly
improved by the grants in aid given by the local government board.

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In some scattered areas a “ cottage midwife” is employed, who lives
during the lying-in period in the house of her patient, doing house­
hold work as well as looking after the mother and child. These
women are chosen from among the people whom they are to attend,
and their training is frequently paid for by the local authority. A
few County education committees also have offered scholarships in
midwifery training. In some rural districts the midwife combines
the function of health visitor or district nurse with her more special­
ized calling, and so is enabled to earn an income sufficient to keep
her in the neighborhood. County nursing associations and local
organizations have been active in providing nursing midwives for
rural areas.56
In Scotland in 1915 and in Ireland in 1918, midwives’ acts were
adopted similar to those in force in England, embodying in addition
certain recommendations of the committee Teporting in 1909 on the
working of the midwives’ act. In 1918 a new midwives’ bill for
England came up for consideration in Parliament and in November
became a law. The law brought the midwives’ act of 1902 in line
with the new laws relating to midwives that were operative in Ire­
land and Scotland, so that legislation on the subject became uniform
throughout the kingdom. In order to secure more effective super­
vision, it repealed the power of county councils to delegate to district
councils its powers in respect to midwives. It authorized local
authorities to contribute toward the training of midwives through
grants. It sought to protect the midwife’s income by empowering
local authorities to compensate the midwife when, through no fault
of her own, she is suspended from practice, and by requiring them to
pay the doctor’s fee from Government funds when, in complying
with the original act, the midwife calls in a doctor.
/
The midwife situation was rendered more acute throughout the
war by the shortage of doctors and nurses, which resulted in an
increase in the number of confinements intrusted to midwives. The
shortage became such that in spite of the urgent need for nurses in
the military service the war office refused to accept any that were
already acting as health visitors or midwives.
BABY WEEKS AND EXHIBITIONS.

In July, 1917, a national baby week was held in England, con­
ducted under the direction of the National Baby Week Council, a
voluntary body of which the prime minister was president, and the
president of the Local Government Board of England and Wales,
chairman. The object of the campaign was, in the words of the
5« Local Government Board, Forty-fourth Annual Report, 1914-15, Supplement continuation of the report
of the medical officer, containing a report on Maternal Mortality in connection with Childbearing. Cd.
8085, pp. 95-97.


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secretary of the council, “ to arrest the attention of the man in the
Street to the facts in connection with infant mortality, and to create
an atmosphere of civic responsibility in relation to the safeguard­
ing of the greatest asset the nation possesses, namely, its babies.” 57
A second national baby week was held in the summer of 1918, the
object this time being to reach welfare workers, and to show them
more specifically just how the babies could be saved. Medical authori­
ties of national repute were able to state that if all the known meas­
ures, social, sanitary, and medical, bearing on child welfare were
to be applied in every area, half the wastage of inf ant life might be
avoided, thus saving approximately 1,000 babies each week.
Similar educational work was carried out by the National Society
for the Prevention of Infant Mortality, through courses and exhibits
in London addressed to workers in the centers. Many workers were
prepared in this way to take examinations offered to infant-welfare
workers by the Royal Sanitary Institute.58
The National Society for the Prevention of Infant Mortality organ­
ized exhibits, also, in various parts of the country outside London.
In Scotland the educational work was extended by a maternity
and child-welfare traveling exhibition. Shortly after the passage of
the notification of births extension act, 1915, the Scottish Union
of Women Workers undertook to bring home to the local authorities
the provisions and possibilities of the act, and to create a popular
demand for infant-welfare work. After a few experiments, the
traveling exhibition was instituted. The first exhibit was held in
Keith on August 7, 1916, and within a year it had visited 39 places.
It continued to fill engagements and was in great demand. The
exhibits, which were lent free to any local committee undertaking
the cost of transportation, included some statistical charts and
diagrams, but the majority dealt with practical demonstrations of
the feeding, clothing, and bathing of children, as well as with simple
instructions in home economics and home nursing. One of the
most valuable results of the exhibit was its benefit to the outlying
villages and rural districts. “ I consider,” said Dr. Mackenzie,
medical member of the Local Government Board of Scotland, that
such an exhibition should be maintained in Scotland until the out­
lying parts of the country have been fully explored.” 59
TEACHING OF MOTHERCRAFT.

The strictly educational as well as the medical aspects of the
centers increased rather than diminished with the war, especially
u

Pritchard, Eric, “ Impressions of National Baby W eek,” in The Child, August, 1918, p. 517.

» The Medical Officer, Mar. 17,1917, p. 96.
os Report on the Physical Welfare of Mothers and Children, V oi. I l l , p. 219.
Trust.

173389°—20-----3


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with the encouragement extended to them through the hoard of
education grants. Practically every center has more or less system­
atic instruction in sewing, in the hygiene of mother and child, and
in the practical care of the infant. Many have cooking classes. In
many schools for mothers these classes are opened to young women
and growing girls, so that potential mothers may be trained in the
ways of baby saving.
The teaching of mothercraft to girls between 12 and 14 in the
elementary schools increased between 1914 and 1918. A number of
city, schools carried on successful work. In several London schools
and in schools of the larger provincial cities arrangements were made
for the girls to visit local day nurseries and to help with the work
there, under the supervision of the nursery staff. Whether the
regular teacher with her training in pedagogy and her knowledge of
children, or the nurse or doctor with more specialized knowledge of
infant care but without the teacher’s special qualifications, is the
more suitable instructor has never been definitely decided. It has
been suggested that courses in infant care should be taught to young
women in normal schools as a part of the regular course of teachers’
training. The problem of teaching mothercraft to older girls, say
from 14 to 18 years, was a more difficult one. The medical officers i
of health recommended the placing of the subject in the curriculum
of the secondary school, but as a majority of the girls most in need
of proper teaching do not reach the secondary school and evening
continuation schools are not practicable for this use the problem
remained unsolved, in spite of increased efforts to deal with it.
TRAINING OF VOLUNTEER WORKERS.

The problem of training welfare workers themselves was variously
met. In 1914, the National Society for the Prevention of Infant
Mortality, realizing the need of more systematic training for volun­
teer workers in order to turn their enthusiasm, hard work, and good
will into the maximum of benefit to the community, organized in
London courses for volunteer workers. Lectures by specialists and
demonstrations under trained workers formed the courses, which
were so eagerly received that they have been extended to embrace
work for the advanced welfare worker as well as for the beginner.
Various centers also offered instruction and opportunities for obtain­
ing practical experience. The St. Pancras School for Mothers has an
especially well developed system of instruction for workers, both
voluntary and professional. It started this work in 1915.
An increased effort was made during the war, in spite of many
handicaps, to raise the standard of work among volunteers. The
Local Government Board of England and Wales, while it points out
many ways in which the unpaid worker may give valuable service,


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constantly emphasizes the necessity for professional supervision of
these workers.
PROVISIONS FOR NUTRITION.

Much of the work thus far considered outside of public health
measures had for its object, more or less directly, the education of
the mother. Sir George Newman has said that “ The principal oper­
ating influence [in infant mortality] is the ignorance of the mother,
and the remedy is the education of the m other/’ 60
At least equally authoritative, however, is the opinion of Sir
Arthur Newsholme that not ignorance alone, but poverty and
ignorance, each aggravating the effects of the other, are responsible
for the large number of preventable infant deaths. “ There is no
reason to assume,” asserts Sir Arthur Newsholme, “ that the one
mother is more ignorant than the other. But the ignorance of the
working class mother is dangerous because it is associated with rela­
tive social helplessness. To remedy this, what is needed is that the
environment of the infants of the poor should be leveled up toward
that of the infants of the well-to-do, and that medical advice and
nursing assistance should be made available for the poor as promptly
as it is for persons of higher social status.”
With the war special economic problems had to be faced, more
especially by those whose struggle for existence is at the best of
times severe. With the outbreak of the war, milk became scarce
and dear. It was early recognized that what was a luxury for
others was a necessity for the infant population, and it became
clear that expectant and nursing mothers and children under 5
should have priority of supply. A milk supply priority scheme 61
advocated by the Government was put into force by a number of
local authorities, but many mothers, because of the high price,
could not afford to buy the milk to which they were entitled under
this scheme. It was argued that free or cheap milk should be dis­
tributed as a public health measure. On February 8, 1918, a milk
(mothers and children) order62 directed local authorities in Eng­
land and Wales to arrange for priority of the milk supply to mothers
and young children, to supply free or cheap milk, and to make the
price fit the means of those holding priority certificates. These
certificates were given out to nursing and expectant mothers and
to children under 5 at the order of the health officer or the physician
in charge of a welfare center. The local government board under
the regulations regarding grants for maternal and child welfare
defrayed half the cost.
60 Annual Report Medical Officer, Board of Education, 1914, Cd. 8055, p. 28.
61 Board of Agriculture and Fisheries, Second Interim Report of Committee on Production and Distri­
bution of Milk. Cd. 8886, pp. 5-6.
82 Manual of Emergency Legislation Food Control, revised to Apr. 30,1918, pp. 364-365.


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In the early part of the war the question of free or ehèap dinners
for the expectant or nursing mother arose. A provision of this
sort was felt to be necessary in many cases to enable mothers to
breast feed their babies. In a circular letter,63 dated November s ,
1914, sent out to local committees on the prevention and relief of
distress, the Local Government Board of England and Wales
directed that suitable arrangements be made for the relief of distress
arising from the war to expectant or nursing mothers. The impor­
tance of proper nourishment for women in this condition was stressed,
and the local committees were advised to furnish free meals, to be
paid for out of the national war relief fund. The local government
board made no provision for the feeding of mothers through its
grants for maternity and child-welfare work until 1918.
Many of the voluntary centers had carried on work in this direc­
tion since their beginning, and in response to appeals from the
war relief committees they increased their efforts. The mothers’
and babies’ welcomes of Nottingham, for example, furnished 14,000
meals to mothers during the month of September, 1914.64 Where
possible the mother paid a nominal sum for the meal, but in many
cases it was given free. During 1916 six welfare centers in London
served to mothers 44,958 meals, of which 31,623 were paid for by
the mothers.65 In some places the “ ex-baby” also was allowed a
hot meal. Between November, 1913, and March, 1915, 5,771 din­
ners were served to mothers, and about 1,400 to children between
1 and 5, at the North Lambeth babies’ care in Kennington.66 In
the Manchester schools for mothers, the number of dinners supplied
fell from 11,998 in 1914 to 7,712 in 1915.65 In fact, it was said that,
in general, when separation allowances for enlisted men were in­
creased the applications for meals fell off.
FINANCIAL PROVISIONS.

Separation allowances.
With regard to separation allowances, England required every
man in the army with dependents to make an allotment from his
pay amounting, in the case of a private, to 3s. 6d. a week. This
sum formed part o f the separation allowance, the balance being
supplied by the Government. The allowance for a wife was fixed,
October 1, 1914, at 12s. 6d. a week and remained the same through­
out the war. The rate for one child which, on October 1, 1914,
was 2s. 6d., was raised on March 1, 1915, to 5s., on January 15, 1917,
to 7s., on October 1, 1918, to 9s. 6d., and on November 1, 1918, to
68 Local Government Board. Forty-fourth Annual Report, 1914-15, Appendix. Cd. 8195, p. 65.
« Journal of the Royal Sanitary Institute, June, 1915, p. 233.
« Report on the Physical Welfare of Mothers and Children, Voi. II, p. 102, Carnegie United Kingdom
Trust.
««Ibid., p. 103.


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10s. 6d. Although an allowance was made for every child in a fam­
ily, the amount was slightly less for each subsequent child than for
the first. A wife and four children, for instance, would draw on the
dates given above, 22s., 25s., 31s., 35s. 6d., and 40s. 6d., respectively.67
In the navy a man was not compelled to make an allotment,
though the payment of the separation allowance to the wife was
conditional upon his doing so. Separation allowances were paid
to children without regard to the allotment made by the man.
Maternity benefits.
Before the war maternity benefits had been provided under the
national insurance acts of 1911 and 1913. Wnen the war began
every man who enlisted in the army or navy was required to be
insured. In this way, the wife of every soldier or sailor became
eligible for the maternity benefit. Under the act, maternity bene­
fits were paid in 1914 throughout the kingdom to the amount of
£1,259,339 to insured husbands and £210,913 to women who were
themselves insured.68 Parliament recognized the importance of
the work by securing its continuance through a grant of £500,000
when the insurance fund, in 1914, was facing a deficit.69 The next
year the amounts of maternity benefits decreased to £1,136,395
to men and £182,503 to women, and in 1916 to £1,089,138 and
£171,130, respectively.68
The act does not cover all women who may be in need of financial
assistance at the critical period of childbirth. To provide more
adequate provision in confinement, the Women’s Cooperative Guild
in a memorandum on national care of maternity, in May, 1917,
suggested a Government allowance of 10s. a week for two weeks
before and four weeks following confinement, for all women below
the tax income limit of £160.70 The opinion was often expressed
that an allowance to mothers would be preferable to forcing them
into the labor market.
PROTECTION OF MOTHERS IN INDUSTRY.

The number of women engaged in outside work increased during
the war by almost 1,500,000; in industry alone the increase was
about 750,000.
In July, 1914, 2,176,000 women were engaged in industrial occu­
pations; and by April, 1918, 537,000 more had entered industry,
chiefly in the chemical and metal trades. This does not include
Government establishments— arsenals, dockyards, and national shell
filling and projectile factories—in which before the war 2,000 women
67 W ar Pensions Gazette, December, 1918, p. 252.
48 Report on the Administration of National Health Insurance, 1914-1917.
69 Ibid., p. 80.
70 Memorandum of W om en’s Cooperative Guild, May, 1917.


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had been employed, but which b y April, 1918, had absorbed 197,000
more in answer to the repeated call of the Government for more and
more munition workers.71
The figures give no indication of the number of expectant mothers
or those with young children thus entering into industrial life, but the
number was thought to be considerable, especially among the wives
of soldiers and sailors.
No legislation was enacted for the special protection of pregnant
women and nursing mothers in industry. While the factory act of 1901
forbade the employment of a woman in a factory within four weeks
after childbirth, it was not always easy to prove that an employer
who hired the mother of a young child was cognizant of her recent
confinement. Night work and overtime work were very common,
especially in the early part of the war, and the committee on the
health of munitions workers found it necessary to make this sugges­
tion regarding the employment of mothers:72
Clearly, everything i t is possible to do should be done to reconcile the mother’s
conflict of interest between her duties to her home and children and her work on
munitions.

Wherever other labor is available, the employment of mothers with

infants is to be deprecated, as is also that of the mother of any young fam ily, for it
must be remembered that the mother’s work is certainly not ended with her factory
day.

Her children make m any claims upon her tim e and energy, more especially,

of course, at the period of the m idday meal and bedtime.

In some factories the ma­

jority of the women employed at night are married, and m any of them express a prefer­
ence for their work because i t leaves them free for domestic duties during the day.
In thus undertaking double duties, their zeal m ay easily outrun their strength, and
factory and home equally m ay suffer.

Where married women are indispensable,

every effort should be made to give them the preferential treatment common in
normal times in some factory districts.

I t is the experience of managers that con­

cessions, such as half an hour’s grace on leaving and arriving, or occasional “ tim e o ff”
is not injurious to output, as the lost tim e is made good b y increased a ctiv ity , and
under the system of eight-hour shifts i t m ight arrange, without industrial dislocation
of any kind, that married women are employed only in that shift which would cause
the least dislocation in their home.

For organization of this kind the welfare super­

visor would be invaluable.

The actual effect of factory employment on pregnant women
continued to be debated during the war. The long standing often
involved and the lifting of heavy weights, as shell cases, combined
with the tendency on the part of many women to hide pregnancy for
fear of dismissal, caused some gynecological experts to condemn it
without reserve. Others found it, if properly directed, not incom­
patible with a normal confinement and the bearing of healthy children!
A physician at one of the national shell factories, after an observa­
tion of 101 cases, over a period of nine months, came to the con71

Report of the Board of Trade on the Increased Employment of W om en during the war in the United

Kingdom up to April, 1918, p. 12.
72 Ministry of Munitions.
Health of Munition Workers Committee.
orandum 4,1916, pp. 9-10.


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GREAT B R IT A IN .

39

elusion that the pregnant woman might stay at her work with
“ benefit to herself and to the State,” providing she were put on tasks
commensurate with her strength.73
Along this line of adjustment arrangements were made, it is said,
in at least one of the national factories for the expectant mother to
give up her ordinary work four months before her confinement,
and to be put on light shell-filling work. Two months before that
time she was detailed to needle work, and dinners were provided for
her in the middle of the day.
Whatever the effect of industrial employment on the mother-to-be,
little doubt was expressed as to its undesirability from the point of
view of the young child deprived of breast feeding owing to its
mother’s daily toil in the factory. In 1918 the medical officer of the
local government board observed that “ the evil effects of the indus­
trial occupation of the mothers of young children are becoming
increasingly appreciated.” 74
ESTABLISHMENT OF DAY NURSERIES AND NURSERY SCHOOLS.

A great increase in day nurseries or crèches was brought about b y
the employment of married women in large numbers. In 1914,
the Board of Education of England and Wales recognized the work
of the nursery through its grants, thus providing a useful check
on the character of the accommodation. By 1918, 137 day nurseries
in England and Wales were being assisted by grants in aid from the
board, and experimental day nurseries were receiving governmental
encouragement.75 From the adoption of the notification-of-births
extension act in 1915, day nurseries in Scotland were aided by local
government board grants. From time to time the Board of Educa­
tion of England and Wales published regulations for the guidance
of nurseries receiving grants. In 1918 a revision76 of earlier regula­
tions changed the grant from 4d. per child per attendance to 50 per
cent of approved expenditure, thereby affording assistance in the
outlay of capital on nursery premises and equipment. In his report
for 1917, Sir George Newman, the chief medical officer of the board,
expressed the hope that “ these increased grants will result in in­
creased efficiency. They [the board] have not been satisfied with the
way in which many nurseries have been maintained hitherto, though,
in view of the increased cost of maintenance and the small grants
available, they have refrained from urging improvements likely to
js The
h

Medical Officer, Sept. 14,1918, p. 92.
Local Government Board. Forty-seventh Annual Report, 1917-18, Supplement containing the Report

of the Medical Officer. Cd. 9169, p. X X X V I .
»A n n u a l Report, Chief Medical Officer, Board of Education, 1917. Cd. 9206, p. 10.
7« Board of Education Memorandum.
Regulations under W hich Grants are Payable to D ay Nurseries.
Cd. 9129, April 1,1918.


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prove costly.” 77 The following extracts 78from Sir George Newman’s
report illustrate the standards demanded. He says:
I t m ay be w ell if I recapitulate some of the conditions which the board regard as
essential to ordinary efficiency.
Staff: A visitin g medical officer, who should receive a suitable salary, should be
attached to all nurseries. T h e matron in charge of a nursery should possess, in. addition
to more general qualifications, either a crèche training, or adequate previous experi­
ence of crèche management.

In appointing a matron, it is important to consider

whether she w ill b e responsible m ainly for infants, or for children over 2.

T he matron

should be provided with at least one responsible assistant nurse who has had a crèche
training. Further trained staff should be appointed as required. I t .w ill usually
be found that one crèche trained nurse is needed for every 10 children under 2 years
of age, a crèche trained nurse and probationer for 20 children; a crèche trained nurse
and two probationers for 30 children.
Premises: E v e ry nursery should be conducted as far as possible on open-air lines.
Nurseries which have no yard or garden should make every effort to arrange that
children shall be taken out daily.

In the case of new nurseries, a yard or playground

should be regarded as essential, and open-air outdoor shelters should be provided
when practicable.
T h e number of children to be admitted to one-room nurseries should depend, not
only on the floor space of the nursery, b u t also upon the adequacy of arrangements
for bathing and dressing children, laundry work, etc.

A separate room should be

provided for infants and toddlers whenever practicable, and always in the case of
new nurseries.

A receiving room for bathing children and suitable sanitary accom­

modation should always be provided.

More adequate arrangements w ill be required

in new nurseries than has been allowed in certain nurseries of old standing.

An

isolation room should also b e provided.
D a ily routine: A s a general rule, all children under 2 years should be bathed
d a ily and dressed in nursery clothes.

Children over 2 should be bathed d a ily when­

ever necessary, and in an y case two or three times a week.

A diet sheet should be

kep t showing (I) infant feeding, (II) meals for older children.
record should b e kep t of the dinner actu ally provided.

*

*

In addition a d aily
*

Records: A ll infants under 1 year old should be weighed w eekly and the records
suitably recorded.

Older children should be yeig h ed from time to time, and records

of their progress should be kep t.78

In later regulations (Apr. 1, 1918), the board stated that “ day
nurseries are for children under 3 years of age, for whom care can
not be provided in their homes because the mother is at work or
absent for other similar cause. Children over 3 may be admitted.
Children should attend ordinarily not less than nine hours a day,
and not less than five days a week.” In estimating grants the board
considered not only provisions as to staff, premises, and equipment,
but also “ method adopted for confining the benefits of the institu­
tion to infants and children of mothers at work, or where they can
not be cared for at home, the character and accuracy of the records
kept, the coordination of the work with similar institutions in the
district providing for infant welfare, and with the local education
authority on one hand and sanitary authority on the other.”
Annual Report for 1917, Chief Medical Officer of the Board of Education.
» Annual Report for 1917, Chief Medical Officer of the Board of Education.

Tt


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Cd., 9206, p, 11.
Cd. 9206, pp. 11-12.

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GREAT B R IT A IN .

41

The special need of day nurseries for the children of war workers
was early recognized. The first nursery intended solely for the
children of munitions workers was organized in July, 1915, at Handsworth, under the direction of some Birmingham social workers. It
accommodated about 40 children. It soon became apparent that
in order to be of real use to munitions workers it must be open both
day and night, involving a heavy increase in expense. The mothers
paid what they could, and the grants of the board of education were
available. But these sources of income did not suffice. The ministry
of munitions was approached, but the assistance sought was not
extended until a number of such nurseries had been established and
had joined in the appeal. The ministry then agreed to pay 75 per
cent of the approved initial cost of these schemes, and 7d. daily
for each child actually cared for, the payment to be made for the
work of the preceding year, on the recommendation of the board of
education, which conducted the necessary investigation.79 Stimulated
by such encouragement about 15 of these nurseries were opened
within a few months in munitions centers such as Woolwich and
Coventry, with prospects for the establishment of additional ones as
need arose.80
A few day nurseries were opened in agricultural districts also, for
women who, because of the war, were working on the land. Day
nurseries of this kind were opened, for instance, in Hertfordshire,
Kent, and Lincolnshire. They were in many cases out-of-door
nurseries, the indoor equipment being very simple.
Grants to day nurseries by the board of education were £4,960
in 1914-15, £6,395 in 1915-16, £8,077 in 1916-17, and £10,716 in
1917-18.81
Nursery or infant schools, much discussed in England since the
war began, reflect the growing interest in the child of from 1 to 5
years. That this important period of childhood was largely neglected
was intimated by the circular letter sent out by the Local Government
Board of England and Wales on the eve of the outbreak of war;
and evidence of the neglect is seen in the numerous reports of the
board of education commenting on the extent of defects among
children admitted to the public schools. “ The need,” said Sir
Arthur Newsholme, “ for bridging over the interval between infancy
and school life is shown by the fact that 1entrants’ into infant
schools are found to display disease in a proportion of their total
number and to an extent which shows how great is the amount of
undetected and neglected disease among children between infancy
and school age.” 82 Throughout the period of the war a growing
79 Annual Report, Chief Medical Officer, Board of Education, 1916. Cd. 8746, p. 20.
90 Report on the Physical Welfare of Mothers and Children, Vol. II, p. 124. Carnegie United Kingdom
Trust.
81 Board of Education, Annual Report for 1916, Cd. 8746, p. 17; and for 1917, Cd. 9206, p. 10.
82 Local Government Board, Forty-second Annual Report, 1912-13, Supplement in Continuation of the
Report of the Medical Officer containing a second Report on Infantile and Child- Mortality» Cd. 6909,
p. 92.


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tendency to follow the child up to the doors of the school is dis­
cernible. The closing of the London schools to children under 5 and
the general tendency everywhere during the war to exclude the
younger children from schools gave impetus to this discussion.
No action was taken to encourage nursery schools, however, and
no grant was available except under aids to experimental day
nurseries.
The infant or nursery school is in reality an extension of the day
nursery to meet more fully the needs of toddlers, and it is in connec­
tion with nurseries that the schools have sometimes been opened.
No attempt is made to follow the usual school routine. The children
sleep, eat, and play as in the ordinary day nursery, but educative
play, self-help, and simple work, usually along Montessori lines,
tend to place the emphasis rather upon training than upon care only,
as in the case of the ordinary crèche.
The new education act (England), 1918, provides for the establish­
ment of these schools at the option of local authorities. The board
of education has issued regulations for nursery schools, emphasizing
especially adequate arrangements for rest, meals, recreation, and
medical inspection of the children.83 The board will pay grants to
approved schools up to 50 per cent of the expenditure.
GOVERNMENT APPROPRIATIONS.

The efforts of the Board of Education of England and Wales have
been second only to those of the local government boards in pro­
moting schemes for maternal and child welfare, encouraging, however,
the educational rather than the hygienic or medical aspect. In 1914
the board of education issued a memorandum stating the regulations
for grants in aid of schools for mothers, pointing out the main lines
which instruction in these schools should follow. This plan super­
seded that by which schools for mothers had received grants from the
board of education in accordance with its regulations for technical
schools, and it permitted more types of schools for mothers to come
within the scope of the grants. The local government board had
likewise promised grants to infant consultations, schools for mothers,
welfare centers, under whatever name they might go, provided the
character of the work in behalf of mothers and babies was approved.
This procedure resulted in an unsatisfactory overlapping, so that on
May 31, 1915, the two bodies issued a joint circular in which they
defined the scope of work of each. The local government board
planned to grant aid to centers provided by local sanitary authorities,
or by the county council acting through its public-health committee,
or to voluntary infant consultations directly connected with the
sanitary authorities and not already aided by the board of education,
as schools for mothers. The board of education, on the other hand,
« The Times, London Educational Supplement, Jan. 23,1919, p. 41.


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was prepared to give grants to schools for mothers if the institutions
made provisions for collective systematic teaching, to infant consul­
tations which were provided only for women attending the school for
mothers thus aided, and to health visiting only for children regis­
tered at such schools, if local sanitary authorities had made no other
arrangement for it. Whether an institution received grants from
the board of education or the local government board depended on
its predominant character.
The sums granted by both the boards show a rapid increase covering
the years of the war.
In 1914-15 the Local Government Board of England and Wales
gave a grant amcuiting to £ ll,0 00 .8i In 1915-16. £42,000 was
divided by the Local Government Board between local authorities and
voluntary agencies engaged in infant and maternity welfare work,
£33,500 going to the former and £8,500 to the latter.85 The grant of
the Local Government Board in 1916-17 was £69,000,85 an increase
over the preceding year of more than 60 per cent. The next year
£122,000 was distributed,84 while £230,000 was the sum asked for in
the budget of 1918-19 and granted.86
Such schools for mothers in England and Wales as were not eligible
for grants from the local government board received from the board
of education grants amounting to £5,869, £8,938, £10,945, and
£13,393 in the years ended March 31, 1915, 1916, 1917, and 1918.
The number of institutions receiving this aid in 1917-18 was 286,
as compared with 157 in 1914-1587and 27 in the two school years
between 1912 and 1914.88 Table II shows the amounts granted by
each of the boards, and the relative extension in the infant and
maternity welfare work of each:
T able

II. — Amount o f grants in each financial year to local authorities and voluntary
agencies.0

Year.

1914^15........................................................................................................................... .....................
1915-16.......................................... ......................................................................................................
1916-17.................................................................................................................................................
1917-18........ •...................................................................................................................................
1918-19.................................................................................................................................................
a
b
c

Local gov­
ernment
board for
maternity
and childweliare
schemes.

£11,000
42.000
68.000
122,000
6 230,000

Board of
education
in aid of
schools for
mothers
and day
nurseries.

£10,830
15,334
19,023
24,110
«28,500

I ocal Government Board. Annual Report for 1916-17, P t. i n , p. 39: and 1917-18, P t. I l l , p. 20.
Estimates for Civil Services for the year ending Mar. 31, 1920, Class II, p. 90.
Estimates for Civil Services for the year ending Mar. 31,1920, Class IV , p. 11.

MLocal Government Board. Forty-seventh Annual Report, 1917-18, Pt. I. Cd. 9157, p. 20.
® Local Government Board. Forty-sixth Annual Report, 1916-17, P t. m . Cd. 8697, p. 39.
88 Estimate for Civil Service for the Year Ending Mar. 31, 1919, Class I I , p. 73, and for Year Ending
Mar. 31, 1920, Class I I , p. 90.
87 Annual Report, Chief Medical Officer, Board of Education, 1916, Cd. 8746, p. 17; and 1917, Cd. 9206,
p. 10.
88 Annual Report, Chief Medical Officer, Board of Education, 1912. Cd. 7184, p. 331.


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Fear of possible duplication of effort by these two bodies or of a
lack of efficiency due to divided responsibility was expressed, and
there arose a demand for a special department which would take over
all the public work for infant and maternity welfare. Such a depart­
ment is provided in the new ministry of health, organized by the law
of June 3J 1919.
Both Scotland and Ireland through grants in aid given by their local
government boards increased their expenditure on work for mothers
and infants. The sum in Scotland rose from something less than
£340 in 1916 89 to a grant in 1918-19 of £20,000,90 while Ireland in
1917 received £5,000 and in 1918 £6,000.91
GRANTS FROM PRIVATE SOURCES.

The National Baby Week Council announced in 1918 that it would
make grants to voluntary institutions up to 50 per cent of their
approved expenditure on new infant-welfare centers and day nurs­
eries and would also make small grants toward the initial equipment of
municipal undertakings. In carrying out this plan, the council
almost immediately distributed grants, we are told, amounting in
London to £5,099, and in Greater London and the provinces to
£5,015.93
Late in the war the National League for Health, Maternity, and
Child Welfare received from the American Red Cross £15,000 for
infant-welfare work in the British Isles. The money was to be
expended chiefly in equipping and maintaining maternity and lyingin homes for poor women in munitions districts, and in opening
prenatal clinics throughout England, Ireland, Scotland, and Wales.93
These institutions were made eligible for grants from the local govern­
ment board.
INFANT AND MATERNAL MORTALITY RATES.

The infant mortality rate in England and Wales— that is to say,
the number of deaths under 1 year of age in every 1,000 infants born
alive in the same year— was for the 10-year period 1891 to 1900, 153;
for the 10-year period 1901 to 1910, the time of growing activity for
infant and maternity welfare, this figure dropped to 128; while for
the 5-year period 1911-1915, 110 is recorded.94 The infant mortality
rate in Ireland also declined, but to a lesser degree than that of Eng­
land and Wales, the periods just referred to having a rate of 104, 96,
® Local Government Board of Scotland, Twenty-second Annual Report, 1916, Cd. 8517, p. X X X I I I .
*o Estimate for Civil Service for the year ending Mar. 31,1920, Class U , p. 138.
“i Estimate for Civil Service for the year ending Mar. 31, 1919, Class n , p. 128; and for the year ending
Mar. 31, 1920, Class n , p. 155.
92 The Medical Officer, N ov. 23,1918, p. 179.
98 Daily News and Leader, N ov. 29,1918.
»< Local Government Board. Report on Maternity and Child Welfare, 1917, p. X V .


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and 91, respectively.95 In Scotland a fall from 127.9 to 116.2 to 112.8
is indicated for the three periods.96
Table III shows the general decline in infant mortality since 1900,
under what may be termed in general prewar conditions, although
two war years are included in the last 5-year period.
T able

II I .—Number o f deaths under 1 year per 1,000 live births.
Period.

England
Scotland.2
and Wales.1

1891-1900....................................................................................................................
1901-1910....................................................................................................................
1911-1915....................................................................................................................

153
128
110

127.9
116.2
112.8

Ireland.3

104
96
91

1 Local Government Board'. Maternity and Child Welfare, 1917, p. X V .
2 Annual reports of the registrar general for Scotland, thirty-seventh to sixty-first (1891-1915), calcu­
lated from number of births and of infant deaths in the separate years.
3 Report on the Physical Welfare of Mothers and Children, Vol. IV , p. 5. Carnegie United Kingdom
Trust.

The infant mortality rate for the year 1914 was lower in England
and Wales and in Ireland than the rate for 1913; in Scotland it
was one point higher than it had been for the year just preceding the
war. In all three countries there was a rise in 1915, the greatest
increase being in Scotland. In 1916 the rates fell to the lowest figures
ever recorded in the respective countries. While there was an in­
crease for 1917, the rate for each of the three countries was only two
points higher in each instance than the rate for 1912, the lowest re­
corded in the respective countries before the war. In 1918 there was
a rise in the rate for England and Wales of only one point, in spite
of the influenza epidemic. In Scotland and Ireland the rate declined.
Table IV gives the rates for the years of the war, with the 1912 and
1913 rates for comparison.
T able

IV .—Number o f deaths under 1 year per 1,000 live births.1
Year.

England
and Wales.

Scotland.

95
108
105
110
91
96
97

105
110
111
126
97
107
100

1912................................... ...........................................................................................

1916................................... ................................. ....................... ................................

Ireland.

86
97
82
97
83
88
86

1 Eighty-first Annual Report Registrar General England and Wales, 1918, Cmd. G08, pp. C L X I I -C L X I I L
N o t e .—T his table gives the rates when stated b y the usual method per 1,000 births during the same year.
Because of the great decline in births during the war, this method overstates the mortality of infants during
the war. “ N orm ally,” says the registrar general of England and Wales in the annual report for 1917,
‘ the births registered in each year maintain a iairly constant ratio to the infant lives at risk, and so can be
used in place of the latter in measuring infant mortality; but this is not the case when a great decline in
births occurs.”
This source of error is corrected for England and W ales in his report for 1917 by stating
the infant mortality rates “ per 1,000 of the population aged 0-1 .” W hen this is done the rates for 1912-1917
for England and W ales become, respectively, 104,117,113, 111, 98, 94. This indicates that there has been
a steady decline in infant mortality during the war. See Eightieth Annual Report Registrar General
England and Wales, 1917, Cmd. 40, pp. X X I X - X X X L
* Report on the Physical Welfare of Mothers and Children, Vol. IV , p. 5.

Carnegie United Kingdom

Trust.
«« Annual reports of the registrar general for Scotland, thirty-seventh to the sixty-first (1891-1915), cal­
culated from number of births and of infant deaths in the separate years.


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I N F A N T -W E L F A R E W O R K I N

E U ROPE.

The phenomenal drop in 1916, while it has been attributed in part
to the greater prosperity of the working classes, is due, no doubt, in
large measure to the increased activity in infant and maternity
welfare work. A cool, wet summer was also favorable to health.
Analysis of the low rate for 1916 shows that while the rate for diarrhea
and enteritis was lower than during either of the two years preceding,
it was not the lowest rate yet recorded for these diseases. On the
other hand, the mortality rate from all other diseases was lower for
1916 than for any previous year.
“ The greater part of the decrease,” said the registrar general, Sir
Bernard Mallet, “ is accounted for under other headings less subject
to climatic influences [than diarrhea], and therefore gives the greater
promise of permanence. * * * The improvement upon the rate
for 1912, the lowest hitherto recorded, is increased by exclusion of
diarrhea from the comparison. In other words, thé low rate of 1912
owed more to the accidental circumstance that the season was un­
favorable to diarrhea than did the still lower rate of 1916.” 97
The fall in causes other than diarrhea is limited to the present
century.98 Table V shows for England and Wales the gradual decline
since 1910 in the infant mortality rate from certain main causes of
death and indicates the variations in the rate for diarrheal diseases.
T able V

.— Number of deaths under 1 year per 1,000 live births.1
1910

Cause of death.

7.22
Common infectious diseases....................
3.91
Tuberculous diseases.................................
Diarrhea and enteritis...................... ,------ 8 12.64
Developmental and wasting diseases.. 3 40.50
41.17
Miscellaneous diseases...............................

1911

1912

1913

1914

1915

1916

1917

1918

7.69
3.81
36.20
41.37
40.99

7.79
2.81
7.72
37.78
38.75

5.71
3.02
19.32
39.26
41.10

6.97
2.86
17.40
37.77
39.62

9.00
2.88
15.14
37.27
45.43

5.21
2.39
10.58
35.61
37.42

5.74
2.75
10.30
36.55
41.14

7.95
1.94
9.54
35.52
42.21

1 Eighty-first Annual Report of the Registrar General of Births, Deaths, and Marriages in England and
W ales (.1918), femd. 608], p. CL (for all years).
8 Diarrheal diseases.
* Wasting diseases.

The infant mortality rate in England and Wales is generally lower
in rural districts than in the large centers of population. The more
favorable position of the rural communities was maintained during
the war, as shown in Table VI.
T a b l e V I .—

Number of deaths under 1 year per 1,000 live births.1
1913

Locality.

106
124
105
88

1914

104
121
99
85

1915

112
122
107
90

19161

19171

89
106
86
76

104
107
92
82

1918

108
109
92
80

1 Seventy-ninth Annual Report Registrar General England and W ales, 1916, Cd. 8869, p. X X V ;
Eightieth Annual Report, 1917, Cd. 40, p. X X X I V : and Eighty-Arst Annual Report, 1918.
97 Seventy-ninth Annual Report Registrar General Births, Deaths, and Marriages in England and Wales,
1916, Cd. 8869, p. X X I V .
“ Idem .


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GREAT B R IT A IN .

The maternal mortality rates from puerperal fever declined steadily
in all four countries between 1881 and 1914, with the exception of the
Welsh and the Scotch rates for the first two years of the new century.
The first complete year of war showed a rise in each country. This
was followed in England by a decline during 1916 and 1917, and by
only a slight rise in 1918, so that the rate for each of these war years
was smaller than any attained before the war. After 1915 the Welsh
rates again decreased each year, until in 1918 the lowest rate from
puerperal fever ever attained in the United Kingdom was reached
in that country. This was the more remarkable in that the Welsh
rate had been the highest in the Kingdom until after 1910 and was
then surpassed only by the Irish. In Scotland a higher mortality
rate from puerperal fever was shown during the first three years of the
war than had prevailed during the three years immediately preceding
it. In 1918, however, the Scotch rate, like the Welsh, showed a
striking decrease and became the second lowest ever recorded in the
Kingdom. The Irish rate did not decrease until 1917, and then,
although the rate was the lowest ever reached in Ireland, it was the
highest recorded for the United Kingdom in that year. As deaths
from puerperal fever are almost entirely preventable by the observ­
ance of modern measures of asepsis, the lowered death rate from this
cause is no doubt due in part to efforts in Great Britain to secure
trained attendance at delivery, more especially efforts directed
toward the training and supervision of midwives.
The maternal death rate from all other causes connected with
pregnancy and childbirth, on the other hand, though somewhat
variable, has shown a tendency to rise, except in Ireland, where in
1918, after a steady decline, it reached its lowest for that country.
Tables V II and V III give the death rates in each of the countries
from puerperal fever and from all other puerperal causes. The rates
for Wales are given separately, as they are in general considerably
higher than the English rates.
T able

V II.—Death rates per 1,000 births from puerperal fever.

Period.

1881-18901.........................................................................................
1891-1900................................................................................. ........
1901-1902 2........................................................................................
1903-1910............................................................................................
1911-1914............................................................................................
1915 4......... .........................................................................................
1916......................................................................................................
1917......................................................................................................
1918...................................................................................... ..............

England.

2.56
2.22
2.10
1.62
1.39
1.44
1.35
1.27
1.29

Wales,
including
Monmouth.

3.11
2.99
3-24
2.05
1.67
1.83
1.71
1.69
1.12

Scotland.

2.42
2.01
2.29
1.93
*1.44
1.94
1.68
1.69
1.15

Ireland.

2.83
2.62
2.22
2.04
2.01
*2.12
*2.32
* 1.93
«1.83

1 Great Britain, Forty-fourth Annual Report Local Government Board, 1914-15. Supplement containing
a report on maternal mortality in connection with childbearing, Cd. 8085, p. 40.
2 The statistics for the two years 1901-2 aré given separately from the rest of the period 1901-1910. The
midwives act was passed July 31, 1902. Its terms applied only to England and Wales.
* These statistics are for the years 1911-1913.
< Furnished by the courtesy of the registrars general of England, Wales, and Scotland, respectively.
* Deaths from puerperal septic diseases. Fifty-fourth Annual Report Registrar General tor Ireland, 1917,
Cd. 9123, p. X X V .
6 Furnished by the courtesy of the registrar general of Ireland.


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T able

I N F A N T -W E L F A R E W O R K I N

E UROPE.

V I I I Death rates per 1,000 births from other accidents and diseases o f preg­
nancy and childbirth.

Period.

England.

2.08
2.74
2.33
2.13
2.47
2.61

1881-1890 ».
1891-1900..
1901-1902 ».
1903-1910..
1911-1914..
1915 . . . . . . .
1916»...........
1917»...........
1918»...........

2.68
2.48
2.42

Wales,
including
Monmouth,

2.99
3.95
3.65
3.21
3.91
3.84
3.52
3.74
3.50

» Great Britain, Forty-fourth Annual Report Loral Government Board,1914-15.

Scotland.

3.03
2.71

2.66
3.37
2 4.26
4.18
4.Ó1
4.20
5.83

Ireland.

4.24
3.98
3.99
3.41
3.19
»3.27
»3.19
»3.00
«2.97

Supplement containing

m l d ^ v r a a i t w ls p ^ s e d July 31, 1902. Its terms applied only to England and Wales.
» These statistics are for the years 1 9 U 7 I 9 1 3 .
General
f°« Fumiriied'by the wurtesy o f the registrar general of Ireland.

SUM M ARY.

A striking decrease in the infant mortality rate for England and
Wales, Scotland, and Ireland took place during the first 10 years of
the twentieth century, as compared with the preceding decade.
The following five-year period shows a further decline. During the
first complete year of war (1915), the infant death rate rose; but
1916 saw the lowest rates ever reached in the three countries, and
though in 1917 there was a rise throughout the Kingdom the rates
for that year were lower for each country than they were in 1913
and except in Ireland, lower than in 1914. In 1918, the rate was
lower for Scotland and for Ireland than in 1917, but somewhat
higher for England and Wales.
In England and Wales the rise in 1917 is said to be only a statis­
tical and not an actual one, due to the fact that the usual,method
of stating the infant death rate per 1,000 live births within the same
year somewhat overstates the actual rate when the number of births
is unusually small, as it was during the war. When the rate is stated
per 1,000 of the population under 1 year, there is a decline for each
year of the war.
.
.
Maternal death rates from puerperal fever declined m general
after 1890 and continued to decline during the war, when each country
showed its lowest mortality rate from that cause. Death rates from
all other puerperal causes, however, have shown a tendency to rise
except in Ireland.
. . . ....
Infant-welfare work in Great Britain has a firm basis m legislation.
Provision for a confinement rest for industrially employed women
was made in 1901 (except in Ireland); a system of maternity insur­
ance was inaugurated in 1911; the practice of midwifery (m England)


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GREAT BRITAIN".

49

was regulated by the Government after 1902; and early notification
of births was made compulsory— in some districts— in 1907, in all parts
of Great Britain in 1915. As a result of the notification-of-births
acts, home visiting was undertaken on a large scale by local author­
ities. With the exception of home visiting, the greater part of the
direct work for infants before the war was initiated and controlled
by voluntary agencies.
From the beginning of the war a great expansion took place in all
infant-welfare work, owing to financial assistance given by the Gov­
ernment, to the effect of education of public opinion, and to the
development of public conscience awakened by war. Grants of local
government boards and extensive increased grants by the board of
education in England and Wales became available just before the
war and proved a great incentive to the adoption of infant-welfare
measures by local authorities. The notification-of-births extension
act of 1915 facilitated the carrying out of these measures and extended
the work to Scotland and Ireland. In August, 1918, all restrictions
on the powers of local sanitary authorities to promote infant-welfare
work were removed by the passage of the maternity and child-welfare
act.
County councils and sanitary authorities in nearly every area in
England and Wales, and a large number in Scotland and Ireland,
adopted plans for infant- and maternal-welfare Work, including some
or all of the features recommended in the complete scheme published
by the Local Government Board of England and Wales in 1914.
This scheme covered prenatal and obstetrical care, hospital and
lying-in accommodation, and the supervision of infants from birth up
to 5 years of age. Systematic instruction of mothers in the hygiene of
pregnancy and infancy, and of growing girls in the care of infants,
and the training of young children in day nurseries or in nursery
schools were encouraged by the grants of the board of education in
England and Wales, and by the local government boards and local
educational boards of Ireland and Scotland. The scope of grants
was considerably widened in the case of the local government boards
of all three countries. Coordination of all types of child-welfare work
was systematically encouraged. Close supervision and regulation of
all grant-aided work tended toward the maintenance of good stand­
ards. The work of many volunteer societies was crippled by the war,
so that a greater and greater share of the work fell upon official
agencies. Cooperation was secured between public and private bodies
by the regulations of the grants, which resulted, it was stated, in
effective use being made of the experience of voluntary agencies.
The employment of voluntary unpaid workers, except when under
173389°—20— —4


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IN F A N T -W E L F A R E W O R K I N E UROPE.

the direction of trained and paid workers, was discouraged, although
under proper supervision their work was considered valuable.
Infant-welfare centers, both public and private, increased in Eng­
land and Wales from 842 in 1916 to 1,365 in 1918. Both Scotland
and Ireland also show an increase in the number of centers. The
increase in centers under municipal direction was especially marked.
Some rural centers were opened, usually under the supervision of the
district medical officer of health. Although the absence of doctors
on military duty is said to have interfered with the work, there has
been a growing tendency to regard the regular attendance of a doctor
as indispensable to the proper conduct of any center, and to encourage
the employment of infant specialists for the purpose wherever possi­
ble. Maternity centers for prenatal care were opened in many places.
A large number of centers made arrangements for examining and
advising pregnant women and furnished milk and other suitable
nourishment for expectant mothers. Practically all centers extended
their care to children above the age of infancy.
Health visitors, carrying advice and help to mothers in their own
homes, probably doubled in number in England and Wales during the
war. They were appointed either by local authorities following the
adoption of the notification-of-births act or by private societies.
The health visitor in some instances served also as district or school
nurse, or as tuberculosis nurse, giving only part of her time to
infant-welfare work. The standard set by the English local govern­
ment board of one full-time health visitor to every 500 births was
raised on the recommendation of the board in 1918 to 1 for every
400 births, owing chiefly to the extension of health visiting to the
expectant mother and the child between 1 and 5 years of age. Health
visitors also acted in some districts as supervisors of midwives, but
in 1918 the Local Government Board of England and Wales recom­
mended that preferably only qualified women doctors should under­
take those duties.
Improvement in the midwifery service was secured during the
war by a number of measures. The period of training for midwives
was lengthened from three to six months. Local government boards
offered grants in aid of the provision of a midwife for communities
insufficiently supplied, resulting, it is thought, in an improvement of
midwifery service in sparsely settled places.
A new midwives’ act for England (1918) provided more efficient
supervision of midwives and sought to secure a greater number of
practicing trained midwives. This act also made it the duty of local
authorities to pay the fees of doctors called in by midwives to assist
in obstetric emergencies. Scotland, in 1915, and Ireland, in 1918,
had already passed similar bills for raising the standard of midwifery.


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Lying-in accommodations, especially in rural areas, were insufficient
for the need. Grants given at first by the local government boards
in aid of lying-in provision for complicated obstetrical cases were later
extended, in all three countries, to normal confinement cases. Some
cities had already made special arrangements for parturient women,
often in connection with the work of a welfare center; others were
encouraged by the grants to undertake similar work. A number of
centers maintained small hospitals. Lying-in provision, nevertheless,
was considered far from satisfactory even in 1918.
Assistance during confinement was extended in many cases by
furnishing domestic help and by maintaining older children away
from home during the mother’s lying-in. Prematernity homes and
rest homes for convalescent mothers with their infants were estab­
lished in some places. Local government board grants became avail­
able late in the war for all these projects.
Owing to the compulsory insurance of all enlisted men, compara­
tively few women were without maternity benefit during the war.
While more and more provision was made for raising the standard
of the child’s home care, outside care in day nurseries also increased,
owing to the growth in industrial employment of women occasioned
by the war. The Board of Education of England and Wales, through
its grants to day nurseries, was able to insist on small numbers, -fresh
air, and absolute cleanliness. The board of education supervised day
nurseries for munition workers, which were aided by the grants of
the ministry of munitions. In Ireland and Scotland grants to nur­
series were made by the local government boards, which exercised
over them a supervision similar to that of the board of education in
England and Wales. By the education act (England), 1918, nursery
schools for children between 3 and 5 were recommended for estab­
lishment where there was need, and grants in aid were offered for
this purpose.


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AUSTRIA.
INTRODUCTION.

In 1912 Austria ranked ninth among 10 European countries according to infant mortality rate.1 During the first decade of the twentieth
century almost 200,000 infants died annually.2 A nation-wide
inquiry sometime between 1910 and 1913 revealed the fact that the
most frequent causes of infant mortality in the country were stomach
and intestinal diseases of artificially fed infants among the poor and
that these causes were, therefore, largely removable.3 One of the
foremost leaders in infant welfare in Austria, Dr. Leopold Moll, in
discussing the facts brought to light by the inquiry, asserted that
artificial feeding, which had been found so disastrous, was resorted
to because of poverty and consequent undernourishment of the
mother; increasing employment of women outside the home; depar­
ture of fathers for distant Provinces to seek employment, in which
cases the mothers were frequently left to do heavy farm work them­
selves; and industrial home work, because its low earnings, long hours,
and lack of outdoor exercise rendered the mother physically unfit to
breast feed her infant.4 Social measures, therefore, as well as the
specifically hygienic and educational measures commonly regarded
as an integral part of modem infant-welfare work, are seen to be
necessary to lower the infant-mortality rate.
Such work with its emphasis on the preventive care of children
had been undertaken early in the twentieth century in some of the
larger Austrian cities. There, because of the infant-welfare work,
it was stated, and because of better sanitation, a lower infant mortality
had resulted than in the rural districts,5 although even this rate was
high. In 1913, the last year unaffected by the war, the rate for 101
large cities was 160 per 1,000 live births,8 whereas the rate for the
whole country was 189.9.7
Offsetting to some extent, though only numerically, the high
infant mortality rate was the high birth rate, which prevailed in all
except one or two Provinces. Table IX gives the birth rates by
Provinces for 10 years preceding the first complete year of war (1915)
1 Statistisches Jahrbuch für das Deutsche Reich, 1915, pp. 20*, 21*, 40.
* Österreichisches Statistisches Handbuch, vol. 3 2 , 1 9 1 3 , p. 36.
* Das Österreichische Sanitätswesen, N o. 38,1913, p. 4 .
4 Ibid., pp. 5-6.
6 Ibid., pp. 31-35.
4 Statistisches Jahrbuch für das Deutsche Reich, 1 9 1 5 , p. 20*.
7 Wiener Klinische Wochenschrift, Aug. 22,1918, p. 950.

53


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IN F A N T -W E L F A R E W O R K I N

EUROPE.

and for 1915. The figures show how comparatively slight had been
the decline until affected by war conditions.
T able

IX

.-— Number of live births 'per 1,000 of the population.1

Provinces.

1905*

19062

19073

19081

19096

19106

19117

19128

1913»

19149

Lower Austria................
Upper Austria................
Salzburg............................
Styria................................
Corinthia..........................
Cam iola............................
Tyrol..............................
Vorarlberg......................
Bohemia...........................
Moravia............................
Silesia................................

28.1
30.3
30.9
28.8
31.8
34.5
30.2
28.2
30.0
33.2
36.6

28.0
30.3
30.8
29.3
32.8
34.5
31.0
27.8
31.3
34.0
36.9

27.0
29.2
30.4
28.8
32.4
32.6
30.9
28.2
30.2
33.2
35.7

26.6
29.8
32.8
29.9
32.8
34.9
31.1
30.4
31.8
34.8
39.1

25.2
29.5
30.2
29.7
32.9
35.0
32.2
28.3
29.6
32.9
35.4

24.4
28.3
29.9
29.4
31.5
33.9
31.6
28.6
28.5
31.8
34.7

22.66
27.66
28.69
27.71
30.49
31.73
30.62
27.63
27.59
30.55
33.66

22.18
28J22
29.03
28.44
31.25
32.67
31.24
27.34
26.34
30.19
32.50

20.71
26.96
27.06
27.02
30.00
31.63
30.92
26.65
25.88
29.04
31.63

20.4
27.4
27.8
27.9
29.9
31.3
31.1
26.5
25.3
29.1
32.0

1915»

16.2
21.0
21.4
22.1
24.0
24.0
18.8
18.6
18.5
21.5
23.4

1 The birth rate is given for these Provinces because it is only for them tha figures are available after
1913. No figures for the whole country are available after 1913.
2 Statistisches Handbuch, 1908, pp. 35,36.
3 ^statistisches Handbuch, 1909, p; 39.
* Österreichische Statistik, vol. 88, Pt. I l l , pp. X - X I I I .
6 Statistisches Handbuch, 1910, p. 31.
6 Österreichische Statistik, vol. 92, part 1, pp. X I X - X X I .
7 österreichische Statistik, Neue Folge, vol. 8, part 1, p. 6.
8 Statistisches Handbuch, 1914, p. 52.
8
Zeitschrift für Kindershutz und Jugendfürsorge, August-September, 1918, p . 209. These figures ar«
said to be from official sources.

The loss to the nation in potential lives, coupled with heavy losses
on the battle field, was sufficiently striking during the war to give
added impetus to work which had been planned or already begun
in the years just preceding the war and to cause new work to be
undertaken in behalf of infants.
INFANT-WELFARE W ORK BEFORE THE W AR.
LEGISLATION.

The national importance of combating infant mortality had al­
ready been recognized by several Government measures for the pro­
tection of maternity and infancy. A law of March 8, 1885, pro­
hibited factory employment of women during four weeks following
confinement. No public financial aid was available for women
during this period of enforced unemployment. Three years later,
however (Mar. 30, 1888), compulsory sickness insurance, including
a maternity benefit, was instituted. Maternity benefit to the
amount of sick benefit was to be paid for four weeks following
normal childbirth, and up to 20 weeks in case of complications.
The State regulated the training and practice of midwives. Mid­
wives were trained free of charge in the clinics of the medical de­
partments of the universities. In each institution there were pro­
fessors whose special duty was the instruction of midwives. Candi­
dates for the course had to pass an examination in elementaryschool subjects. They were required to live near the clinic in order


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55

to attend cases there. In addition to the practical experience thus
secured, midwives received theoretical instruction. The training,
lasted five months. The midwife was then examined both by her
teacher and by a Government commission. She was obliged to
register with the police and health officials in the district where she
expected to practice, and her work was supervised by a Government
physician. She was allowed to conduct normal cases alone, but for
abnormality or in any emergency she was required to summon a
doctor.
PRIVATE AND MUNICIPAL WORK.

That the urban infant mortality rate was lower than the rate for
rural districts was due somewhat, no doubt, to the more advanced
sanitation and more thorough public-health measures enjoyed by
the cities. Direct work, moreover, for the welfare of infants had
been undertaken usually only in large towns and during the decade
preceding the war.
Several private organizations, such as the Säuglingschutz (society
for the protection of infants) and the Säuglingsfürsorge (infant-wel­
fare society) in Vienna, carried on work for mothers and babies.
This work consisted chiefly in establishing infant-welfare centers.
The first infant-welfare center was opened in Vienna about 1904,8
and gradually centers were opened in the capitals of most of the
Austrian Provinces. The work of the center followed closely that
of the French consultation des nourrissons. Infants were regularly
weighed and a record kept of their progress. Each mother was
given advice as to the feeding and general care of her baby, and if
she nursed it herself she received from most centers during the
nursing period a nursing premium consisting oi a few pennies a day.
Doctors were in attendance at the centers. Some of the centers
dispensed milk for infants who could not be breast fed.
Day nurseries for children under three whose mothers went out to
work were established to some extent by private societies. Nurs­
ing rooms, where breast-fed infants could be cared for during the
working day, and to which mothers might retire to nurse their babies,
were maintained in a number of Government factories, and in a few
privately owned establishments.9
Several years before the war began the municipal authorities of
Mäbrisch in Ostran made inf ant-welfare work a part of their activi­
ties for the protection of children, and it was not long before their
example Was followed by a number of other cities, including Vienna.8
In some cases this work was begun in the interests of infants born out
s Zeitschrift für Kinderschutz und Jugendfürsorge, June, 1918, p. 145.
9
KeUer, A ., und Klumker, Chris. J.: Säuglingsfürsorge und Kinderschutz in den Europäischen Staaten
p. 607*


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of wedlock, among whom the mortality rate is invariably much higher
than for the legitimate born, and was later extended to include all
children. Nursing premiums given out of municipal funds were not
uncommon. In Bohemia, for instance, local authorities gave money
premiums to midwives who persuaded mothers to breast feed their
babies.10
In an endeavor to form a center for the existing welfare organiza­
tions and to assist them by mutual exchange of experiences and
information, and by suggestions, the Zentralstelle für Kinderschutz
und Jugendfürsorge (the national society for the protection of
children and young people) was organized in 1907.11 Its activities
extended throughout the Empire. Besides publishing a paper in
the interests of infant welfare it used its experience in this work to
draft bills for the legislature or proposals for administrative
authorities.
Following the Emperor’s jubilee in 1908, a fund for the protection
of mothers and infants was raised by private subscription, with the
object of establishing an institute 'tfhieh should have general super­
vision over the founding of infant consultation centers and the
education of mothers in the care o f babies. The fund was especi­
ally concerned with the extension of instruction in breast feeding,
as according to Austrian public-health physicians, one of the main
causes of the high infant mortality was the “ total ignorance on the
part of mothers of the simplest rules of child care and of the im­
portance of breast feeding.” 12 The institute was designed to be a
“ school which would carry the principles of infant care to the widest
groups of the population. Thus by sending out trained infant
nurses and welfare workers, the institute will take its teaching to
distant localities and will gain for the maternity and infant-welfare
work new ground and new adherents.” 13 Plans for the institute
were submitted by infant specialists. The one finally adopted em­
bodied the training of midwives and of nurses especially for infant
work, post-graduate courses in children’s diseases and child hygiene,
for physicians, the instruction of mothers in the care and feeding of
children at a model consultation center connected with the institute,
and provision for dependent infants. A subsidy was given by the
minister of the interior to assist in building. The institute was
not opened until after the war began. Its organization bureau,
however, prepared immediately a pamphlet on child care which it
distributed free of charge. It also conducted an inquiry into the
causes of infant mortality in Austria.
»# Zeitschrift für Kinderschutz und Jugendfürsorge, July, 1916, p. 200.
u Ibid., January-February, 1914, p. 4.
« Ibid., April, 1914, p. 93.
u Das Österreichische Sanitätswesen, No. 1-4, Jan. 27,1916, pp. 100-102.


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INFANT-WELFARE W ORK DURING THE W AR.
GROWTH OP INFANT-WELFARE CENTERS.

After the outbreak of the war, according to Dr. Leopold Moll, a
great many new agencies for the preservation of the child’s life
were established and existing ones extended.14 Child-welfare work
in general consisted chiefly in the establishment of infant-welfare
centers. Committees formed in almost every district for the care of
mothers and infants were composed of representatives of both
private and public work. Originally established for the protection
o f the child born out of wedlock, many committees of this sort after
the war began appointed a subcommittee charged especially with
welfare work for legitimate infants. These committees assisted
Women in confinement (one of them in Bohemia began its work by
opening a lying-in home in Prague),15 but their chief work was organ­
izing welfare centers within their districts. Although a few centers
speak of a falling off in attendance, and several had to be closed,
usually because the consulting physician was called to the colors, the
tendency was toward a steady increase in the number of children
coming under the supervision of consultation centers. In Reichenberger, in northern Bohemia, for instance, a center which during
1914 gave advice to 907 mothers in 1915 records the attendance of
1,838 and in 1916 of 1,978 mothers.16 Some centers, because of war
conditions, extended their care to the child of preschool age, while
others regretted that because of lack of funds they were unable to do
so. Infant-welfare centers seem invariably to have had a physician
in charge, assisted by volunteer infant-welfare workers, most of
whom were untrained. Trained and salaried welfare workers were
more and more in demand.
Private societies generally opened and maintained the center with
help from local funds. The war sponsorship society (Kriegspatenschaft), founded shortly after the beginning of the war to help the
families of soldiers financially and through education of the mother,
developed into the largest organization in Austria for maternity and
inf ant-welfare work.17 It received contributions from philanthropic
persons and a subsidy from the war-relief office of the minister of the
interior. This subsidy amounted in 1916 to 75,000 kr.16 Its object
was to keep mother and child together wherever possible, and with
this object financial assistance was extended to mothers, largely in
the form of nursing premiums. All mothers thus aided were obliged
14 Zeitschrift für Kinderschutz und J.ugendfiirsorge, August-September, 1918, p . 209.
u Ibid., January, 1918, pp. 14-15.
M Ibid., April, i917, p. 99.
B Ibid., October, 1918, p. 245.
“ Ibid., March, 1917, pp. 70-71.


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to bring their children for medical supervision to the centers main­
tained by the society, and the children were visited in their homes
by welfare workers. Seventeen centers were opened in Vienna and
67 in other places throughout the Empire.17 In Vienna the centers
were opened in the children’s hospitals, which supplied doctors and
nurses for the work. Gradually the work was extended to rural
districts. This work was done by individual welfare workers, who
visited the infants in their homes, rather than through the establish­
ment of centers. Before the end of the war more than 29,000
children were under the care of the centers belonging to the society,
and upward of 8,000 mothers received nursing premiums.17 Of the
children 10 months old aided by the society almost 94 per cent were
at one time breast fed, and a striking decrease in infant mortality
was noted.19 Of 4,282 children under the supervision of the society
before October, 1916, only 3 per cent died, whereas of 4,200 infants
born of the same mothers before the organization of the society 19
per cent had died.20 Efforts were made to get in touch with the
expectant mothers as well as with mothers of young babies, and in 1918
almost 90 per cent of all pregnant women in Vienna were in the care of
the society.21 The society was said to be intending to continue its
activity after the war and for this purpose put aside each year a part
of its income as a reserve fund.18
Other private organizations carried on work of a similar nature.
Branches of the Zentralstelle für Kinderschutz und Jugendfürsorge
(national society for the protection of children and young people)
were opened in several Provinces after the war began. They estab­
lished numerous infant consultation centers in many cities and towns,
in some places where none had been in existence before, as in NeuSandez,22Liesing, Ingersdorf, and Lieberhorten.23 In 1918 the society
had 30 welfare centers in Bohemia alone.22 “ In various places,”
said Dr. Moll, “ mothers’ consultations have been established even
in localities deprived until now of any protection for the child.” 14
In addition to the customary baby weighings, the giving of
nursing premiums, and the distribution of milk, the activity of these
centers comprised in some cases courses for mothers— to which
young girls also were admitted—-and the organization of traveling
exhibits on infant care. Many centers extended their care to children
of preschool age. Some of the branches maintained a traveling
h

Zeitschrift für Kinderschutz und Jugendfürsorge, August-September, 1918, p. 209

Ibid., October, 1918, p. 245.
18 Ibid., March, 1917, pp. 70-71.
w Ibid., February, 1916, p. 45.
so Das Österreichische Sanitätswesen, N o. 9-12, Mar. 23,1916, p. 296.
21 Zeitschrift für Kinderschutz .und Jugendfürsorge, February, 1919, p . 37.
n Ibid., October, 1918, p. 258.
n

so Ibid., July, 1918, p. 185.


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infant-welfare worker. This was first undertaken in Moravia, in
December, 1916.23 Funds for the work were obtained partly from
private sources, partly from municipal funds.
The society for the protection of infants and the infant-welfare
society, in operation in Vienna a number of years before the war,
increased their activities. The latter acted as adviser to the new
infant-welfare agencies that were organized after the war, and
cooperated with them in a variety of ways. According to an arrange­
ment between the inf ant-welfare society and the municipal children’s
bureau, mothers who were given a three months’ nursing premium
at the welfare stations maintained by the bureau were at the end of
that time transferred to the three welfare stations directed by the
society, where their nursing premiums were continued.24 A nursing
benefit operated by the infant-welfare society derived its resources
from membership dues paid by the women themselves,25 an arrange­
ment said to be unique among Austrian infant-welfare societies.
The society also organized the infant-welfare work for the refugees
from Galicia and Bukovina. Ifi 1916 the society cared for over
1,700 children, including children of preschool age as well as infants.26
It is said that 8 per cent of the children born in Vienna in the early
years of the war were under the supervision of this society.25 The
daily attendance at its centers, which before the war had been 300,,
increased to more than 3,000 during the later years of the war.28
Other voluntary societies were active in establishing infant-welfare
centers. The society of Catholic women of Lower Austria (Katho­
lische Frauenorganisation für Niederösterreich), for instance, opened
four centers in Vienna after the war began.29 Centers were also
established in several cities by the municipal children’s bureaus.
The offices of public guardians, too, both municipal and provincial,
before the war usually charged only with the supervision of children
bom out of wedlock, enlarged the scope of their work in many cases to
include welfare measures for all children. Shortly after the outbreak
of the war the office of public guardians in Vienna decided to assist
the mothers of all newly born babies in making their applications for
the military allowances due their children.30
They used this occasion for visiting the mother and advising her
with regard to the care of her baby. In January, 1915, the city
council empowered the public guardians to grant maternity, and
** Zeitschrift für Kinderschutz und Jugendfürsorge, January, 1917, p. 13.
** Ibid., July, 1918, pp. 181-183.
* Ibid., December, 1917, p. 311.
» Ibid., July, 1918, p. 182.
** Arbeiter Zeitung, January 12,1919, p. 7a.
• Zeitschrift für Kinderschutz und Jugendfürsorge, July, 1918, p. 187.
*> Ibid., October, 1915, p. 234.


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nursing aid and in February made an appropriation of 8,000 kr. a
month for this purpose.31 Maternity aid was extended by the public
guardians to the last wee’ s of pregnancy in some cases. The guardians
also reached an agreement with the larger sick-fund societies whereby
they had control through their welfare centers over nursing mothers
who applied to. the societies for the Government nursing premiums.32
In the Province of Lower Austria an office of public guardians was
established in 1916, and opened 50 consultation centers, not only
in cities, but also in the rural districts of the Provinces.33 In some
cases these were traveling centers. In 1918 it was expecting to
open 30 additional infant-welfare stations.33
In rural districts, contrary, it was said, to expectation, the attend­
ance was very good.34 In order to bring the existence of the center
to the mothers’ attention the public guardians, to whom all births in
a district were reported, sent to the mother a printed invitation to
visit the center. The midwives of the district were also urged to
impress upon mothers the importance of visiting centers. Local
officials and the public guardianship office furnished practically all
the funds necessary for carrying on these centers. “ Tt was recog­
nized,” it was said, “ that the establishment in rural districts of
accessible mothers’ consultation centers under the direction of physi­
cians is one of the most necessary requirements of practical childwelfare work.” 34 Many infant-welfare workers urged during the
war the formation of a public guardianship system for each of the
Provinces of Austria.
TRAINING OF WORKERS.

The first courses for infant-welfare workers in Austria were estab­
lished after the war began at the imperial institute for the protection
of mothers and children (Reichanstalt für Mütter und Säuglingsfürsorge). Although plans for this institute were under way before
1914 it was not organized for work until November, 1915.35 One of
its principal functions was the training of infant-welfare workers,
either volunteer or professional. Students from all Provinces were
admitted. They were expected to serve as a-connecting link between
the institute and different parts of the Empire. The training at the
institute lasted a year; both theoretical and practical instruction was
given, and students were taught to deal with both sick and well infants.
Another course of three months’ duration was given twice a year to
trained nurses who wish to take up infant-welfare work.3* In the
m

Zeitschrift für Kinderschutz und Jugendfürsorge, April, 1915, pp. 103-104.

ss Ibid., September, 1917, pp. 204-206.
ss Ibid., April, 1918, p. 95.
ss Ibid., April, 1917, p. 89.
* Ibid., February, 1917, p. 39.
•« Ibid., August-September, 1918, pp. 208-214, and October, 1918, pp. 249-254.


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third year of its existence 30 students were trained at the institute.
The demand for trained workers, on the other hand, was very great.
By order of the ministry of the interior, August 7, 1916, courses
were established also at nurses’ training schools in Vienna, Triest,
and Prague to prepare trained nurses for welfare work in all branches
of public health, including infant-welfare work. The courses lasted
six months.37 The training of infant-welfare workers formed a part
of the public guardianship system of Lower Austria. This training
was given at the central children’s asylum of the Province.38 The
need of systematic instruction in infant care at the schools of mid­
wifery was stressed during the war.
The recommendation that the duration of midwives’ training be
extended from four to nine months and that the last three months
be devoted to infant care was made by Prof. Epstein, a well-known
Austrian pediatrician and public-health physician.39 While this was
not done, on January 29, 1918, a two-months’ course was instituted
b y order of the ministry of the interior to train midwives in infantwelfare work.40
The importance of maternity and infant-welfare work, we are told,
prompted the ministry of the interior to organize also continuation
courses for physicians, the first of which was opened in Vienna ©n
March 4, 1918, and lasted three weeks.41 Physicians in the service
of the Government were required to attend and were given their
expenses. Those not in Government service who came from outside
Vienna were paid 500 kr. to cover their expenses.41
EXHIBITS AND COURSES FOR MOTHERS.

In December, 1915, an infant-welfare exhibit was given in Vienna
-among a number of war-relief exhibits organized by the minister of the
interior.42 Early in 1916 it was sent as a traveling exhibit through the
Provinces of German-speaking Austria. Many cities, large and small,
applied for it. It was held for a week or so in each place, and three
lectures were given daily by a woman lecturer who accompanied the
exhibit. As a result, it is stated, eight cities decided to establish
welfare centers and to appoint infant-welfare workers.43 In spite of
war-time difficulties, four of these plans had been put into operation
by September, 1918.43
For the further instruction of mothers, pamphlets on child care
were published by several agencies. The organization committee of
37 Das Österreichische Sanitätswesen, 1916,'Nos. 31-35, pp. 1266-1274.
3» Zeitschrift für Kinderschutz und Jugendfürsorge, November, 1917, p. 273.
3* Ibid., July, 1916, p. 200.
*>Ibid., June, 1918, p. 147.
« Ibid., M ay, 1918, p. 136.
8» Das Österreichische Sanitätswesen, No. 1-4, Jan. 27,1916, p. 102.
8* Zeitschrift für Kiaderschutz und Jugendfürsorge, August-September, 1918, pp. 223-224.


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the Emperor’s jubilee fund for the protection of mothers and chil­
dren put out in 1915 two pamphlets containing instructions on the
feeding of infants.44 The minister of the interior also prepared and
gave free of charge leaflets on the care of the baby and in 1918 was
said to be planning a new uniform pamphlet of instruction.45
Free lectures and courses for mothers increased in many cities.
In the city of Neunkirchen, for instance, courses for mothers were
given for the first time in March, 1917, under the direction of the
public guardianship board of Lower Austria.46 These courses were
to be repeated in turn in all the districts of the Province. In some
places, as in the case of Vienna, where brief courses in infant hygiene
were organized shortly after the war began,47 lectures were intended
for mothers and volunteer welfare workers; in other cases they were
open also to young girls. Sunday schools for mothers to teach
infant care were established in several cities after the war began,
following the example of Prague, where one had been organized in
19 l l 48 by a physician who believed that not only working mothers
but also those of the middle class were greatly lacking in the most
elementary knowledge needed for the bringing up of children.
PROVISIONS FOR NUTRITION.

During the war many cities took steps to increase the supply of
milk or to conserve what was at hand for the children. Karlsbad,
for example, maintained for a long time a herd of goats in order to
relieve the difficult milk situation.49 On September 11, 1916, the
minister of the interior issued an order empowering local officials to
take measures for “ assuring the necessary amount of milk for the
population with special regard to children, nursing mothers, and
sick persons, especially in large centers.” 50 This order was followed
on the next day by a circular containing detailed regulations for the
hygienic production and sale of children’s or infants’ milk.51 In
some cities, as in Vienna, the office of public guardians distributed
the milk cards to nursing mothers when they came to the welfare
centers.30 Infant-welfare centers in many cases handled the milk
supply for mothers and children.
Expectant and nursing mothers and children under 5 were allowed
also a larger sugar ration than the rest of the population, according
to an order of the food administration, effective December 1, 1917,52
so Zeitschrift für Kinderschutz und Jugendfürsorge, October, 1915, p. 234.
M Das Österreichische Sanitätswesen, Supplement to Nos. 14-15, Apr. 8 and 15,1915.
« Zeitschrift für Kinderschutz und Jugendfürsorge, June, 1916, p. 147.
<6 Ibid., M ay, 1918, p. 135.
« Ibid., June, 1915, p. 149.
48 Ibid., July, 1918, p. 189.
49 ib id ., March, 1918, p. 69.
60 Das Österreischische Sanitätswesen, Nos. 36-43, September-October, 1916, p. 1527.
Ibid., p. 1535.
M Ibid., December, 1917, p. 312.

h


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Infant-welfare committees and private societies in a number of
places provided cheap or free dinners and milk for nursing mothers
and pregnant women. In Vienna also three diet kitchens furnishing
cheap or free meals for children recommended by physicians were
maintained partly by State funds.53
GOVERNMENT MEASURES.

On April 23, 1918, the minister of the interior addressed a circular
to the political authorities of all the Provinces.54 This circular dealt
exhaustively with the main points to be borne in mind in increasing
welfare work for infants and young children, and with the extent to
which State aid was available for this purpose. It emphasized the
increased need of the work in these words:
T h e need for the preservation and increase of the energies of the people requires
measures and arrangements for the preservation of the life and increase of the strength
of infants and young children.

For this purpose efforts should be made to take new

measures w ith the cooperation of all interested factors; the organizations already
existing must be urged to extend their activity .

Protection of pregnant women and

women in confinement is most closely connected w ith the practical welfare measures
for the infant and the child below school age.

It stated that—
T h e willingness to feed the child at the breast should be promoted b y oral propa­
ganda and b y writing.

Energetic instruction along this line is before all the task of

physicians and m idwives; it is also advisable to enroll for this instruction clergymen,
teachers, and other persons.

Leaflets and pam phlets for mothers in combination w ith

personal instruction are very useful. * * * Particularly in the rural districts the
m idw ives under the supervision of the physician in p ublic service are called upon to
instruct the mothers, even in the pregnancy period, in the importance of breast feed­
ing and in the need of sufficient care.

*

*

*

T h e establishment in each Province

of a traveling exh ib it for welfare work w ith mothers, infants, and young children
* ,* * seems advisable.

It spoke at length of the establishment of welfare centers:
T h e number of arrangements of this kind existing in A ustria is still entirely insuf­
ficient.

These places are the centers of instruction and welfare work for all mothers.

T h e main rules for the arrangement and maintenance of mothers’ consultation centers
w ill be issued in the near future.

A t present it can only be stated that Governmental

ass'stance to the welfare stations is intended only for places w ith a high infant mor­
tality, especially cities and centers of home industries. * * * In larg% cities a
children’ s physician should be in charge, in smaller cities and in the country a p h y­
sician in public service experienced in infant-welfare work, such as the district or
municipal physician. * * * In cities and large industrial centers, special infantwelfare workers should devote themselves under the supervision of physicians to
infant-welfare and mothers’ consultation work. * * * T h e nature of the individual
welfare stations w ill vary according to local circumstances. For the larger cities a
distribution of the welfare stations according to districts can be recommended, in
such a w ay that the consultation and supervision of the mothers can be carried out
without special difficulties.

T h e welfare stations can be established b y municipal or

M Zeitsschrift für Kinderschutz und Jugendfürsorge, March, 1918, p. 75.
M Ibid., June, 1918, pp. 146-150.


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communal authorities, State p ublic guardianship boards, State' and district commis­
sions for the protection of children, and welfare work w ith young people, societies,
sick funds, and others.

*

*

*

A central coordination of the work of all welfare

centers is urgently needed, especially as regards the individual applications, the
nature of the service given, and the tim e of the end of such service.

Cooperation w ith

the existing organizations for welfare work w ith mothers, infants, and young children
is to be promoted as much as possible.

Subsidies should be given to these societies

and their a c tiv ity should be extended.

With regard to the aid extended by the State to infant-welfare
work, the circular made the following statement:
T h e agencies m a in ta in in g the consultation or welfare centers should obtain the
greater part of the necessary funds from the Government of the Province, municipal
authorities, and private sources.

O n ly in exceptional cases w ill assistance be granted

b y the State; its maximum amount w ill be 50 per cent of the total outlay.

A pp lica­

tions for subsidies from the State should be sent through the political authorities of the
district and the Province. E ach application should specify—
(1) T h e name of the agency m aintaining the center; whenever possible, copies
of annual reports, constitutions, regulations, or similar literature.
(2) A description of the quarters and the arrangement of the welfare center.
(3) Information about the head physician; references.
(4) Similar data about the infant-welfare worker, w ith a detailed statement of
her professional training. * * *
(5) Statem ent about other employees of the welfare station, in cluding volunteer
workers.
(6) Am ount of the State subsidy applied for w ith a detailed statement of the
cost of establishing and m aintaining the station. Number of mothers
coming to the center for advice and assistance; statement of assistance
given b y the Province, com m unity, private organizations, and in d ivid ­
uals.

*

*

*

For the time being it was considered sufficient for the State merely
to recommend the measures considered necessary, requesting the
authorities to suggest those measures and to assist in carrying them
out. “ Legislative compulsion and the assurance of a definite sub­
sidy are still missing,” says one writer, “ but we are much nearer to
the goal because the State recognizes and expresses the principle that
the protection of mother and child is decidedly its own duty.” 55
In 1918 two new ministries were formed, a ministry of social welfare
and a ministry of public health. Each included in its activities wel­
fare work for infants. An advisory board on children was estab­
lished in connection with the ministry of social welfare with the pur­
pose of giving advice and suggestions on child-welfare matters, in
order to bring about cooperation on the part of the Government with
private child-welfare agencies and to assist the latter in their work.
On June 17, 1918, the board held its first meeting.56 It proposed a
bill for the establishment of provincial and district children’s bureaus
for the local administration of child-welfare work, and supervision
66 Zeitschrift für Kindersehutz und Jugendfürsorge, June, 1918, p. 146.
•* Ibid., July, 1918, pp. 194-195.


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over public and private child-welfare agencies. Subsidies to infantwelfare work were given by both the ministry of social welfare and
the ministry of public health. The sums were said to be very mod­
erate.57 The agencies interested in the social and legal side of welfare
work with mothers, infants, and young children came under the
authority of the ministry of social welfare.57 The ministry of public
health, on the other hand, made grants to agencies concerned merely
with health matters relating to children below school age. These
agencies included institutions for pregnant women, lying-in homes,
homes for mothers, mothers’ consultation centers, infant-welfare sta­
tions, and nurseries.58
PUBLIC FINANCIAL AID.

Maternity insurance.
An extension of the protection of mothers and infants was brought
about through the amendment to the sickness insurance law granting
maternity benefit. The amendment (Jan. 4, 1917) states explicitly
that the granting of maternity benefits is one of the objects of insur­
ance. The woman entitled to maternity benefit received, according
to this amendment, free medical treatment, including the attendance
of an obstetrician and the care of a midwife; free medicines and
therapeutical appliances; and a cash benefit which varied from 0.60
kr. to 5 kr. a day, according to the wages which the woman had been
receiving and the amount of the premium that she had paid. Con­
finement benefit was in this amendment extended to cover six weeks
after, delivery instead of four. At the same time the industrial code
was amended, prohibiting the industrial employment of women for
six weeks after confinement.
In addition to the benefit, women who fed their infants at the
breast were eligible to a nursing premium of half the sick benefit
for a period not exceeding 12 weeks after delivery. Between April
9, 1917 (when the amendment providing nursing premiums went
into effect), and the end of ^December, 1917, the general workers’
sick fund of Vienna spent 45,059 kr. and the district sick fund of
that city 28,612 kr. in nursing premiums.59
The maternity benefit and the nursing premium were required
from the sickness-insurance'societies. They might, if they desired,
introduce further benefits, such as a pregnancy benefit to the amount
of sick benefit for not more than 4 weeks to women who on account
of pregnancy were unable to continue their work; or the extension
of nursing premiums up to 26 weeks; or the substitution of hospital
or nursing treatment during the lying-in period in place of part of
67 Zeitschrift für Kinderschutz und Jugendfürsorge, June, 1918, p. 167.

88W iener Medizinische Wochenschrift, No. 33,1918, p. 1466.

" Österreichische Zeitschrift für öffentliche und private Versicherung, 1918, vol. 8, N o. 3, p. 293.

173389°—20

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the cash benefit, this substitution to be made only with the consent
of the women. Sickness societies were permitted also to extend
their benefits to the uninsured dependents of insured men, and this
was done in some cases, for example, by the district sick fund of
Vienna.60 Many sickness societies established welfare centers for
their members.
As the law failed to include large groups of home workers, salaried
employees, domestic servants, and small independent business
people, a “ considerable subsidy” was granted by the ministry of
health to the organization of nursing funds for uninsured women,
not only in Vienna but in the country districts as well.81 Each
pregnant woman not subject to compulsory insurance may pay
into the fund 50 kr. and receive- in return a pregnancy benefit, a
maternity benefit, an allowance toward the payment of the mid­
wife’s fee, and a nursing premium, everything together amounting
to 150 kr. On the orders of a physician, mstead of cash benefit,
assistance in kind may be given, such as linen, articles necessary
for the care of the infant, and food for the infant. Each member
of the nursing fund is instructed during her pregnancy by a physician
or a nurse in the rules of hygiene which a woman in her condition
must know and is given the advice she needs to prepare herself to
nurse the child. A number of cities granted nursing premiums
out of municipal funds. In some cases where premiums for breast
feeding had been given before the war the amount was increased.
Vienna, for example, raised its premium from 4 to 24 kr. a month.62
Separation allowances.
By imperial order of March 30, 1917, the prewar law on separation
allowances was amended, increasing the allowance to the wife 25 per
cent in Vienna, and 20, 15, and .10 per cent in other places, according
to the locality. Children under 8 in families living in rented quarters
received the same allowance as adults instead of only half, as previ­
ously; children in families not living in rented quarters, however,
received one-half the adult allowanced On July 27, 1917, a new
separation law was issued, making void the order of March 30.
The allowance was granted to all persons who had been supported
by the work of a soldier, if their income were insufficient for support.
The allowance was 2 kr. daily for each person in Vienna, and 1.80 kr.
and 1.60 kr. in other localities.6*1
«Zeitschrift für Kinderschutz und Jugendfürsorge, January, 1918, p. 19.
«»Ibid., October, 1918, p. 246.
® Ibid., January, 1915, p. 15.
•s Ibid., May, 1917, pp 139-140.
m Soziale Rundschau, Heft 6-8. 1917, pp. 220-222.


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A U S T R IA .

67

ESTABLISHMENT OF DAY NURSERIES AND CENTERS.

In 1915 women constituted over one-third of all persons employed
in Austria, an increase of 5 per cent over the number of women
working in 1914.65 The increased employment of women resulted,
as in other countries, in an increase in day nurseries. Early in
the war a number of nurseries were opened in Vienna under the
impression that women in large numbers would find employment.
This, however, was not the case, for in Austria, as elsewhere, a period
of unemployment followed the declaration of war. The nurseries
so hastily established were said to be badly equipped, poorly run,
and lacking in space and facilities, so that it was considered by
welfare workers a fortunate thing when they closed for lack of
attendance. As the war continued, a real demand for additional
day nurseries arose. In 1916 a society for day nurseries for war
orphans and soldiers’ children began its work in Vienna. In 1917
the society had two centers, both of which received subsidies from
the military authorities and fulfilled “ in every respect all the require­
ments of such institutions.” Each accommodated 200 children,
about one-fifth being under school age. They were open daily
from 6.30 a. m. until 7 p. m. Once a week the children were examined
by a doctor. An annex for children whose mothers were working
at night was also opened, providing for 32 children. By 1918 the
society had increased its day nurseries so that in all over 600 children
could, be cared for.88
The organization Die Bereitschaft (preparedness society) through
its child-welfare committee, began opening nurseries in September,
1914, and in 1918 was maintaining seven nurseries. These nurseries
were maintained by private contributions pnd by what the mothers
were able to pay.87 Another society, Kinderfreunde (friends of
children), operating in the Province of Lower Austria, during 1917
cared for over 356,000 children in its day centers or nurseries for
children above the age of infancy.68
Only healthy children were admitted to the nurseries. The
tendency present in the early months of the war to have only a
volunteer physician in attendance at the nursery, if there were any
physician at all, gradually gave way to the custom of having paid
physicians regularly visit the nursery.
An effort was made by private societies to induce factory owners
to install nurseries and nursing rooms on factory premises. A few
factories did this. In Government tobacco factories nurseries were
required by law.
Die Gewerkschaft, May 29,1917, pp. 125-126.
M Zeitschrift für Kinderschutz und Jugendfürsorge, July, 1918, p. 185.
17 Ibid., August-September, 1918, pp. 201-208.
« Arbeiter Zeitung, Apr. 7,1918, p. 6b.


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IN F A N T -W E L F A R E W O R K I N

EUROPE,

INFANT MORTALITY RATES.

Until the war was well under way the infant mortality rate in
Austria, though still high, was declining.69 Each period between 1891
and 1913 shows an appreciable decrease in most Provinces,70 and in
1914, except in the case of Upper Austria, there was a still further
decline. But in 1915 an increase is recorded in every Province ex­
cept Vorarlberg. This increase over the 1914 rate ranges from 4 per
cent in the case of Lower Austria to 40 per cent in the case of Carniola. In 1916 the rate declined in every Province, in 5 below the
prewar rate. Table X gives the figures for 11 Provinces from 1891
to 1916.
T ablb X

Provtnce.

.— Number of deaths under 1 year per 1,000 live births.

1891-1895» 1896-1900» 1901-1905» 1906-1910» 1911-1913*

I ower Austria...............
Upper Austria...............
Salzburg...........................
£ tyria................................
Corinthia..........................
Carniola.................... .
T y rol.................................
Vorarlberg.......................
Bohemia..........................
M oravia.................... ..
Silesia............... ...............

250i7
262.5
256.0
222.4
221.6
194.8
219.3
193.4
265.1
250.7
239.3

222.7
243.7
235.1
213.4
217.3
187.3
208.1
192.9
243.4
221.1
227.1

204.8
237.6
216.9
201.0
213.2
168.8
199.4
173.8
229.9
219.3
216.9

191.7
220.9
207.1
190.5
194.8
177.7
192.2
154.8
205. 2
204.0
210.1

176.7
206.5
182.3
186.3
186.2
170.8
186.4
150.7
192.5
186.8
196.4

1914*

163
209
158
164
172
149
170
146
180
178
170

1915»

1916*

169
221
206
226
237
208
236
140
221
223
220

144
220
175
212
205
188
209
137
192
196
193

1 Das Österreichische Statistische Handbuch. Calculated from number of live births and infant deaths.
1892, pp. 24 and 26; 1893, pp. 27 and 29; 1894, pp. 17 and 19; 1895, pp. I7„andl9; 1897, pp. 14 and 20; 1898,p p ,
14 ana 20; 1899, pp. 14 ana 20; 1900, pp. 16 and 22; 1901, pp. 12,18,80, and 36; 1903, pp. 42 and 48; 1905, pp. 22
and 28; 1906, pp. 16 and 20; 1907, pp. 20 and 26; 1908, pp. 22 and 24; 1909, pp. 22 and 28; 1910j.pp. 15 and 16;
1911, pp. 19 and 22; 1912, pp. 19 and 28; 1913, pp. 39 and 48; 1915, pp. 47 and 54; and Das Österreichische
Sanitätswesen, 1916, Beiheft, Säuglingssehutz und Jugendhygiene, lie ft V I I , p. 9-14; Das österreichische
Statistik, V o l. 88, part 3, p. v .
8 Zeitschrift für Kinderschutz und Jugendgfürsorge, August-September, 1918, p. 209. The sources are
said by the author, D r. Leopold M oll, to h e official.

Urban infant mortality rates are generally lower than those for
Austria as a whole, as is indicated by Table X I, which gives rates for
cities with a population of 100,000 or over. The fluctuations during
the first two years of war are similar to those recorded for the Prov­
inces. Even in 1915, when, with the exception of Cracow, there was
a considerable increase over 1914 in the rate for e'ach city, the rates
did not rise far above the average prewar level except in Lemberg;
es The infant mortality rate for Austria as a whole is given for five-year periods between 1901 and 1910, and
for the three-year period 1911-1913, for purposes of comparison with rates for other countries. No figures
are available for the whole country after 1913.
N u m b e r of de at hs u n d e r 1 y e a r p e r 1,000 live births a.

1901-1905..................................................................................................... .......................
1906-1910.............................. ........................................................................ . . i . ................
1911-1913........................................... ........... ............................... ...................J .............
a

Rate.
. 215.9
. 201.5
. 192.9

Österreichisches Statistisches Handbuch, 1912, pp. 15 and 26; 1913, pp. 39 and 48.

M The Provinces under discussion are those included in the table, since rates are available for no
other entire Provinces after 1913.


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69

AUSTRIA.

and in Vienna, Triest, and Cracow the 1915 rate was lower than that
in 1913.
T a b l e X I .—

Number of deaths under 1 year per 1,000 live births.1

Cities of 100,000 population and over.

Vienna...........; ...................................................
Graz......................................................................
T riest...................................................................
F rague.................................................................
Brunn..................................................................
Lem berg.............................................................
Cracow................................................................

1901-1905

1906-1910

177.9
143.3
200.2
178.9
160.7
296. 2
152.9

170.7
123.9
196.6
168.4
123.3
160.1
143.9

1911

1912-

1913

1914

165.6
136.6
215.5
172.1
80.9
128.5
159.9

149.2
115.8
183.6
157.8
131.9
136.6
142.9

156.0
118.7
208.3
142.9
113.3
128.4
159.6

139.5
115.2
181.9
147.8
107.5
197.2
172.4

1915

152.4
132.3
207.0
160.5
142.0
305.5
156.5

1 Das Österreichische Sanitätswesen, Beiblatt (in each case) 1902, pp. 39 and 40; 1903, pp. 35 and 36; 1904,
pp. 31 and 32; 1905, pp. 39 and 40; 1906, pp. 51 and 52; 1907, pp. 39 and 40; 1908, pp. 31 and 32; 1909, pp. 59
and 60; 1910, pp. 43 and 44; 1911, pp. 57 and 58; 1912, pp. 115 and 116; 1914, pp. 119,120,317 and 318; 1915, pn.
420 and 421; 1916, pp. 144 and 145.
|
’'

SUMMARY.

The infant mortality rate in Austria, which had been falling for a
number of years, increased during the first complete year of war.
But in 1916, 11 Provinces 71 showed a decrease as compared with
1915, while in 2 Provinces, Lower Austria and Vorarlberg, there was
a drop in the rate even below the prewar figure. A similar tendency
is seen during the war in urban rates. These rates in Austria are
generally lower than rates for the whole country.
Legislation dating back to 1885 attempted to protect the mother
at work in a factory by prohibiting her employment for four weeks
following confinement. Compulsory sickness insurance instituted in
1888 made it possible for working mothers to receive maternity
benefit. The training and practice of midwives were regulated by
the State.
Private organizations in some cities aided by municipal funds
carried on all infant-welfare work, such as consultations for well *
babies and the like. Their development dates from the early years
of the present century. Private funds also undertook an inquiry
some time between 1910 and 1913 into the causes of infant mor­
tality in Austria, with the object of providing a basis for future work
in a national institute of infant welfare. The opening of this institute
was somewhat delayed by the war.
Unofficial work during the war was expressed chiefly through the
war sponsorship society, which established centers, aided nursing
and expectant mothers, and assisted women in confinement. Other
private societies interested in the welfare of infants extended their
work. Consultation centers, which had been comparatively few in
number before the war, were established in great numbers by these
societies. A few rural centers were opened, and the need for rural

nThe only complete Provinces for which figures are available.


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INFANT-W ELFARE W ORK IN EUROPE.

work was widely agitated. The imperial institute for the protection
of mothers and infants, which in 1915 was finally opened, provided a
training school for welfare workers. Trained workers were more and
more in demand. Every effort was made through the centers, the
welfare workers, written propaganda, and courses for mothers to
teach mothers the importance of breast feeding their babies. In
order to increase the number of breast-fed infants, nursing allowances
were given to mothers, sometimes by private agencies, sometimes by
the Government through its insurance system.
Special steps to provide pure milk for mothers and young children
were taken during the war by both ministerial order and municipal
action. Private and municipal agencies were active in furnishing
nourishing meals for expectant and nursing mothers. Several
municipal and provincial offices of public guardians, whose function
was the supervision of children born out of wedlock, extended their
work during the war to include the welfare of all infants. They
established centers, gave financial assistance at confinement and. in
some cases during pregnancy, cooperated with the sick benefit
societies in order to increase breast feeding, and arranged courses in
child care for mothers.
Cooperation between public and private work was sought through,
representation of each on local committees. The ministries of social
welfare and of public health, both created during the war, assisted
also in bringing about this cooperation.
An increasing recognition during the war on the part of the Govern­
ment of its responsibility toward the infant population and of the
need for child conservation is manifest in Government measures.
The ministries of social welfare and of public health were each
charged with some phase of infant-welfare work. In 1918 public
* funds became available in small amounts for infant mortality work,
chiefly, however, for work in districts with an unusually high infant
mortality. At the same time a ministerial circular sent out to all
political authorities set forth in detail the lines along which develop­
ment in infant-welfare work should be made.
Separation allowances were twice increased during the war. The
sickness insurance law was also amended in 1917 to provide for a
more generous maternity benefit and nursing premiums for all insured
women. The Government subsidized a nursing fund for uninsured
women. At the same time compulsory confinement rest was extended
to six weeks.
An increase in the number of employed'women caused the opening
of numerous day nurseries and also of centers caring for children of
preschool age during the mothers’ absence at work. The nurseries
and centers were private enterprises. Regular medical supervision
of these institutions became more and more customary.

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BELGIUM.
INTRODUCTION.

Belgium shared early in the modern infant-welfare movement.
When the war came the country was familiar with the main types of
infant-welfare work.
Table X IA shows that, like every other belligerent country, Bel­
gium •suffered an unprecedented fall in the birth rate during the first
year of the war.
T able

Year.

191)7
iflOfc

X I A .—

Number of live births per 1,000 of the population.1

Births.

26.18
25.73
25.30
24.89

Year.

1909....................................
1910. .
1911....................................
1912....................................

B irth s.

23.68
23.72
22.94
22.61

Year.

Births.

21.6

1913 *..................................
1914 3..................................
1915 2 ..................................

16.1

i Annuaire Statistique de la Belgique, 1913, p. 126.
* Revue Internationale de la Croix Rouge, A pril 15, 1920, p. 399.
* Not available.

A tremendous fall in the birth rate and rise in infant mortality
were inevitable under the conditions prevailing during 1914-1918.
It is not surprising, therefore, even with resources at a minimum,
that every effort should have been made to continue the prewar
work for conserving infant life. But the expansion, coordination,
and adaptation of -this earlier work during invasion and war form a
remarkable chapter in the history of infant-welfare work.
In the words of Dr. Lucas, “ It is generally evident that infant con­
ditions are on the whole better than normal, that class having been the
object of great solicitude since the beginning of the war.” 1
INFANT-WELFARE W ORK BEFORE THE WAR.
LEGISLATION AND GOVERNMENT AID.

Belgium was one of a number of European countries which had
early enacted a law providing for a confinement rest for the factory
mother. This law, passed December 13, 1889, prohibited the factory
employment of any woman within four weeks after childbirth. There
was no compulsory health insurance with provision for maternity
benefit, so that the mother was without public financial assistance
during this period, though compelled by law to desist from work.
i Journal American Medical Association, 1917, L X V I I I , p. 32.

71


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72

I N F A N T -W E L F A R E W O R K I N

E UROPE.

Women in confinement were protected by the State regulation of
midwifery. Two royal decrees issued on December 30, 1884, brought
schools of midwifery under Government supervision and prescribed
the course for midwives. The decree provided that clinics for practi­
cal work must be attached to all schools. In order to be admitted to
the school a woman must be between 18 and 30 years of age; she
must present a certificate of good conduct, must be able to read and
write the language in which instruction is given, and must know ele­
mentary arithmetic. The course lasts two years. Theoretical
instruction includes anatomy, physiology, obstetrics, the theory of
operations, hygiene, and medical ethics. Practical instruction- con­
sists of practice on a dummy and the management of labor and, in
the second year, assistance at difficult cases of confinement. A royal
decree of July 1, 1908, prescribed the program of the final examination
of midwives. This is to consist of anatomy, physiology, obstetrics,
hygiene (including infant hygiene), and medical ethics. On the same
date a royal decree was issued regulating the practice of midwifery.
It prescribes in detail the duties of the midwife toward the patient and
the baby, and the rules of cleanliness; it enumerates the cases when a
physician should be called. The midwife is, however, subject to no
systematic supervision or inspection after she begins to practice.
In support of both private and municipal work for infants the
State gave subsidies.4 This aid was extended to approved infant
consultations and milk depots. Up to 1885 crèches for children
under 2 had been subsidized by the State, but in that year public
assistance was discontinued, though subsidies continued to be given
to écoles gardiennes, or infant schools caring for children over 2 years
old and up to school age.8
PRIVATE AND MUNICIPAL ACTIVITY.

“ Private charity,” says a Belgian report, “ freed from the trammels
which impede the normal development of every official organization,
has shown itself more progressive [than official work!, and a number
of agencies have tried to organize preventive aid, especially for the
protection of children.” 6
The first milk depots or gouttes de lait were established through
private enterprise during the closing years of the nineteenth century.
They were practically identical with the original goutte de lait'in
Paris. Infants who could not be breast fed were provided with milk
and were regularly weighed and examined by a physician.
Side by side with the milk depot was the infant consultation center,
which also had a French origin. Here the emphasis was entirely on
4 Keller, A ., und Klumker, Chr. J.: Säuglingsfürsorge und Kinderschutz in den Europäischen Staaten,

p. 28.
* Buisson, F . E .: Dictionnaire de Pédagogie et d'instruction Primaire, part 1, vol. 2, p . 1875.
1 Projet de loi instituant l'Œ u vre Nationale de l’Enfance, Chambre des Représentants, N o. 64, p. 16.


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BELGIUM.

73

breast feeding. Mothers were encouraged, usually by means of small
gifts of food, clothing, or medicine, to nurse their babies.7 The babies
were kept under constant supervision by the doctors in charge of the
centers and were weighed every two weeks. Volunteer workers
assisted the doctor at the consultations and gave hygienic advice and
instruction to the mother. By 1914 there were 83 of these infantwelfare centers in the country, of which 18 were in Brussels and its
suburbs, 6 in the rest of Brabant, 6 in the Province of Antwerp, 15 in
the Province of Liege, 13 in East Flanders, 7 in West Flanders, 14 in
Hainaut, 2 in Limburg, 1 in the Province of Namur, and 1 in Luxem­
bourg. About 70 of these infant consultations were located in terri­
tory which was invaded during the war.*
While both welfare centers and milk depots were usually estab­
lished and maintained by private agencies, a few were organized and
directed by municipal, communal, or provincial authorities.8 All
were entitled to the State subsidy if they were properly organized
and conducted by a physician and were open to inspection. In some
cases cities gave subsidies also to consultation centers and milk
stations established by private funds.
Two canteens for mothers (cantines maternelles) were opened, one
by an infant-welfare center in Brussels and one by the bureau of
charities in Antwerp. * These canteens gave one meal a day free of
charge to any expectant mother from the fifth month of pregnancy
and to any nursing mother as long as she continued to nurse her child.9
In October, 1903, the Ligue Nationale pour la Protection de
PEnfance du Premier Age (national league for the protection of
infants) was organized through private initiative and financed by
private resources. The purpose of the league was ‘ ‘to work for a more
extensive application of infant hygiene, to centralize inf ant-welfare
agencies in order to facilitate their common work, to collect all
information relating to the protection of infants, and to search for
and to test all welfare measures in order to be able to suggest them
to the charitable organizations, public authorities, and other bodies
intending to do anything for the protection of endangered children.’ ’1(>
Practically all inf ant-welfare work in existence affiliated itself with
this association, and as a result of its activities a number of new
infant-welfare centers and milk stations were established.
The league endeavored, through pamphlets, lectures, and courses,
to educate the public in the importance of proper infant care. It
6 Projet de loi instituant l’ Œ uvre Nationale de l’ Enfance, Chambre des Représentants, No. 64, p . 16.
Keller, A ., und Klumker, Chr. J.: Säuglingsfürsorge und Kinderschutz in den Europäischen Staaten,

7

p . 27.
s Ib id ., pp. 27-28.
9 Psojet de loi instituant l’ Œ uvre Nationale de l’ Enfance, Chambre des Représentants, N o. 64, p . 25.
» Keller, A ., und Klumker, Chr. J.: Säuglingsfürsorge u n d Kinderschutz in den Europäischen 8taaten,
p p . 26-27,


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IN FAN T-W ELFARE WORK IN EUROPE.

also distributed throughout Belgium leaflets for mothers on infant
care and hygiene.
In 1910 day nurseries or creches numbered about 50, of which
Brussels with its suburbs had 17. The majority of these were
privately owned. Liege 11 had 6 municipal nurseries, but no other
city or Province maintained nurseries, although a number subsidized
them.12 Infant schools (écoles gardiennes) were set up in some
communes for children between 3 and 6 years old. There the children
are fed and cared for during the hours that their parents are away.
They have a program consisting of Froebel games, singing, simple
language lessons, manual work, and gymnastics. These schools are
subsidized by the State.18
INFANT-WELFARE W OR K DURING THE WAR.
ORGANIZATION UNDER THE NATIONAL COMMISSION FOR FOOD RELIEF.

Very soon after the outbreak of the war voluntary infant-welfare
agencies discovered that, although the need was greater than ever,
they could not continue their activities because of restricted resources.
Many of them applied for assistance to the local committee of the
national commission for food relief (Comité National de Secours et
d’Alimentation), which had been organized in the opening days of the
war and was functioning all over the country with the assistance of
ministers of several neutral countries. As increased appeals for aid
came in and the problem of infant nourishment became more pressing,
the commission decided to establish a separate department for infantwelfare work and to centralize the infant-welfare work of the local
committees. This department of the commission was founded Feb­
ruary 20, 1915.14 In a circular addressed to all infant-welfare agen­
cies it expressed its purpose of coming to the aid of administrative
authorities and agencies assisting any children in need of help. It
was the intention of the department on infant welfare when it was
first organized to limit its activity to aiding organizations already in
existence, but it soon became apparent that in order to reach all chil­
dren new organizations would have to be created. In August, 1915,
the department was authorized by the national commission to estab­
lish new infant consultations and milk stations (gouttes de lait), and
in October of the same year to open canteens for sick babies and for
nursing and expectant mothers.
A few months later (July 1, 1916) a special division was created
to look after food for children, as distinct from aid to placed-out
11 Keller, A ., und Klumker, Chr. J.: Säuglingsfürsorge und Kinderschutz in den Europäischen Staaten,
pp . 38-39.
12 Internationales Kongress für Säuglingsfürsorge, Berlin, 1911, pp . 677-678.
i» Büisson, F .: Dictionnaire de Pédagogie et d’ Instruction Primaire, pt. 1, yol. 1, p. 778.
H Projet de loi instituant i ’ CEuvre Nationale de l ’ Enfance, Chambre des Représentants, N o. 64, p. 18.


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BELGIUM.

75

and abandoned children and orphans. This division, the Commission
de 1Alimentation de l ’Enfance, began its work on July 1, 1916.15
A provincial committee was appointed for each Province, and a
local committee for each commune. Each ageney was regularly in­
spected by both the national commission and the provincial committee.
The latter made half-yearly reports to the national Commission. The
commune and the Province each bore one-third of the expense of the
work, the national commission paying the remaining third.18
Free aid was extended to any family with an income of less than
175 francs a month for the first person and 50 francs a month for each
of the other members of the family. Part payment was exacted from
all other families having less than 225 francs a month for the first
person and 60 francs for each of the remaining members of the family.
Nevertheless, provincial committees might, at their discretion, reduce
this standard.
INFANT FEEDING.

' No food for children under 3 was provided except in connection
with an infant-consultation center.17 The consultations were con­
ducted by a physician assisted by several voluntary workers. Each
infant was weighed every two weeks; after the first year weighings
were less frequent. A chart was kept of each child, showing how its
progress compared with the normal, so that the doctor could keep a
careful watch over the growth of the baby and regulate its care and
diet accordingly. No subsidies were given to infant consultations
where expert medical care was not furnished.
Mothers, too, were kept under careful supervision at the centers,
and every effort was made to assist them and to induce them to breast
feed their babies. Voluntary workers visited the homes of the infants
to help the mother in carrying out the advice of the physician and to
“ overcome any prejudices” that the mothers might entertain. The
visitors were required to report regularly to the doctor in charge of
their center.
Although mothers were urged to nurse their infants whenever this was
possible, artificially fed babies were enabled to secure milk prepared
according to formulae at the milk stations, or gouttes de lait.18 Milk
for the gouttes de lait was purchased only from such farmers as ac­
cepted the supervision of the national commission. Farms and cows
were inspected. The milk was delivered directly to the milk stations,
where it was boiled and put into bottles. It was not possible to divide
the milk into feedings because of the scarcity of glass bottles.
Up to 7 months infants were given only sterilized and sweetened
milk. After that age a farinaceous food was allowed them. At 14
m Projet de loi instituant l’ Œ uvre Nationale de l’ Enfance, Chambre des Représentants, N o. 64,
pp. 19-20.
lfi Ibid., pp. 23-21
17 Ibid., p. 20.
18 Ibid., pp» 21-22.


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months cocoa and a small ration of bread were given, and from 2 to 3
years the child received a ration of soup and a larger bread ration in
addition to the cocoa.
In 1918, 768 centers and milk stations were functioning, with
90,130 infants under their care.19
Children over 3* years old who were delicate or weak were given a
meal each day, in addition to the ordinary ration given to poor
Belgians, in canteens established especially for undernourished and
anemic children.
THE MILK SUPPLY.

Everthing possible was done by the committee to assure a supply
of-fresh milk for children, in large cities and in several industrial
centers dairies were established, the cows being brought from Holland
when it was impossible to secure a surplus from outlying farms.
Fresh cow’s milk was supplemented by condensed and dried milk,
which was imported in enormous quantities.
THE FEEDING OF MOTHERS.

The national commission for food relief very early in its activity
for infant welfare realized that the feeding of mothers presented a
special problem which could not be satisfactorily met by merely
increasing rations. For one reason, mothers were only too apt to
divide the extra food among the members of their families instead
of eating it themselves. To meet this difficulty, even before the
war mothers who were unable to attend the mothers’ canteens (can­
tines maternelles) had been given a specially prepared food, known
as lactigène, the basis of which was a farinaceous food and milk.20
During the war this custom was continued in cases where the mothers
lived at too great a distance from the canteen to take advantage of
its meals.
j n all other instances, however, the canteen was found to offer the
best solution of the problem of feeding expectant and nursing
mothers. The canteens provided one nourishing meal a day to all
mothers from the fifth month of pregnancy to the ninth month after
confinement. As the mother is frequently in a weakened condition
after a long period of nursing, the commission toward the end of the
war decided that the mother might continue to receive the meal for
a month after weaning.
Attached to every canteen was a doctor, to supervise the health of
the mother, and infant and to advise the mother concerning breast
feeding. Mothers receiving the dinners generally attended a con­
sultation center also.
These canteens rose in number from 2 to 473 and aided over 7,000
expectant mothers and almost 14,000 nursing mothers.21
i* Projet de loi instituant l'Œ uvre Nationale de l'Enfance, Chambre des Représentants, N o. 64, p. 24.
80 Ibid., p. 21.
« I b i d ., p. 25.


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CRÈCHES.

Because of the prevailing unemployment during the war there was n o
need for new day nurseries. . Only one new nursery was established.
This was at Dinant, where the number of children left without super­
vision when too young to be placed in an orphanage made it necessary
to open a crèche to receive them. Nurseries already in existence,
however, continued their work, receiving subsidies from the com­
mittees.
APPROPRIATIONS.

When the infant welfare department of the national commission
for food relief was first established it received from the commission
subsidies, amounting to 50,000 francs a month. The number of
children needing care increased, however, and at the same time the
cost of necessities rose, so that in a little more than a year the sum
increased successively to 100,000, 150,000, and 200,000 francs, and
finally 4,000,000 francs a mgnth.24 This expenditure included school
lunches, as well as infant consultations, gouttes de lait, mothers’
canteens, canteens for sickly children, and crèches. But over onefourth of the school lunches were given to children between 3 and
6 attending infant schools (écoles gardiennes).
The cost of feeding children up to 3 years old was calculated to
have been about 16,000,000 francs up to the fall of 1918. For
mothers’ canteens the sum of 1,885,140 francs was spent, and for
canteens for delicate children over 3 years, 5,921,888 francs. The
subsidy given by the national commission in aid of school lunches
amounted to 35,374,836 francs for the duration of the war.27 These
sums represent one-third of the total expense, since the commune and
the Province each bore a third of the expense.
CREATION OF NATIONAL CHILDREN'S BUREAU.

The work of the national commission for food relief emphasized
the need and desirability of a permanent national organization charged
with the protection of children. A bill providing for a national chil­
dren’s bureau was drafted in the last months of the war and introduced
into the Belgian Chamber of Representatives in February, 1919, and
was passed in September of the same year.28 According to its provi­
sions, the new bureau will work for the extension and application o f
S( ientific methods of child hygiene, whether in private families o r
institutions public or private. It will encourage and subsidize
agencies doing child-welfare work, over which it will exercise an
administrative and a medical control. The bureau will establish
infant consultations, in those communes where there are none, and
« Projet de loi instituant l’Œ uvre Nationale de PEnfance, Chambre des Représentants, No. M pp. 18-20.
» Ibid., pp. 24-28.
s» Moniteur Belge, Sept. 26,1919.


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IN FANT-W ELFARE WORK IN EUROPE.

where they already exist they must meet the approval of the bureau.
Local committees on infant consultations will be formed, charged not
only with the establishment and direction of infant consultations
and with the local system of feeding young children, pregnant women,
and nursing mothers, but also with the supervision of placed-out
children. School lunches may also be provided, according to the
bill, but this work will be under the control of another committee.
The bureau will establish or approve colonies for delicate children.
The expenses of the entire scheme of child welfare will be borne
one-half by the commune and one-half by the State.
INFANT MORTALITY RATES.

Table X II gives the infant mortality rates for Belgium in five-year
periods beginning with 1891 and extending through 1910. The twoyear period 1911-1912 is added. No rates are available for the whole
of Belgium after 1912.»
T a b l e X I I .—

Number of deaths under 1 flear per 1,000 live births.1

Period.

Rate.

1891-1895................ ..................... .............. . . . .
1896-1900........ 1...................................................
1901-1905..............................................................

164.0
157.9
147.7

Period.

1906-1910............................
1911-1912............................

1 Calculated from the number of live births and of infant deaths in Annuaire Statistique de la Belgique
for 1892-1913.
'

An official Belgian publication makes the following statement:
According to the infant mortality statistics which we possess for certain localities,
nam ely, Brussels, Antwerp, and the region of Charleroi, the infant mortality has been
considerably decreased since the organization of the [infant-welfare] agencies.23

Dr. William Palmer Lucas gives the following figures for infant
mortality in certain parts of Belgium:
Rate per 1,000 live births.
Brussels:
First trimester 1904-1908...................................................................... , ................................. 124
First semester 1916......................................................................... ........ ................................... 94
Namur:
Period of 1911-1913................................................ .................................................................... 150
First semester 1916........................................ ............................................................................. 84
Antw erp: Infant mortality decreased 8 per cent (no date given).

In Mons, an industrial center, infant mortality, Dr. Lucas says,
had increased, though there had been a decrease in deaths from diar­
rhea.
SUMMARY.

The infant-mortality rate of Belgium, while relatively high before the
war, was decreasing. The Government regulated the practice of mid­
wifery and forbade the employment of women for four weeks after
83 Projet de loi instituant l’Œ uvre Nationale de l ’Enfance, Chambre des Représentants, N o. 64, p. 23.


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confinement. It also aided infant-welfare work by subsidies. Private
enterprise had established milk stations, consultation centers, can­
teens for mothers, and day nurseries. In some cases these agencies
were aided by municipal or provincial funds, and in a few instances
municipalities or Provinces initiated such work themselves. Infant
schools for the young children of working parents were opened under
communal direction in a number of places and received assistance
from the State.
Prompt action was taken to protect children under the new condi­
tions brought about by the war. All child-welfare work was or­
ganized early in 1915 under a special department of the national
committee for food relief, with provincial and local committees.
Financial assistance up to one-third of approved expenditure was
extended by the committee to all agencies, public or private, inter­
ested in the care of children. ‘ This included subsidies to infant con­
sultations, gouttes de lait, mothers’ canteens, children’s canteens
(feeding delicate children from 3 to 17 years old), crèches, colonies
for anemic children, and school lunches. The remaining two-thirds
of the expense was equally divided between the Provinces and the
commune. No subsidy was granted unless the character of the work
was approved by the committee. Medical supervision was a pre­
requisite in every case, and the necessity for such supervision was
constantly stressed.
Under this stimulus the number of infant consultations and scien­
tifically operated milk stations in the occupied territory increased
from 70 to more than 700; and mothers’ canteens reached a total of
473, as compared with 2 in prewar years.
Owing to the paralysis of industry and the consequent unemploy­
ment no extension of the crèche took place in Belgium.
As a result of the work of the committee, infant mortality is said
to have decreased in Brussels, Antwerp, and Charleroi. A real­
ization of the importance of child-welfare work on a national scale
resulted from the work of the committee. A demand for permanent
national protection of mothers and children crystallized in a bill for a
national children’s bureau/ introduced in the chamber of represen­
tatives in February, 1919. The bill provided that half the expense
of all approved child-welfare work be met by State funds. It
enumerated specifically the types of work for which State aid would
be eligible, covering practically the work done by the national com­
mittee during the war, and proposed th 3 establishment of local
committees as administrative bodies. In September, 1919, the bill
was passed.


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FRANCE.
INTRODUCTION.

In France economic urgency was early added to humanitarian and
social reasons for conserving infant life. For many years there had
existed a low and steadily declining birth rate. With the war the
fall in the birth rate, like that in other countries, became more
marked, as Table X II I shows:
T able X I I I . — Number o f live births per 1,000 o f the population .*

Year.

Year.

Rate.

20.6
20.5
19.7
20.2

1909....................................
19ÏÔ....................................
1 9 li....................................
1912....................................

Year.

Rate.

19.5
19.6
18.7
19.0

Rate.

18.8
18.0
11.3

1913....................................
19142..................................
19152..................................

» Statistique Générale de la France, Annuaire statistique, 1914-15, p. 168.
2 Journal Officiel, Feb. 10, 1919, annèxe,p. 105.
Provisional figures for 77 Departments only, instead
of 87.

Partly as a result of the diminishing population, France had been
a pioneer in many infant-welfare measures and had originated types
of work now almost universally adopted.
While the larger provincial cities and many smaller towns had
taken steps through work for mothers and infants to lower the infant
mortality rate, the greatest development of the work had been in
Paris. Many of the available accounts of infant-welfare work in
France deal principally or exclusively with work in Paris. This is
especially true of the war years. In general the amount and char­
acter of work for mothers and infants outside Paris during these
years are only to be inferred from occasional and isolated references,
so that it is not possible to picture in any detail the situation through­
out France.
INFANT-WELFARE W O R K BEFORE THE WAR.
GOVERNMENT PROVISIONS.

Early legislation dealt with the dependent child and only incidentally
touched upon the child in normal circumstances. The Roussel law
(Dec..23, 1874) was enacted for the supervision of children under 2
put out to nurse and of the places where the children were boarded,
whether at the expense of the Government or of the parent. This
practice was very common among French working women. No
further legislative action in behalf of infancy took place until the
173389°—20----- 6


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INFANT-WELFARE WORK IN EUROPE.

end of the nineteenth century. A ministerial decree of May 2,1897,
followed on December 20 of the same year by an order containing^
regulations,1 provided supervision for day crèches and other places
in which children under 3 were being cared for. Medical supervision
was made obligatory.
Legal protection of the mother was initiated by a law (Nov. 27,
1909) guaranteeing to a woman the possibility of rest without loss of
her employment for eight weeks before and after the birth of a child.
The employer was obliged to hold open their places for women thus
incapacitated. No provision was made, however, for reimbursing
the woman for the financial loss occasioned by absence from work
due to pregnancy and childbirth, or for expenses incident to this
condition. A law intended to remedy harmful influences during
pregnancy by permitting a pregnant woman to leave her work at
any time without becoming liable to penalties for breach of contract
and providing for a rest period for the mother after the birth of a
child was passed on June 17, 1913. By its provisions each French
mother deprived of support, if an employed woman, is assisted
during the confinement rest of four weeks by a benefit of from 50
centimes to 1.50 francs a day according to the locality in which she
lives. Upon application the woman’s case is investigated by the
mayor, and she receives her benefit through his office. He transmits
a report to the prefect, who in turn reports to the ministry of the
interior. A pamphlet of instructions in the care of the baby, com­
piled by the Academy of Medicine, is given to mothers when they
begin to receive the benefit. A woman visitor (dame visiteuse),
who receives from the mayor’s office instructions as to her duties,
carries this pamphlet to the mother and at the same time gives her
such advice and help as her circumstances make desirable. Accord­
ing to a circular from the ministry of the interior to local officials,
the law is good chiefly in so far as it brings hygienic knowledge to
the mother.3
A nursing premium of 50 centimes daily was added to the maternity
benefit by the law of July 30, 1913. The sale of nursing bottles with
long tubes had been forbidden by law, April 6, 1910.
An endeavor to raise the birth rate by the encouragement of large
families caused the passage of a law (July 14, 1913) whereby needy
parents with more than three children, a father with more than two, or
a mother with more than one child are assisted by a yearly allowance
of from 60 to 90 francs for each extra child. The amount is to be
determined for each community by the municipal council, subject to
the approval of the general council of the Department and the minis­
try of the interior. A needy parent is described as one who lacks
l Revue Philanthropique, April, 1898, pp, 917-920.
* Journal Officiel, Dec. 24,1913.


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sufficient means to rear the child, but the term is admittedly im­
possible to define accurately and whether or not a parent is needy is
to be determined by local officials and in certain cases by courts of
law.
The Government has for many years regulated the practice of
midwifery. There were midwives of two classes. There was no
essential difference in their training. A candidate for the second
class diploma, however, before admission to the course had to pass
an examination only in certain elementary school subjects, whereas
a candidate for the diploma of the first class had to have completed
either a required elementary course or three years in a secondary
school before entering upon her training. A midwife of the second
class might practice only in the Department in which she was trained,
the first-class midwife, on the other hand, might practice anywhere
in France. Training was both theoretical and practical, and lasted
two years. It consisted in the first year of the study of anatomy,
physiology, and elementary pathology; in the second, of the theory
and practice of midwifery. Training was given at the medical
department of a university, in a preparatory medical school, or in a
maternity hospital. In any case the final examination had to be
given only by the medical department of a university. No midwife
may practice without certification, and illegal practice is heavilyfined. Midwives are under no systematic supervision. No pupils
are admitted free to midwifery courses, though a few scholarships
may be obtained, usually from municipal authorities. Some munici­
palities also provide midwives for needy women.
The State encouraged infant-welfare work by subsidizing both
municipal and private agencies for maternity and child welfare.
Subsidies were administered through the minister of the interior, to
whom the prefects reported on the activities in their respective
Departments, answering questions as to the financial condition and
character of the work of each inf ant-welfare agency applying for
State aid. Although not fixed by law, the amount of the subsidy
was generally about 20 per cent of approved outlay.3 In a minis­
terial decree of June 21, 1909, it was stated that those societies
would be especially eligible for help which made no religious dis­
criminations, encouraged maternal nursing, and made a special effort
to teach hygiene and baby care. Before the passage of the law of
June 17, 1913, a large portion o f the subsidy was given to societies,
extending pecuniary aid to mothers during the confinement rest.
The total amount provided in the 1913 budget for infant and mater­
nity welfare was 700,000 francs. Over 1,800 applications had been
received.4
* Journal Officiel, Aug. 27,1914.
* Revue

des Établissements de Bienfaisance et d ’Assistance, 1914, p . 65.


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E UROPE.

PRIVATE AND MUNICIPAL WORK.

The establishment and maintenance of institutions for the protec­
tion and care of infancy was generally left before the war to private
individuals and voluntary societies. These societies were numerous
but uncoordinated.
There were several voluntary agencies interested in the care of
the mother. The earliest ones, like the Société de Charité Maternelle
(mothers’ relief society), founded in 1786, and the Association des
Mères de Famille (organization of* mothers of families), established
in Paris in 1836, were concerned with the relief of poor mothers in
money or kind. Relatively early, however, the object of many such
societies came to be not only the relief but also the hygienic instruc­
tion o f‘mothers and the best physical care of both mother and baby.
Such an organization was the Société Protectrice de l’Enfance (society
for the protection of children), 1865, whose chief work was the pro­
motion of breast feeding. The beginnings of the modern emphasis
on prenatal care are discernible in the work of the Parisian Société
d’Allaitement Maternel (society for the promotion of breast feeding),
1876, which, aiming to encourage maternal nursing, gave» assistance
and advice to both expectant and nursing mothers. It sent visitors
to the homes of the women before and after confinement and offered
mothers the opportunity of monthly examinations by a physician
during pregnancy. It also cared for women in preconfinement homes.
Prof. Adolphe Pinard, of the University of Paris, is quoted as saying
of the mothers aided in this way that “ their babies come into the
world in the best condition, above the average in weight and re­
markably well developed.” 6
Women in confinement were assisted also by the mutualités mater­
nelles (mothers’ mutual aid societies), which came into existence 20
years or so before the war. Any woman might belong. For four
weeks after childbirth or in exceptional cases for six weeks, she re­
ceived a weekly sum of money, varying with the locality. In Paris
it was 12 francs. These societies were supported by the dues of the
participating members, the contributions of honorary members, and
State subsidies.9 The mutual-aid societies operated in small places
as well as in large cities. Dammarie-les-Lys, for example, with 1,600
inhabitants, was said to have a very successful one. The societies
were permitted to administer the State maternity benefit in the
communities where they worked, and their activities were encouraged
by Government grants.
All maternity hospitals received sick pregnant women, and in prac­
tically every city there were homes for women during the latter weeks
of pregnancy. In Paris there were 11 maternity hospitals directed
* M om et: L a Protection d e là Maternité en France, p. 89.
* Revue Philanthropique, February, 1916, p . 116.


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by the assistance publique (department of public relief), which is sup­
ported by voluntary contributions as well as by State and local sub­
sidies. It was customary also in Paris for certain midwives approved
by the maternity hospitals and paid by the city to receive for con­
finement a limited number of women, on an average of six by one
midwife. Lying-in facilities were said in 1910 to be very bad in the
Provinces, though some towns even among the smaller ones had good,
maternity hospitals, such as Nimes, Macon, Brive, Autun, Cognac,
la Rochelle, and Montpellier.7
Homes for convalescent mothers had been maintained for many
years in Paris and a few of the larger cities of France. In these homes'
•(pouponnières) mothers were allowed to stay as long as they nursed
their babies, usually without money payment. In many cases a
mother was asked to nurse also the child of some other mother who was
unable to breast feed her baby. Temporary homes for older children
during the confinement of the mother were in some cases provided
by philanthropic agencies; and domestic assistance during confine-,
ment was occasionally furnished by organizations such as the society
for the promotion of breast feeding.
Cantines maternelles (mothers’ canteens) for expectant and nursing
mothers had been since 1905 a distinctive feature of the infant-welfare
service in Paris. These were established by the Federation des Can­
tines Maternelles, a private society, and were later subsidized by the
State. All women were received without charge and without ques­
tion from the fifth month of pregnancy until 14 months after con­
finement. The only requirement in the case of a pregnant woman
was the presentation of a certificate as to her condition from one of
the infant-consultation centers, and in the case of a nursing mother
proof that she fed her child at the breast. Two meals were given
daily. The number of meals served in these canteens in Paris, in
1913, was 245,365.®
In 1913 a canteen was opened in Lyons by the municipal authori­
ties. Several years earlier societies in Nice and in Remiremont had
opened somewhat similar restaurants for mothers in connection with
milk stations.
The last decade of the nineteenth century saw the rapid growth of
the milk station (goutte de lait) and the consultation center (consul­
tation des nourrissons). In 1890 Prof. Hergott established in Nancy
an institution to which mothers delivered in the maternity hospital
brought their babies one month after birth for examination. They
were paid a small sum, if satisfactory progress was being made. It
was in 1892, however, that the first real consultation center was
installed by Dr. Pierre Budin, at the Charité maternity hospital in
1 M om et: La Protection de la Maternité en France, pp. 115, 1 1 6 .
* Bulletin de l ’Académie de Médecine, Dec. 17,1918, p. 568.


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EUR O P E.

Paris. Here children of mothers delivered in the hospital were
admitted for regular medical supervision up to 2 years of age. After
the death of Ôudin his friends and students established by subscrip­
tion (May, 1909) the Pierre Budin foundation, the object of^which
was to open consultation centers and to help maintain them.9 The
foundation was supported by the subscribed fund, by private contri­
butions, and by Government subsidies.
Early in 1914, under the direction of the department of public
relief for the Department of the Seine and receiving financial assist­
ance from it, a consultation center was established in each one of the
i t maternity hospitals of the city. The center was open to all
mothers of the district, instead of being restricted to the women
delivered in the hospital with which the center was connected. Attend­
ance, it is said, was general and not confined to the very poor.
The Ligue Contre la Mortalité Infantile (league for the prevention of
infant mortality), founded in 1902, was very active in encouraging
centers all over the country. Centers were maintained also by
various private societies, such as the society for the promotion of
breast feeding, in Paris, and the mutual-aid societies. As a result of
the activity of these various organizations infant-consultation centers
were widely distributed throughout France, in small towns as well as
in large cities.
•
, '
,
At the centers mothers were advised as to the care and feedmg of
their babies, who were regularly weighed and examined. The chief
work of the center was to encourage maternal nuising, and m order to
assist poor mothers to breast feed their infants a small nursing pre­
mium was usually given. Consultations for pregnant women were
not uncommon. AU the large centers in Paris maintained them.
LUle since 1907 had had half a dozen. Wasqueha! in the Department
of Nord was said to have a particularly successful center for expectant
mothers.10 Some centers gave courses to mothers in infant hygiene
in addition to medical advice and supervision. The centers created
by the department of public rehef in Paris made a special point of
such teaching and were known as instituts de puériculture (childwelfare institutes).
.
, ,
Phvsicians, in many cases infant specialists, directed the work of
the consultation centers in every instance. The doctor was assisted
by one' or more volunteer workers. Volunteer workers also did home
visiting in connection with some centers, though home visiting was
not a universal custom. Soon after the establishment of the first center the first milk depot
was opened in Paris in connection witn a dispensary by Dr. Vanot,
a weU-known leader in infant-welfare measures. A year later (1894)
» Revue Philanthropique, June, 1909, p. 283.
10 M om et: L a Protection de la Maternité en France, p . 76.


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a goutte de lait (as the milk station was then for the first time called)
was instituted by Dr. Dufour in Fecamp. At the goutte de lait milk
was dispensed to those babies who could not be breast fed. Regular
weighing and the keeping of records formed an important part of the
work of the depots, and medical supervision of the infants was. con­
stant. In fact, a large number of milk stations were operated as part
of a consultation center. In 10 years after the establishment of the
first milk depot there were over 100 towns in France with gouttes de
lait. The majority of them were philanthropic enterprises, aided by
the municipality, but in many towns they were maintained entirely
by city funds, as in Nantes and Elbeuf, which were among the first
to support public milk stations. The gouttes de lait admitted all
babies, some free, others paying according to their means. State aid
was available for both the consultation center and the milk station.
The teaching of infant care to young girls Jiad received some atten­
tion. In Bordeaux, for example, in 1897, the' École des Mères
(school for mothers) was established through private philanthropy.
The school taught the elements of infant hygiene to girls between 11
and 13 and accommodated over 150 pupils. The movement to give
similar courses to children in the grammar and high schools of
southwestern France received impetus from the success of this school.
In Paris during 1902-3 Dr. Pinard himself gave lectures to school
girls on the care of the infant.11 Some centers held classes in baby
care for growing girls. This was especially true of centers estab­
lished under the auspices of the Ligue Contre la Mortalité Infantile.
A large number of day nurseries or crèches were in existence. The
first one, financed by private funds, had been opened in Paris in 1844.
A small charge was made for each child. Three years later the Société
des Crèches (day nursery society) was formed in order to standardize
the crèches rapidly coming into 'existence. Municipal crèches were
common. Private as well as municipal institutions had since 1862
been.assisted by the State. By 1909 there were 67 crèches in Paris,
44 in the Department of the Seine, and 323 in other departments.12
These figures probably include about 30 crèches which factory
owners had installed in or near the factory for their women workers.13
Écoles maternelles (nursery schools) were a part of the publicschool system. Communities with a sufficient number of children
from 3 to 6 were obliged to maintain them, but attendance was not
compulsory. The object of these schools was to give small children
such care as they would receive in a good home nursery. Rest and
play and short, simple lessons in language and sense training made up
the school day. These schools were open all day until 6 or 7 o ’clock
in the evening. A midday meal was served.
n Revue Philanthropique, February, 1917, p p .55-56.
» M om et: La Protection de la Maternité en France, p. 270.
« Ibid., pp. 278-282.


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INFANT-WELFARE W OR K DURING THE W AR.
IN

P A R IS .

On August 4, 1914, Paul Strauss, president of the national league
for the prevention of infant mortality, proposed the creation of a
special organization for the protection of mothers and babies in Paris
during the war. By September 1 of that year the Office Central d
Assistance Maternelle et Infantile (central office for the assistance of
mothers and infants) was opened under the department of public
relief. The oft-repeated purpose of the organization was, in the
words of its president, Prof. Pinard:
During the entire war, and in every part of the m ilitary government of Paris, to
assure to every n eed y woman who is pregnant or who has a b a b y less than 3 years old
the social, medical, and legal protection to w hich she has a right in a civilized society.
To see that no woman is forgotten and no child ignored.14

It is to Prof. Pinard’s annual reviews of the work of the organiza­
tion that we are mainly indebted for our knowledge of the work in
Paris during the war years. The central office worked in cooperation
with lying-in hospitals and with private maternity and infant-welfare
societies already established in order, by unifying the work, to make
it as efficient as possible. At least one society under this encourage­
ment undertook entirely new lines of work. The Œuvre des Crèches
Parisiennes, for example, concerned only with day nurseries before
August, 1914, began after the war to establish preconfinement and
lying-in homes. To these societies the.central office referred mothers
applying to the department of public relief for aid, when the resources
o f the 11 public maternities were exhausted. In support of these
private organizations it gave 1.50 francs a day until January,. 1910,
and then 2 francs a day, for each woman cared for in the private
maternity homes.15 Its contributions to private agencies functioning
in that part of Paris under military government increased from
96,150 francs in 1914 to 153,969 francs in 1915.16 As a part of the
department of public relief the central office drew its funds froîn the
contributions of philanthropic persons, and from municipal, depart­
mental, and State subsidies.
The care of expectant mothers was an important part of the work
of the central office. “ Prenatal ca re/’ said Prof. Pinard,17 “ should
begin the moment it is certain that a mother is pregnant.” During
the first year of the war (Aug. 1, 1914, to Aug. 1, 1915) the public
maternity homes almost tripled the number of their beds for pregnant
women.18 Such maternity homes as the Asile St. Madeleine and the
14 Bulletin de l’Académie de Médecine, Dec. 19,1916, p. 540,
u Revue Philanthropique, November, 1916, p. 532.
“ Ibid., p 536.
it Bulletin de l’Académie de Médecine, Oct. 5,1915, p. 344.
“ Ibid j ) . 345.


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Asile Michelet increased their preconfinement work. The society for
the promotion of breast feeding and the new organization of Paris
nurseries alone cared for almost 3,500 pregnant women,1* both societies
having established several homes for expectant mothers during the
first months of the war. As a result of this type of activity, Pinard
states that there was practically a complete disappearance of acci­
dents during pregnancy.20
Of the 37,085 births in Paris during the first year of the war, over
33,000 took place under the care of the central office, the greater part
of them in institutions, though public aid was extended to a few
confinements in private homes.21 In the second year of the war,
95.2 per cení of all births in the city were cared for by the depart­
ment of public relief as compared with 78.5 per cent in the year pre­
ceding the war.22 By the fourth, year the number had risen to 97.3
per cent.23 Less than 100 women, in other words, were confined
without public aid. The military government of Paris provided
motors day and night to carry the women to and from the hospitals.
Before the war ambulance service for the maternity hospitals had
been severely criticized.24
In the early months of the war the number of beds available for
women convalescing from childbirth rose from 260 to 400.25 Every
effort was made in the convalescent homes to prepare and teach
mothers to nurse their infants, and so successful was the work
directed to this end that it is said not one woman was encountered
who, having been recently confined, had no breast milk for her baby.
The effect of the nursing home, according to Dr. Lesage, general
secretary of the central office, was to increase the number of nursing
mothers, to decrease the number of abandoned babies, and to reduce
almost to zero infant mortality among the babies cared for in the
home.15
One of the first difficulties encountered by the central office was
with regard to feeding. Breast feeding was encouraged at every
consultation center in practically every case by means of nursing
premiums in addition to instruction and medical advice. So great
was the importance attached to it that if infants were unable to be
breast fed they were in some cases given human milk from a special
bottle. Some of the consultation centers employed incubators for
prematurely born or delicate children, and if their own mothers
« Revue Philanthropique, November, 1916, p. 532.
l*Ib id ., pp. 345, 346.
» Ib id .y F e b . 16, 1915, p. 234.
a Ibid., Oct. 5,1915, p . 346.
» I b i d ., Dec. 19,1916, p p . 542, 543.
» I b i d ., Dec. 17,1918, p . 565.
u M om et: La Protection de la Maternité en France, p. 105.
» Bulletin de l’Académie de Médecine, Oct. 5,1915, p . 349 and Feb. 16,1915, p . 234.
* Ibid., Feb. 16,1915, p. 234.


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could not nurse them they were fed by mothers having sufficient
milk to feed an extra baby. Although breast feeding had been
officially recommended by the Academy of Medicine and every effort
was made to secure it wherever possible, a number of infants had to
be artificially fed. Early in the war large quantities of condensed
milk were stored in the department of public relief in case of future
need. From August 2 to September 15, 1914, there was a serious
shortage in the milk supply for Paris. This was met in part by the
provision of milk for babies from a herd of cows provided by the
city. About 12,000 liters from this herd were distributed daily,
some of it either free or at cheap rates, much of it through infantwelfare societies and centers.27 This distribution continued through­
out the war. The gouttes de lait increased their work, and free
meals for nursing and expectant mothers were liberally provided by
the mothers’ canteens. The rule whereby women were not received
until the fifth month of pregnancy was abolished, and any woman
from the beginning of pregnancy might obtain meals at the canteens.
After the meal mothers were usually given advice as to the feeding
of their babies and young children. These canteens gave 1,013,241
meals during the initial 12 months of the war. At least one of
these canteens fed children between 2 and 6.21
A decrease in attendance, however, came in the following year,
attributed by Pinard to the widespread employment of women,
although even in 1917-18 (Aug. 1 to Aug. 1) almost three times as
many dinners were given as in the year before the war.28
Under the stimulus of the department of public relief there was a
growth in the number of consultation centers. The number of
mothers attending the centers also increased early in the war. For
instance, in 1912 there were 1,380 mothers in attendance and 6,500
consultations at the child-welfare institute connected with the
Maternité hospital. In 1915, despite the fewer number of infants
born, the number of mothers in attendance had risen to 1,735, while
the number of consultations had grown in much greater proportion,
reaching in that year 11,050.29 After 1915, however, a rapid and
progressively growing decrease in the number of babies brought to
the centers was noted. Of six centers in one district two were closed
because of a lack of babies. It was said that in many places there
were literally no babies to bring.
Suggestions for compulsory attendance at centers were put forward
by physicians who contended that the country’s interest in the in­
fant was supreme, above even that of the parent, and that attendance
® Bulletin de l'Académie de Médecine, Oct. 5,1915, p. 346.
*> Bulletin de l’Académie de Médecine, Dec. 19,1916, p. 545.
*8 Bulletin de l'Académie de Médicine, Dec. 17,1918, p. 568.
“ Report on the Physical Welfare
Trust.


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of Mothers and

Children, Vol.

II, p. 90.

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at centers, like attendance at public schools, should be obligatory.
In some Departments, as in Yonne, where the consultation center was
especially well organized, this had been done in the case of mothers of
infants receiving public assistance. Mothers who do not attend, it
was asserted, should be compelled to s£nd to the authorities a monthly
certificate of the condition of their babies.30
. Pinard believed that the results of the work of the central office
were satisfactory enough to justify the establishment in Paris and
elsewhere of a permanent organization to do similar work after the
war.31
IN THE PROVINCES.

With the exception of invaded districts infant-welfare work con­
tinued in all the Departments of France where it was already under
way, judging from the amount of the "State subsidies allocated to the
different Departments and the list of agencies receiving the money
as compared with similar lists for prewar subsidies.32 In 1915 a
sum was set aside for infant-welfare work in the invaded Provinces.
This money was intrusted to the league for the prevention of infant
mortality, to be held until the opportunity should come to distribute
it; as parts of the occupied Provinces were regained, the reserve
fund was used to reestablish maternity and infant centers.34
The agenciés most active in furthering measures for infant pro­
tection were the mothers' relief society, the mutual-aid societies,
and the society for the protection of children. The first two societies
received larger subsidies from the national treasury than before the
war, because of their increased activities.35
‘‘Private beneficence," said Dr. R. Raimondi, director of the
institut de puériculture of the University of Paris, “ always supported
by municipal, departmental, or State budgets has increased the
number of refuges for expectant mothers and mothers with their
infants." 36 Infant consultations increased not only in Paris, but
also in other towns and in the country. “ Bordeaux," continued
Dr. Raimondi, “ Havre, Marseille, Lyon, Tours, and Vienne (Isère)
were especially active. In Lyon, in addition to the extended work
of the consultation centers, three canteens for mothers were estab­
lished by the city." 37
The mutual-aid societies and the society for the protection of chil­
dren made a special effort to found consultation centers and gouttes
de lait throughout the country. In the larger cities, including
*> Revue Philanthropique, March, 1916, p. 131.
*i Bulletin de l’Académie de Médecine, Dec. 17, 1918, p. 561.
¡» Revue Philanthropique, March, 1913, pp. 603-648; November, 1915, pp. 327-338; September, 1916, pp.
431-444, and October, 1917, pp. 512-518.
31 Revue Philanthropique, June, 1915, p. 174.
35 Journal Officiel, Sept. 3,1915.
38 Maternity and Child Welfare, September, 1918, p. 303.
37 Bulletin des Usines de Guerre, Aug. 19,1918, p. 133.


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Paris, both maintained centers; in the smaller towns, one or the
other. A t the third congress of the mutual-aid societies (1918)
the following resolutions with respect to consultation centers were
adopted:38
That supervision of pregnancy be introduced as soon as possible in all the m utualaid societies and be considered as a fundamental function of these societies.
That this supervision be both medical (and in that ease to he carried out as much
as possible through pregnancy consultations arranged preferably under the direction
of the society) and educational (this to be carried through home visiting of the preg­
nant members of the society) * * *
That a strict control over the bringing up of infants be organized in all the m utualaid societies, this to be carried out as m uch as possible through infant consultations
conducted under the direction of the society.
That a real and effective supervision be continued until the end of the second year
of the child’s life.

Much difficulty was introduced into the work by the mobilization
of doctors. An infant consultation without a consulting physician
was an anomaly in France, as it is more and more becoming every­
where, and centers in charge of trained nurses were unknown.
An attempt was made during the war to bring the benefits of the
consultation center to infants in small communities. In the summer
of 1914, for example, the general council (administrative body)
of the Department of Hautes Alpes established traveling consulta­
tions in the Department, which were held once or twice a month during
the summers of 1914 and 1915 in villages of four communes.39
Efforts were also made by the large cities, particularly Paris and Lyon,
to extend the work for mothers and infants to the surrounding
country. .
MIDWIFERY SERVICE.

In August, 1916, the second-class midwife of inferior education was
abolished in order to secure a better type of candidate. A number
of the less educated ones already certified, however, continued to
practice as in England. In remote country districts, too, the matrone,
or old “ handy woman,” was only too often resorted to as a friend in
need. Pinard in 1918 commented on the necessity of ridding remote
districts of the matrone and of providing such places with properly
trained midwdves.40
BABY WEEKS AND EXHIBITS.

The urgency of reaching the rural districts and small towns was
partly responsible for a campaign carried on by the league for the
prevention of infant mortality and the Commission Permanente de
Preservation Contre la Tuberculose en France (society for the preven­
tion of tuberculosis in France), aided by the American Red Cross and
« Revue Philanthropique, July, 1918, pp. 311-312.
» Ibid., July, 1917, pp. 332-333.


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the Rockefeller Foundation. On January 6, 1918, the traveling child
hygiene exhibit was opened in Chartres, the first of its kind in France.
Equipped with moving-picture apparatus, models, literature, and
attractive posters and charts, the motor truck carrying the exhibit
traveled through the countryside, teaching the hygiene of maternity
and infancy, and covering in January and February the Department
of the Eure et Loir. In its first 10 days it reached through lectures
and demonstrations almost 5,000 persons.
Other exhibits did similar work in various parts of the country,
sent on their way by the Red Cross in cooperation with the French
Government as well as with the great social agencies at work in France
for the protection of mothers and infants.
Dunkirk in April, 1915, held an infant-hygiene exhibit-under munic­
ipal auspices. In April, 1918, a baby-saving show was held in Lyon.
It ran for three weeks and reached thousands every day. The ob­
ject of the exhibit was not only to create an enthusiastic public opinion
in favor of infant protection but also to assist in training the home
visitors who were to demonstrate the principles of infant hygiene in
French homes.
TRAINING OF WORKERS.

Before the war French home visitors had been in practically all
cases untrained volunteers. After the war began short intensive
courses for women with hospital training, some of whom had been
working as volunteers in military hospitals, were instituted in Paris,
Lyon, Marseille, and Bordeaux for the purpose of training infantwelfare workers. The importance of a home visitor to supplement
the work of each consultation center was more and more recognized.
The training of crèche assistants and other infant-welfare workers
was given considerable attention. In 1917 PEcole Centrale de Puéri­
culture (central school of child care) was established in Paris under
the auspices of the league for the prevention of infant mortality, and
with the cooperation of a number of infant-welfare societies.
Similar courses were established in Rouen.41
TEACHING OF INFANT HYGIENE.

Although the emphasis in all French welfare-work was largely med­
ical, some interest in the teaching of child hygiene to mothers and
young girls was manifested. The child-welfare institutes connected
with the public maternity hospitals were obliged to abandon much
of their theoretical instruction in infant hygiene on account of the
shortage of physicians, but the practical aspect of the work was
continued, including visits to day nurseries,42where the pupils received
instruction in baby care.
« Bulletin des Usines de Guerre, Oct. 22,1917, p. 208.
e Revue Phil anthropique, July, 1917, pp. 341-344.


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At Bordeaux, under the auspices of the Bordeaux committee of
the union of women o f France, a school for instruction in the care
of young children was established in November, 1917.43 It gave
both practical and theoretical work to women school-teachers and to
students of high and normal schools as well as to younger public-school
children. It was also offered to all girls and young women intending to
take up any occupation in connection with the various organizations
for child care. Some of the schools organized for training welfare
workers admitted mothers and young girls to their lectures.
In 1917 the teaching of child care in continuation schools was pro­
posed in a new education bill. It proposes that girls between 16 and
18 should be required to take courses in hygiene, elementary medicine,
and care of children for at least 100 hours a year during the last two
years of the continuation course.44 This bill has not yet become a law.45
FINANCIAL PROVISIONS FOR MOTHERS.
M aternity benefits and nursing premiums.

The system of maternity benefits and nursing premiums established
by the laws of June 17 and July 30, 1913, continued in force during
the war, and efforts were made to extend and increase them. In 1916
Dr. Strauss stated that “ people have been, very properly, concerned
since August 2, 1914, with strengthening activities for the protection
of maternity, the sacred institutions for safeguarding nursing babies
and little children. Our legislation protecting infancy and mother­
hood needs to be supplemented. Sometime ago the Government gave
broad instructions for the liberal application of the law of June 17,
1913, on rest for mothers; the Chamber has voted special provisions for
the wives of soldiers and refugees. It is to be hoped that the Senate
will shortly confirm these humanitarian provisions, pending the time
when an amended form of the law on assistance to mothers may assure
to expectant mothers as to those recently confined the protection
which is indispensable for all in the interests of the race and of the
nation.” 46
The desired amendment for pregnant women was not made,
however, though on January 23, 1917, the confinement benefit was
extended to include., all women, whether employed or not, who
were drawing separation allowances, and all refugees receiving special
Government aid. On December 2, 1917, the law was amended a
second time to provide maternity benefit for all women with insuffi­
cient resources.
« Gazette Hebdomadaire de Bordeaux. Oct. 14.1917.
« Journal Officiel, Documents Parldmentaires, Chambre, session ordinaire, 1917, p. 356 ft.
« According to information received since this report went to press, the bill was redrafted and reintroduced
on Sept. 5,1919. In the new bill the m axim um age for girls is 16; no m inim um hours or course of study
are given in the bill, but both are to be decided b y a special commission. (Journal Officiel, annexe, Dec.
22,1919, p. 347.)
* Revue Philanthropique, October, 1916, p. 507.


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Various bills pertaining to maternity and nursing benefits were
introduced during the war to fight depopulation by better protection
of mothers and babies. Financial assistance to pregnant women for
each child less than 13 years of age was proposed.47 A daily allow­
ance from 2 to 5 francs, to be paid during the last four weeks of preg­
nancy, providing the woman refrain from remunerative employment,
and a nursing premium of 100 francs a month for one year, was
another measure suggested.48 None of these bills had been passed
at this writing.
The amounts given were generally considered insufficient to pro­
duce the results hoped for in the framing of the law, and agitation
was strong throughout the whole period to increase them. Early in
1918 in the Department of the Seine the benefit was raised for the
year only from 1.50 to 1.75 francs a day during the eight weeks of
the confinement rest. The nursing premium was also increased by 1
franc, making the daily premium 1.50 francs. At the same time it was
recommended that the maximum amount granted by the law be
accepted by all the municipal councils of the Department as the rate
to all women. It suggested also that the law be amended to permit
the daily allowance to women in confinement to be increased to a
maximum of 3 francs and the nursing premium to be raised to 1.50
francs a day.49
In April, 1918, a decree issued by the Department of the Seine pro­
vided further nursing premiums for that Department.50 Two hun­
dred francs, to be paid in installments, were to be given to each
mother receiving the legal maternity benefit, provided the infant
was breast fed and showed evidence of good care.
In 1914, 65,305 French women received maternity benefits; in
1915, 66,136; while the number receiving nursing premiums had
also increased from 44,143 to 50,466.51
The annual budget for the years of the war provided approximately
3,000,000 francs for nursing premiums and benefits during confine­
ment.52
Monetary aid was given in some communes to women leaving
public maternity hospitals, if they had no other resources, the object
being to induce the mother to keep the infant with her and nurse it
instead of boarding it out and going to work. Money expended for
this cause was recoverable in part from State funds. (See p. 83.)
The mutualités maternelles continued to grant confinement bene­
fits and nursing premiums to their members and to supplement those
received from the Government. A great extension of the work of
47Journal des Débats, Mar. 3,1917.
®Journal Officiel, Documents Parlémeutaires, Chambre, 1917, Annèxo No. 3910, p. 1593.
« Revue Philanthropique, March, 1913, pp. 140 - 141 .
60Ibid., April, 1918, p. 187.
n Ibid., February, 1917, p. 73.
S®»’ ^ ’ *914i ^ 3 ? » 191S; Sept. 29,1915; July 1,1916; Sept. 29,1916;


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these societies was reported.35 Private organizations, aa before the
war, provided nursing premiums for certain women, especially in con­
nection with attendance at a consultation center. There was a par­
ticularly active society in Lyon, which aided factory workers who were
expectant mothers and gave premiums for breast feeding.
•A few employers also gave premiums to encourage breast feeding.
A large metallurgical plant at Ivry,53 for instance, near Paris, gave
50 francs to a working woman or the wife of an employee who had
breast fed her child for four months, 100 francs for six months, and
250 francs if the nursing continued a year. At thé Bon Marché
department store in Paris, according to a plan instituted in April,
1917, the mother of each new-born baby was given 200 francs, and
120 francs a month for 10 months following the birth provided the
mother breast fed the child. If she put the child out to nurse the
sum was reduced to 20 francs a month.54
Separation allowances.

In addition to maternity grants and nursing premiums there was
special war legislation for the financial assistance of mothers. On
August 5,1914, the bill providing aid for families of enlisted men was
passed. At first it covered all needy families of enlisted men, but
on March 31, 1917, the act was extended to include “ all needy
French families residing in France whose bread-winner not a
soldier— is, without fault of his own, a victim of a circumstance
of war suffered on French soil in a region occupied by the French
Army.” By decrees of August 4, 1917, and of November 15, 1918,
the allowances were raised from the original 50 centimes a day for
each child under 16 and 1.25 francs for the wife to 1.75 francs for
the wife and 1.25 francs for each child, with special provision for
more than two dependent children. The child’s allowance started
from the day of its birth, a bill to make an unborn child eligible to
the allowance having failed to pass. Allowances were granted upon
application after investigation, and though they were designed to
prevent actual need rather than to provide a substitute for the
usual income, officials were admonished to interpret the law in a
“ large spirit of humanity.”
PROTECTION OF FACTORY WORKERS AND THEIR CHILDREN.
Increase in employment of women.

The need for financial assistance decreased somewhat with the
flocking of women into industrial life after mobilization had set in. .
The employment of women in factories was common even before
the war. According to the census of 1911, more than 2,500,000
® Journal Officiel, Sept. 3,1915.
» Bulletin des Usines de Guerre, Feb. 5,1917, p. 324.
h Bulletin de l’Académie de Médecine, Dec. 17,1918, p. 605.


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women were engaged in industry, over 1,750,000 of whom were
between 15 and 45 years of age.55 That a law (June 17, 1913) had
already been passed* to protect mothers in factories by insuring them
rest periods before and after confinement is an indication that there
were not a few nursing and pregnant women employed in them before
1914. When the war began women in France, as in other countries,
took up, in addition, much of the work laid down by men called into
the service. The greatest increases in female labor are shown in the
chemical, metal, and woodworking industries.56
It is not possible to estimate the number of pregnant women and
nursing mothers who did factory work during the war. In 1916
Dr. Bar, of the Tarnier Clinique in Paris, after an investigation
covering several munition factories, stated57 that the number of
pregnant women averaged, he thought, about 1 in 140 or 120, certainly
less than 1 in 100. In a Government munition factory near Paris
over 13 per cent of all women under 40 were reported pregnant, but
the number of pregnant women there was said to be relatively high.58
Dr. Bar found that 2 or 3 per cent was the highest proportion of
mothers of young infants in any factory investigated by him.57
Discussion in the Academy of Medicine.

The attempt to maintain many hard-worn labor standards for
women went down before the necessities of war. Night work which
had been prohibited was again authorized and the working day in
many cases lengthened. The speeding-up essential to the war
program was felt in some quarters to be resulting disastrously for the
future generations of the country. This body of opinion was crys­
tallized in Dr. Pinard’s report (read before the Academy of Medicine
on Dec. 5, 1916) on the Protection of Infancy during the Second Year
of the War in the Entrenched Camp at Paris. He presented figures
showing that the per cent of premature infants was higher than the
year before, that the weight of infants at birth was less than that of
children born in the previous year, that the number of abandoned
babies and of those put out to nurse had increased. It was h ia
belief that the employment of mothers in factories was rendering
the public work for mothers and babies of little or no avail. He
urged the absolute prohibition of work in factories for pregnant
women, nursing mothers, or mothers delivered within six months,” s#
and ended his earnest appeal with the words, “ It takes longer' to
produce babies than to make shells or cannon.”
» Statistique Générale de la France, Résultats Statistiques du Recensement Général, effective Mar fi
1911. Vol. I, Pt. III, pp. 12 and 64.
'
M Bulletin du Ministère du Travail et de la Prévoyance Sociale, Marcli-May, 1918, p. 113.
67 Bulletin de l’Académie de Médecine Feb. 13,1917, p. 200.
M Bulletin des Usines de Guerre. Apr. 15,1918, p. 403.
69 Bulletin de l’Académie de Médecine. Dec. 19,1916, p. 568.

173389°— 20------7


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In the discussion that followed, Pinard had as his opponent Paul
Strauss, as eminent in the field of obstetrics and pediatrics as Pinard
himself, and at that time president of the executive committee of the
central ofiice. He believed that Pinard had drawn from the figures
conclusions which were unwarrantable.60 It was his opinion, based
on careful reports made by physicians from the celebrated maternity
hospitals and climes of Paris, that the employment of women m
munitions factories need' not be prohibited altogether but should be
regulated to protect the woman financially and physically during
pregnancy and nursing. He believed with Dr. Bonnaire, of the
Maternité hospital in Paris, that “ to close the door of the factory to
the pregnant woman, under pretext of preserving the child to be
born, could not fail to have the opposite effect to the desired end.
What risks would not pregnancy run on the day that it was decreed
that it constitutes an obstacle to the daily bread?” 61 Pinard, how­
ever, was firm in his conviction that “ the factory is the murderer of
the child,” and on January 2, 1917, proposed to submit to the
authorities the following suggestions:62
1. In French factories work should be forbidden to all nursing mothers and to
all women who are pregnant or who have been confined w ithin six months.
2. E v e r y woman in France, pregnant or nursing a b a b y of less than a year,
should receive on her request an allowance of 5 francs daily.

A committee of 10 was appointed to look into the subject and to
render a report on the issue whether employment in factories should
be abolished or should be allowed under restrictions. The committee
reported on January 30, 1917. Since the country could not afford
to suffer any disorganization of production, and since, moreover, the
cost of Pinard’s plan estimated on a basis of 506,000 births among
manual workers in 1909 would be half a billion francs, the committee
proposed for the consideration of the academy a series of propositions
of its own.63
During the detailed discussion that followed several amendments
were suggested. While Pinard’s opponents acknowledged that his
was the ideal plan for safeguarding the future generations of France,
they were regretfully aware of its impracticability. Not only was
the Government unable to bear the necessary expenditure, but also
the exclusion of pregnant and nursing women from factories would,
they felt, encourage voluntary sterility, abortion, or abandonment.64
For these reasons the Pinard resolutions were rejected and the reso­
lutions submitted by the special committee to ameliorate the evils
of mothers’ labor in industry were finally adopted (Mar. 13, 1917)
in the following form:65
m Bulletin de l’ Académie de Médecine.
« Ibid., p. 34.
«> Ibid., p. 40.


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Jan. 2,1917, p. 27.

s» Ibid., Jan. 30,1917, pp. 120-122.
Ibid., p. 127.
« Ibid., Mar. 13,1917, pp. 367-368.

m

99

FRANCE.

Considering that the extension of manual labor1in factories and especially in war
factories w ill constitute the grave danger of depopulation if the pregnant worker and
the woman nursing her infant are not sufficiently and im m ediately protected, the
academ y resolves as follows:
1. T h e y must be em ployed at tasks calling for only moderate effort in form and dura­
tion

*

*

*.

T h e half day, maximum six hours, should be given them

*

*

*.

N ight work must be prohibited * * * . A ll influences endangering pregnancy or
nursing must be removed from their work.

2.

T h e optional rest of the June, 1913, law, must become obligatory for war factory

workers.
3. Infant and female hygiene consultations, directed b y a doctor, shall be offered
to the workers.

T h e doctor m ay show the necessity of a change of tasks, the modera­

tion, or even the prohibition, of them, when he believes continuation w ill endanger
the mother’s health or the infant’s life.

T o secure the benefit of special hygiene

required b y their sex, a supervising woman agent, serving as an intermediary between
the male working force and the woman concerned, is indispensable.

T h e woman fac­

tory welfare worker in E nglish industry must have her equivalent in France.
4. To encourage breast feeding, measures shall be taken to permit it under rigorously
hygienic conditions during work hours.

Bonuses shall be given nursing mothers.

5. The pregnant or nursing woman obliged b y her condition to change her employ­
ment, to reduce or stop work, shall receive an in dem n ity compensating for the reduc­
tion or stoppage of pay. The expenses resulting shall be assured b y an insurance
organization, under the responsibility of the State.

6.

Besides the nursing rooms (chambres d ’allaitement), the administration must

promote the opening of nurseries for the children (garderies) wherever the necessity
for them shall appear.

Pinard stated that the machinery proposed seemed so elaborate
that probably the mother herself would receive but little benefit,
and that he had never seen more than one factory nursing room
which was properly carried on.66
Voluntary action of employers.

Some of these measures had already been adopted by a number of
employers. By instituting short hours, daytime shifts, and work
adapted to pregnant or nursing women they were responding very
well, it was said during the discussion in the academy, to the move­
ment to safeguard women. Even before the war 50 large plants had
nursing rooms,67 and by 1917 many more had installed them. After
the war began the association of metallurgical industries indorsed a
plan which included premiums to large families, care of pregnant
women and women in childbed, mothers' consultations, nurseries, a
free meal to nursing mothers, and open-air schools for sickly children.68
The iron manufacturers' society, consisting of 55 associations of the
iron, steel, electric, and related industries, declared itself prepared to
enforce maternal protection.69 In a number of places, among them
Lyon, Havre, Besançon, Chauffailles, Amiens, Neuilly, and Levallois-Perret, employers united to secure better protection of the pregM Bulletin de l’Académie de Médecine, Feb. 20,1917, p . 233.
» Ibid., p. 242.


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« Ibid., pp. 244-245.
• Ibid., p. 243.

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I N F A N T -W E L F A R E W O R K I N

E UROPE.

nant and nursing women in their factories.70 In some cases they
established cooperative nurseries; in others, however, the employers
were against common action in the matter, preferring to establish
separate nurseries. Many employers cooperated with the agencies
in Paris and elsewhere training women as factory welfare and nursery
workers by promising to engage welfare workers and by offering their
factories for the training of the candidates.71
A Government investigation 72 early in 1917 showed a number of
garderies and chambres d’ allaitement in course of construction. The
investigation covered 39 nurseries with about 600 children and 17
nursing rooms in which there were 76 babies. Only one nursery had
no regular medical supervision. In all the children-'were either
examined upon arrival or were admitted only on a medical certificate.
The majority excluded children in a suspicious state of health, but
16 nurseries had isolation wards for such cases. Free or cheap milk
sterilized or boiled was furnished for the artificially fed babies in
practically all the nurseries. In most factories free soup and milk
were given the nursing mother. A number gave nursing premiums,
one a grant of 100 francs annually, another a daily premium of 50
centimes. Some employers allowed mothers to go home for half
an hour in the morning and half an hour in the afternoon, making no
deduction from the pay, though pieceworkers suffered a slight loss.
Governmental measures of protection.

In April, 1916, the committee on woman’s work was established
under the ministry of munitions and in conjunction with the league
for the prevention of infant mortality carried on an active campaign
for the protection of mothers and babies. On December 19, 1916,
the committee made the following recommendations 73 with respect
to mothers, based on a report from Dr. Bonnaire, head obstetrician
at the Maternité hospital in Paris:
E xpectant M others.

1. Pregnancy gives right to a change of employment.
2. Overtime and night work should be prohibited.
3. Daywork and half tim e are advocated.
4. Prolonged work while standing should be forbidden.
5. T he following kinds of labor should be forbidden:
(a) Work requiring physical exertion.
(&) A n y attitude endangering pregnancy.
(c) Work which shakes the body.

6.

.

T he legal rest of four weeks before confinement should be enforced among the
munitions workers.

7. No reduction of wages should be connected w ith change of work.

8.

Periodical consultations should be held b y a physician or midwife under the
direction of a physician in all munitions factories.

70 Bulletin
341-353; and
71 Bulletin
72 Bulletin
7* Bulletin

du Ministère du Travail et de la Prévoyance Sociale, Nos. 8-9, August-September, 1917, p.
Bulletin des Usines de Guerre, August, 1918, pp. 132-134.
des Usines de Guerre, M ay 21,1917, p. 26.
du Ministère du Travail et de la Prévoyance Sociale, August-September, 1917, pp. 341-347.
des Usines de Guerre, Dec. 25,1916, p. 279.


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101

FRANCE.
M o th e r s op Y o u n g B a b ie s .

1. A ll factories em ploying women and working for national defense should be
obliged to install a nursing rooip for breast-fed babies.

Mothers should have

the right to leave their work for one-half hour morning and afternoon to
nurse their babies. This should in vo lve no lo&s to the mother.
2. Nursing mothers should work only b y d a y and only in a sittin g position.
3. In addition to a nursing room there should be in State industrial establish­
ments, including the factories run b y power, a nursery for bottle-fed babies
and another for children in second, third, and fourth years.

Careful watch

should be kept each d a y over the health of the children, and for those sus­
pected provision should be made for isolation.74
<

In January, 1917,75 the minister of munitions urged the controllers
of labor to see that precautions recommended by the committee on
woman's work in relation to hours, occupations, etc., of pregnant
and nursing mothers be carried out.
During the spring of 1917 other governmental departments took
similar steps. In April, 1917, the ministry of the interior extended
financial assistance to factories maintaining nursing r o o m s or nur­
series under suitable hygienic conditions.76 Plans for the construc­
tion and administration of both had been published by the Govern­
ment in the Bulletin des Usines de Guerre.77 The ministry of labor
received a set of resolutions drawn up by the national council of
French women in which measures for the protection of expectant and
nursing mothers and of young children were urged.78 In addition to
several recommendations practically identical with those of the com­
mittee on woman’s work, they advised the extension of the period of
rest to six weeks before and after confinement instead of four, the
appointment of more women factory inspectors and welfare workers
and the adaptation of infant schools to children of 2 years of age.
!
On August 5, 1917, a law was passed requiring employers to allow
nursing mothers one hour a day in 30-minute periods to breast feed
their infants. Each establishment employing at least 100 women
over 15 years of age may also be required to maintain a nursing room
in the factory for the use of its women workers. Attempts to intro­
duce legislation of this character had been made as early as 1906 but
had been unsuccessful until the war accentuated the needs of moth­
ers and the necessity of saving every infant life.
Soon after the passage of this law (Sept. 30, 1917) the minister of
munitions addressed a circular to the managers of Government fac­
tories urging them to comply with the law as soon as possible.79
Bulletin des Usines de Guerre, Jan. 1 , 1917, p. 287.
76 Revue Philanthropique, January, 1917, pp. 36-39.
i* Le Temps, Apr. 8,1917.
u

77 Bulletin des Usines de Guerre, Oct. 2,1916, pp. 1 7 7 , 178.
w Revue Philanthropique, June, 1917, pp. 273-284.
n Bulletin des Usines de Guerre, Mar. 18,1918, p. 374.


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..V

102

IN F A N T -W E L F A R E W O R K I N

E UROPE.

Official investigations.

By a decree of October 28, 1917, the minister of munitions insti­
tuted a system of investigations . t*o ascertain hygienic conditions
among employees in thè factories under its control and to find meas­
ures necessary for their welfare.80
One of the earliest investigations 81 into Government-controlled
factories disclosed that “ it is an undisputed fact that great efforts
have been made in the Government establishments toward the pro­
tection of childhood.” Of the 62 munitions works covered by the
inquiry, 20 had instituted permanent nursing rooms, 14 temporary
ones, 14 were in construction, 3 used a nursery in the neighborhood,
4 had no need for a nursery, 7 made no reply. The use made of the
nurseries was reported to be limited. This was ascribed to the low
birth rate, to transportation conditions, making it difficult for the
mothers to bring their babies to the factories with them, and to the
fact that the nursing room being somewhat of an innovation had not
yet begun to be appreciated among the workers.
Several reports 82 on medical service in Government munitions
factories speak of the provision of special arrangements for gyne­
cological service for the working women, and of consultations for
expectant mothers. According to a report88 on the protection of
children in private industries, made in the spring of 1918, 36 nursing
rooms and 5 nurseries had been established in Paris and its suburbs,
in the district of the Loire 1 nursing room was in the course of con­
struction; in Lyon and its vicinity there were 4 nursing rooms, 4
nurseries for infants, and 7 nurseries for children above the age of
infancy; in the other parts of France investigated, 9 nursing rooms
had been opened, 31 infant nurseries, and 4 nurseries for older,
children.
Pinard in his report for the central office for the fourth year of the
war stated that in his opinion protection of mothers even in Govern­
ment factories was a dead letter in spite of ministerial decrees and
the law of August 5, 1917. He spoke of the high cost of the nursing
rooms if properly run, 8 to 12 francs daily for each child, and com­
mented on the few children in attendance. Even at the nursery
established in December, 1917, in the central camouflage factory
near Paris, with its elaborate equipment and trained workers, only a
few children had been cared for. In the summer of 1918, however,
PinaTd admits, the attendance increased so that there were 21 infants
present every day.84

_________________ ___ ________

so Bulletin des Usines de Guerre, Dec. 17,1917, pp. 271-272.
si Ibid., Mar. 18,1918, pp. 374-370 and Mar. 25,1918, pp. 383-384.
«* Ibid., Mar. 4,1918, p 359; and Apr. 15,1918, pp. 401-405.
8* Ibid., June 17,1918, p. 59,
m Bulletin de l ’Académie de Médecine, Dec. 17,1918, pp. 602-603.


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FRANCE.

103

Nevertheless, the woman physician directing the nursery felt that
other measures in addition to factory crèches and nursing rooms were
needed to protect the factory mother and her child. She suggested
(1) that the law of August, 1917, be enforced against employers
neglecting their duty; (2) that the law of June, 1913, be amended so
that not only a nominal sum be given the woman but her whole
salary be guaranteed; and (3) that a maternity insurance system be
organized for working mothers.85
.», ~
GOVERNMENT APPROPRIATIONS.

In aid of maternal and infant-welfare work, besides the previously
mentioned appropriations for maternity and nursing premiums, the
State budget provided during each year of the war (1914-1918, inclu­
sive) 650,000 francs,86except in 1917, when a supplementary appropri­
ation of 500,000 francs was made for the purpose of e s t a b lish in g nurs­
eries for the children of women munition workers.87 Although the sum
was 50,000 francs less than had been annually set aside during the years
just preceding the war, the difference was explained by the fact that
the law of June 17, 1913, had come into full operation, thus permitting
smaller grants to private societies which gave maternity benefits.88
In 1917 the State subsidy actually expended (exclusive of the Sup­
plementary appropriation) was 644,910 francs, distributed as fol­
lows : Five hundred and seventeen thousand one hundred and ninety
francs to various organizations caring for mothers and inf ants, includ­
ing mutual aid societies in so far as they provided medical care and
supervision rather than merely assistance in money; 123,270 francs
to day nurseries; and 4,450 francs to communes (about 30 in various
Departments) which gave financial aid to poor women during the
month that followed confinement in order that the mother might care
for her baby herself.89 Of the total amount Paris and the Depart­
ment of the Seine received 273,910 francs,90 which included the State
grant to the central office for the assistance of mothers and infants
in Paris. The amounts given to various organizations throughout
the country doing maternity- and infant-welfare work were slightly
larger each year of the war, through 1917, whereas the sums granted
to nurseries and to communes giving financial aid to mothers de­
creased.91
« Bulletin de l’ Académie de Médecine, Dec. 17,1918, p. 602.
“ Journal Officiel, Aug. 27,1914; Sept. 3,1915; July 27,1916; Dec. 31,1916; Sept. 24,1917; June 30,1918.
87 France, Chambre des Députés, Commission du Budget. Rapport (sur le) budget ordinaire des services
circes (pour) 1918 Ministère de l ’ Interieure, p. 63.
88 Journal Officiel, Aug. 27,1914.
8» Ibid., Sept. 24,1917.
*» Revue Philanthropique, October, 1917, pp. 513-515.
9x Journal Officiel, Aug. 27,1914; Sept. 3,1915; July 27,1916; Sept. 24,1917.


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104

I N F A N T -W E L F A R E W O R K I N

E UROPE.

INFANT MORTALITY RATES.

The infant mortality rate, that is to say the number of infant
deaths per 1,000 live births, was steadily decreasing in France before
the war. For the whole of France each five-year period from 1891
through 1910 showed a decrease, and the three-year period 19111913 indicates a still further decline in the rate. The greatest drop
in the infant mortality rate for any period during this time occurred
in the opening years of the present century.
The five largest cities in France show a similar tendency. The
decrease in the infant mortality rate for 1911-1913 over that for the
period 1891-1895 ranged from about 15 per cent in the case of Bor­
deaux to almost 25 per cent for Lille.
Rural districts have in general a lower infant mortality rate than
the urban population, exclusive of Paris and the Department of the
Seine. Paris has the lowest rate in the country.
Table X IV gives the figures for France and the five largest French
cities in five-year periods from 1891 to 1910, inclusive; and for the
three-year period beginning with 1911 and including the last year of
peace:
T able X I Y .— N u m ber o f deaths under 1 year p er 1 ,0 0 0 live births.
Period.

1891 1895
1896-1900
1901 1905
1906 1910
1911-1913

i....................................................
1....................................................
1....................................................
1
................ ,1........................
3....................................................

France.1

176.0
158.0
139.0
126.0
124.6

Paris.1

135.2
119.1
110.6
102.1
106.8

Marseille.1

177.4
168.2
165.2
163.8
137.6

Lyon.1

133.7
136.2
126.9
109.2
105.1

Bordeaux.2

137.0
127.5
109.2
105.9
116.2

Lille.2

245.3
238.6
219.3
197.3
186.4

1 Statistique Internationale du Mouvement de la Population, Vol. I (through 1905), p. 464, Vol. n
(through 1910), p. 124*.
2 Direction de l’Assistance et de l’Hygiène Publique, Statistique Sanitaire des Villes (calculated from
number of live births and infant deaths). 1891, pp. 38 and 66; 1892, pp. 72 and 79; 1893, pp. 72 and 81; 1894,
pp. 72 and 81; 1895, pp. 74 and 83; 1896, pp. 80 and 89; 1897, pp. 80 and 89; 1898, pp. 80 and 89; 1899, pp. 80
and 89; 1900, pp. 80 and 89; 1901, pp. 80 and 89; 1902, pp. 80 and 89; 1903, pp. 80 and 89; 1904, pp. 82 and 90,
1905, pp. 82 and 91; 1906, pp. 78 and 94; 1907, pp. 86 and 95; 1908. pp. 86 and 100; 1909, pp. 86 and 100;
1910, pp. 86 and 95; 1911, pp. 102 and 112; 1912, pp. 102 and 104; 1913, pp. 102, 104,138, and 140; 1914, pp.
102 and 104.
* Calculated from the number of live births and infant deaths. Annuaire statistique, 1911,1912, and
1913; p. 9 in each case.

The year 1914, five months of which were passed under war con­
ditions, shows no great variation from prewar infant mortality rates,
so far as figures available for comparison would indicate. In Marseille
there was a slight decline in the rate for 1914 as compared with that
for 1911-1913. In Paris, Bordeaux, and Lyon there was an in­
crease of 2, 6, and 3 points respectively. Bordeaux, however, during
the prewar period 1911-1913 had shown an increase of 12 points
over the previous half decade.
The available rate for the whole of France does not include the 10
invaded Departments and so offers no real basis for comparison with
rates before the war. For 77 Departments the rate for 1914 is only
109.2 per 1,000 live births. The north of France, it would seem, con­
tributed largely to the high infant mortality rate of France during the
prewar years.

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105

F B A S rC E .

The first complete, year of war, 1915, marks for the uninvaded
portion of the country (77 Departments), as well as for each of the
large cities, a striking increase in infant mortality. For all the large
cities the rates for that year are approximately as high as those for
any period since 1890 and in some cases even higher. The rate for
^ Departments is 29 per cent higher than the 1914 rate for the same
territory and higher even than the rate for the entire country (87
Departments) for any period after 1900.
In 1916 the rate for the country still intact (77 Departments)
shows a considerable decrease. While it is not so low as the 1914
rate, it is lower than any prewar rate for the whole country (87
Departments). The rates for Paris, Marseille, and Lyon are lower
than those for the preceding year but not so low, except for Paris,
as the 1914 rates for those cities. Bordeaux has a rate almost 70
per cent higher than the one recorded in 1914. This increase is
explained by one author as due to the drafting of physicians, resulting
in the closing of many consultation centers; to the increased indus­
trial employment of women; and to a shortage of fodder, affecting
the milk supply.
In 1917, however, the rate for Bordeaux falls, though it is still
much higher than for any period since 1890. The Paris rate falls to
the lowest recorded during the war, and lower than the rate for any
five-year period before the war. In each of the other large cities
and in the 77 Departments as a whole there was an increase in infant
mortality, except in Lille, where the rate for 1917 is only 161 as com­
pared with 184 in 1913.92 In a speech before the Academy of Medicine
on sanitary conditions in Lille during the German occupation, this
decline in the infant mortality rate was explained by the fact that all
newly born infants could be nursed by their mothers, sinbe industrial
work had completely stopped.92
The rates for the war years are given in Table X Y :
T able

X V . — N u m ber o f deaths under 1 year per 1 ,0 0 0 live birtTu.

France «
(77 Departments).

Year.

1914.
1915.
1916.
1917.
1918.

109
141

Paris.!)

Marseiile.«

109.2
124.3

122

102.0

123
138

98.5

135.3
168.9
160.6
172.1

Lyon.«

Bordeaux.«

107.9
134.4
116.9

Lille.c

122.5
152.8
208.1
193.1

121.8

« Bulletin de la Statistique Générale de la France, October, 1919, p. 4,
h flftlen la ta fl frnn» fVen nnmBo* n f 1 ; irn
A« J
r » i. j
6 Calculated from tire number of live births and of infant deaths(pre'liminary figures) furnished to the

hllnrATVS Rurfiftii rrn ronnoct h v

c
a

fl+o +iofinnn

____

Unavailable except for 1917.
Bulletin de l ’Académie de Médecine, Jan. 28, 1919, p. 12.
« Bulletin de l’Académie de Médecine, Jan, 28,1919, p. 121.


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°

/

106

I N F A N T -W E L F A R E W O R K I N

EUROPE.

According to rates presented to the Academy of Medicine by
Pinard and based on “ the number of children remaining in Paris,” 93
infant mortality from certain main causes of death decreased in
Paris during the war* The death rate from diarrhea and enteritis,
which increased slightly during the first year (Aug. 1, 1914, to Aug.
1, 1915), fell in 1916-17 to more than 25 per cent less than the rate
for the year immediately preceding the opening of the war. The
infant mortality rate from congenital debility for August 1, 1914, to
August 1, 1915, fell markedly from the rate of the preceding year;
and while it rose slightly during each of the next three 12-month
periods (Aug. 1 to Aug. 1) it remained only very slightly higher than
the rate for 1913-14. The death rate from diseases of the respiratory
organs among children less than a year old decreased during the first
12 months of the war and remained throughout lower than the pre­
war rate for August 1, 1913, to August 1, 1914. The infant mortality
rate from infectious diseases, owing it is said to an epidemic of measles,
increased during the first and second years (Aug. 1 to Aug. 1); but in
the third year the rate dropped below that of 1913-14. The num­
ber of infant deaths due to unknown diseases in proportion to the
number of children left in the city increased steadily until the last
year (Aug. 1, 1917, to Aug. 1, 1918), when there was a slight decrease.
According to Pinard the total infant mortality rate (the number of
infant deaths per 1,000 infants under 1 year remaining in Paris) de­
creased for each of the 12-month periods as follows:94
Aug. 1 ,1 9 1 3 , to Aug. 1 , 1 9 1 4 ...............- — .......................- - .................................... 1 5 5 .1
Aug. 1 ,1 9 1 4 , to Aug. 1 , 1 9 1 5 ........................... ..................................
152. 0
Aug. 1, 1915, to Aug. 1 , 1 9 1 6 ........................... - .................... - .................... ........ . - 149- ?
Aug. 1, 1916, to Aug. 1, 1 9 1 7 ..................................................................• * * * .............144, 1
Aug. 1, 1917, to A ug. 1 , 1 9 1 8 ..................................................................................... 139. 6

SUM M ARY.

Except in Paris, the infant mortality rate, which had been declin­
ing, was in general considerably higher, especially in cities, during
the war than it was during the years just preceding the outbreak of
hostilities. In Paris the rates rose during the first two years of the
war but declined in 1916 and 1917 below the prewar figures.
For some years before the outbreak of the war France had been
active in infant-welfare work. As early as 1874 boarded-out children
were put under State supervision; and, beginning with 1897, day
nurseries have been regulated by the Government. By a law passed
June 17, 1913, industrial workers wore forbidden employment during
the four weeks following confinement, and those who were French
93 Bulletin de l’ Académie de Médecine, D ec. 17,1918, p. 582. Theauthor does not state how “ the number
of children remaining in Paris” is determined, although he does exclude specifically “ abandoned children”
and children who had been placed out away from the city.
m Bulletin de l'Académie de Médecine, Dec. 17,1918, p. 582.


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FRANCE.

107

and had no source of income except their work, received from the
Government a small daily benefit. Somewhat later the maternity
benefit was supplemented by a nursing premium. The training and
practice of midwives were supervised by the State. The State also
granted subsidies for approved infant-welfare work. Such work was
initiated and directed by voluntary agencies. In 1894 the first
consultation des nourrissons (infant-welfare center) in the world was
established in Paris. During the next 10 years various other types
of preventive work for infants were originated by French pediatri­
cians and were extended throughout the country.
In the fight against infant mortality certain definite advances
were made after 1914. France had begun relatively early to see the
importance of maternity care in saving the baby. During the war,
prenatal care was more and more emphasized. In Paris this work
was systematically organized by the establishment of the Office
Central de l’Assistance Maternelle et Infantile, under the assistance
publique, for the purpose of coordinating public and private work.
Private societies increased their hospital facilities for pregnant and
parturient women. Never before, we are told, had pregnant women
been so well taken care of.
The standard of midwifery service throughout France was raised
in August, 1916, by the abolition of the course for midwives of the
second class. In the future only the better-educated midwives will
be permitted to practice.
Both in Paris and throughout the country generally the infantconsultation center and the milk station continued to function after
the outbreak of war. While some centers were closed, new ones
were in a number of instances opened, in spite of a shortage of doctors
and the small number of births. These centers made every effort to
keep up the instruction of mothers and the medical examination of
pregnant women and infants. The mutual-aid societies were espe­
cially active after the war began in providing this type of medical
and hygienic supervision for their members.
During the war special efforts were made to educate the public,
especially mothers, in the importance of infant hygiene. This
movement took the form of “ baby weeks” and exhibits held in the
larger cities, traveling exhibits with demonstrators and lecturers
touring the smaller towns. In connection with the exhibits, lectures
and courses were given in the larger cities and to infant-welfare
workers, especially home visitors. Before the war French infantwelfare workers had been in general untrained. Home visitors were
always voluntary workers. The war years witnessed a movement
to secure the services of a trained home visitor for each infant-consul­
tation center. In carrying out this program the society for the
prevention of tuberculosis in France and the league for the preven­
tion of infant mortality were assisted by the American Red Cross.

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I N F A N T -W E L F A R E W O R K I N E UROPE.

Much of the infant-welfare work had for its object the promotion
of breast feeding. Nursing premiums and maternity benefits given
in accordance with the laws of June 17 and July 30,1913, were ex­
tended through amendments in 1917 to include all women with in­
sufficient resources. In some places, as in Paris, the amounts were
increased by municipal action and appropriation. In many instances
they were supplemented by the maternity and nursing benefits of such
societies as the mutualités maternelles. While the total appropria­
tion from the State for inf ant-welfare work (including day nurseries
and monetary aid to women leaving public maternity hospitals after
confinement) remained about the same, during the years of the war,
the portion granted to private societies caring for the mother and
infant increased each year.
Day nurseries received special attention in France during the
war, owing to the increase in the employment of mothers with young
children. New crèches were opened in industrial centers, in many
cases through the concerted action of employers. The danger to
breast feeding that widespread use of the crèche involves was attacked
by the law of August 5, 1917, which provided that any employer of
100 women over 15 years of age may be required to* provide on the
premises a nursing room (chambre d’ allaitement). Mothers, without
loss of pay, were to be allowed to leave their work for half an hour twice
daily to nurse their infants. A number of factories established, in
addition to the nursing rooms, nurseries for artificially fed infants
and for older children of women in their employ. These nursing
rooms and nurseries were subject to governmental inspection.
Their establishment was looked upon as a palliative measure rather
than an ideal method of meeting the problem of the mother in
industry.


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GERMANY.
INTRODUCTION.

“ To-day we know that high infant mortality is a national disas­
ter,” said Prof. Dietrich,1 one of the earliest leaders in child-welfare
work in Germany; “ on the one hand because numerous economic
values are created without purpose and prematurely destroyed while
those concerned are heavily burdened, and, on the other hand, be­
cause the causes of the high rate of infant mortality affect the powers
of resistance of the other infants and weaken the strength of the
nation in its next generation.” But until fairly recently, Germany,
like most other nations, was relatively inactive, under the assumption
that as long as the birth rate continued high she could afford to lose
large numbers of her infants. The birth rate did continue high for
some years after the general downward trend had set in in other
European countries. After 1900, however, the decline was rapid
and steady, as is shown in Table X VI.
T able

Number of live births per 1,000 of the population.1

X V I .—

Period.

Rate.

1871-1881................................
1881-1890................................
1891-1900................................

39.1
36.8
36.1

Period.

1901-1910.................... .
1911......................................
1912......................................

Rate.

32.9
28.6
28.3

Period.

Rate.

1913 .
1914...
1915

27.5
26.8
*20.4

1 Statistisches Jahrbuch für das Deutsche Reich 1916, p . 6.
* Concordia, June 1,1919, pp. 89-92.

This decline was accelerated by the war, so that the decrease in
1915 and 1916 is 23 per cent and 40 per cent when the birth rates of
those years are compared with that for 1913.2
INFANT-WELFARE W ORK BEFORE THE W AR.
ORGANIZATION.

Up to the present century little organized work had been attempted
and practically none on a national scale. But for about 10 years
there has existed in Germany a most highly devejoped and complex
machinery for combating infant mortality, and measures for the
welfare of mothers and infants have been systematically organized
and, as far as possible, centralized.
1 Säuglingsfürsorge iu Gross-Berlin. Compiled by the Kaiserin Auguste Victoria Haus, 1911, p. 6.
* Bulletin der Studiengesellschaft für Soziale Folgen des Krieges, N o. 3, Die Bevölkerungsbewegung im
Weltkrieg, 16 Mar. 1917.

109


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IN F A N T -W E L F A R E W O R K I N

EUROPE.

The movement to protect the health of infants through caring for
mothers and teaching mothers the proper care of their children be­
gan early in the twentieth century through the efforts of such leaders
as Dietrich, Langstein, Heubner, and Schlossmann, who pointed out
the dangers to the country in the great waste of infant life. Private
charitable organizations and local police and health officials here
and there took steps to reduce the infant mortality by establish­
ing infant-welfare stations, “ milk kitchens,” and day nurseries,
and by distributing information to mothers on the care of babies.
Enthusiasm for the movement is said to have been stimulated by a
letter from the Empress (Nov. 15, 1904) to the Vaterlandis<?her
Frauenverein (women’s patriotic society), an influential private
organization, in which the cooperation of all voluntary official bodies
was urged in all measures pertaining to infant welfare. A few
months later a ministerial decree (Kultus, Feb. 10, 1905) directed
local authorities to unite with private societies in combating infant
mortality.3 The formation of local associations for the protection of
mothers and children followed, chiefly in the larger cities, in all parts
of the Empire. The various societies of a province were organized
into a provincial union, which in turn belonged to the State associa­
tion. These were established in many of the German States in order
to systematize the work within the State and to bring it in harmony
with that throughout the Empire. They received grants from the
State governments and from the provinces and were themselves
welded together in a national league, the Deutsche Vereinigung fur
Sauglingsschutz (imperial association for the care of infants).
This was organized in 1909 and has for its headquarters the Empress
Augusta Victoria House or Institute at Charlottenburg. The pur­
pose of this institution is, through scientific and practical investiga­
tion, to suggest to the public and the Government lines along which
work for inf ant welfare may best proceed. In addition to its laborato­
ries, clinics, and hospitals for mothers and children, and its infantwelfare center and milk station, it contains a training school for
midwives and nurses and offers courses to mothers in the care of
infants. The expenses of the imperial association were met by a sub­
sidy from the German Empire of from 40,000 to 60,000 marks a
year)4 by grants from the Federal States and from municipalities,
as well as by gifts from private individuals.
The work 6f the. local infant-welfare association was usually the
joint concern of private philanthropic societies and public bodies.
The former were in general responsible for the initiation of most of
the measures for infant conservation, which the latter aided by
grants. In many communities the inf ant-welfare association was
* Zeitschrift für Säuglingsschutz, May-June, 1915, p. 217.
* Säuglingsfürsorge in Gross-Berlin.
Compiled by the Kaiserin Auguste Victoria Haus, 1911, p. 16.


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GERMANY.

I l l

represented by a committee consisting of members of private agen­
cies and public officials. This type of cooperation was carried out
also in the provincial and State associations.
The differences in political constitution and social conditions in
the various parts of the Empire caused a lack of uniformity in much
of the inf ant-welfare work. Even when the Imperial Government
issued decrees the administration was left largely to local officials,
and the degree of excellence with which they were carried out was
determined in general by the progressiveness and the prosperity of
the particular communities. As a result, it was usually only in the
cities that great progress was made, not only in work specifically for
infants, but also in those general sanitary and social measures which
are indispensable in diminishing the infant death rate. Dirty and
insanitary conditions in the country, combined with an ignorance of
hygiene and of infant care, are thought by German writers to be in
large part responsible for the high infant mortality rate in the rural
districts, a rate invariably higher than that for the large towns. In
Bavaria, since 1909, 50,000 marks had been granted annually from
State funds for infant-welfare work in rural communities; and in
1910 there were 112 consultation cehters functioning in rural districts.5
The high mortality among children born out of wedlock caused in a
number of communities the institution of protective measures in
their behalf, which in many instances were later extended to include
all infants.
Money for infant-welfare work had been appropriated by cities,
provinces, and Federal States in increasing amounts. No maternity
and infant-welfare aid was regarded as poor relief.
TYPES OF WORK.

The chief activity of the local infant-welfare association was the
establishment of welfare centers. Between 1905 and 1914, 782 cen­
ters were opened throughout the Empire.6 A number of these were
municipal. As early as 1910 Berlin had 7 municipal centers.7 In
charge of each center was a doctor, assisted by one or more trained
infant-welfare workers. Baby weighing and the giving of advice to
the mother on the care of her baby characterized the infant-welfare
center in Germany as in other countries. Home visiting, except in
the case of the child bom out of wedlock, seems not to have been
general. Cooperation with the midwife in some towns was gained
by paying her a small fee for every mother whom she persuaded to
come to the center. The encouragement of breast feeding was con­
sidered the most important work of the center, and many centers
• Zeitschrift für Kinderschutz und Jugendfürsorge, June, 1914, p . 163.
»Zeitschrift für Säuglingsschutz, May-June, 1915, p. 178.
» ßäuglinsgfürsorge in Gross-Berlin.


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Compiled by the Kaiserin Auguste Victoria H aus, 1911, p . 37.

112

IN F A N T -W E L F A R E W O R K I N

EUROPE.

gave money as nursing premiums, white milk kitchens, providing
pure milk for weaned children and infants unable to be breast fed,
were also commonly run as part of these centers. In Germany a com­
paratively large proportion of infants were affected by the welfare
work. For instance, in 1902, 38 per cent of all newly born infants
in Berlin came under the care of consultation centers; in Charlottenburg, in 1908, 41 per cent; and in Frankfort on the Main, in 1911,
29 per cent.8
Many infant-welfare associations included in their general scheme
of work the instruction of mothers by means of courses, leaflets,
pamphlets, and exhibits. The welfare centers in larger cities gave
lectures for mothers several times a year. In Berlin, for instance, at
the Neumann (municipal) children’s clinic, for some years courses in
infant care were given periodically, without charge if the mothers
were unable to pay the fee of 10 marks.9 Many districts gave leaf­
lets on the nourishment and care of babies to newly married couples.
A leaflet put out by the women’s patriotic society was by decree of
the imperial minister of the interior (Jan. 14, 1905)10 given out to
all parents registering births. The Empress Augusta Victoria House
also published such leaflets from *time to time and gave them out
upon request. In 1906 a very large and complete infant mortality
exhibit was held in Berlin, and permanent museums for giving pub­
licity to the proper care of infants were established some years before
the war in Munich and at the Empress Augusta Victoria House in
Charlottenburg. The Bavarian traveling exhibits instituted in
1911 by Prof. Hecker of Munich made a definite effort to train the
mother in child care; lectures on infant hygiene were given and
demonstrations with a large doll.
Protection of industrially employed mothers in the Empire extends
back to 1878, when women were forbidden to engage in industrial
work for three weeks after confinement. In 1883 the first German
sickness-insurance law provided maternity benefits for this period
amounting to one-half the woman’s wages. In 1908 (Dec. 28)
a rest period of eight weeks, at least six of which must follow
confinement, was established by law. In 1911 the maternity benefits
were made more generous. Employed women of certain spec­
ified classes had to be insured, and all insured women received
a money benefit equal to half the woman’s wage for eight weeks
at confinement, at least six of which must be after the con­
finement. In addition to this payment the insurance societies
might make other provision, such as medical care and nursing and
nursing premiums, and might also extend the period of benefit or
s Zeitschrift für Kinderschutz und Jugendfürsorge, June, 1914, p. 162.
» Säuglingsfürsorge in Gross-Berlin. Compiled by the Kaiserin Auguste Victoria Haus, 1911,p. 41.
w Zeitschrift für Säuglingsschutz, May-June, 1915, p. 217.


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g e r m a n t

.

na

grant it to the wives of insured men. These additional aids were
dependent upon larger premiums. From time to time since 1883
the number of insured women has been added to by the inclusion of
various classes of workers.
The administration of the benefits was intrusted to the sicknessinsurance societies, and in some cities, as in Berlin and Frankfort,
the local sickness societies made grants to the centers in return for
a supervision over maternity cases which had a claim on the societies.
B ay nurseries or crèches for the young children of working mothers
had been in existence for some years and were numerous. Usually
they received children from 6 weeks of age up to 3 years. Crèche
associations had been formed in many of the larger cities for the
purpose of fixing standards and lending aid. Just before the
war a number of these united to form the imperial crèche associa­
tion, one of the objects of which was to interest the medical profes­
sion in the creche movement. Nurseries were most often estab­
lished and carried on by philanthropic societies. Some towns had
nurseries supported entirely by the municipality. Grants from the
city in aid of crèches established by private philanthropy were
customary.
There were a few factory crèches in Germany before the war. It
was also customary for working mothers to board out their children,
and over boarded-out children supervision was generally maintained
by local police and sanitary departments. There was no imperial
law providing for such supervision, but in several States it was
legally required.
For children over 3 years old and up to school age whose mothers
were employed there were day centers and kindergartens. The former,
and sometimes the latter, are open from early morning until evening
and provide a midday meal. The day center gives care and en­
deavors to train the child in orderly habits. The kindergarten aims
to develop the child through Froebel instruction. But no hard and
fast line can be drawn between day centers and kindergartens, and
in many places the latter took over some of the functions of the
former. They were both conducted by private agencies.11
INFANT-WELFARE W ORK DURING THE W AR.
EARLY EXPERIENCE.

At the outbreak of the war the work for infants suffered a sudden
collapse. Many institutions were taken over as military hospitals.
Others were closed for lack of doctors and nurses. The Neumann
ppU 5

S

A " ™ d Klumker’ Chr- J-: Saüglingsfürsorge und Kinderschuh in den Europäischen Staaten/

173389°— 20----- 8


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X14

I N F A N T -W E L F A R E W O R K I N

E U ROPE.

foundation in Berlin, with its free clinics and infant-welfare center,
was obliged to close its doors. In Hesse one-fourth of the centers
shut down.12 Some of the centers remaining open had to cut down
their staff, owing to the scarcity of both doctors and nurses, many
of whom had been mobilized or had entered the Red Cross service.
During August and September, 1914, attendance fell off even at the
centers which were able to keep open, a circumstance attributed
partly to the confusion and excitement of the early days of war.
On August 19,1914, the Prussian minister of the interior issued a
decree 13 warning provincial authorities not to neglect the care of
children, but to keep infants’ homes, day nurseries, and all other
activities for mothers and children in full operation during the war.
At the same time the Empress addressed to the imperial association
for the care of infants a letter in which she pointed out the need for
increased activity for mothers and babies. Influenced partly by
these communications, partly by a rise in infant mortality during the
first two months of the war, and partly by the warning given by
infant specialists all over the Empire, a rallying of the forces for infant
welfare took place, and an extension of measures for mothers and
babies followed. Many protests were voiced against the withdrawal
of doctors and nurses. The military authorities released a number
of workers in infant welfare, and by degrees the situation became
more nearly normal, though a shortage continued to hamper the
work throughout the years of the war. Most associations were able,
however, to continue with the most fundamental of their activities,
such as the work of the centers^ but extensions of the work, including
exhibits, traveling courses, and the like, had in many instances to be
abandoned.
NEW ORGANIZATIONS AND APPROPRIATIONS.

With the revival of infant-welfare work new local and State asso­
ciations were formed, and new activities were entered upon, even in
places where few or none had existed before the war. Even before
the war the tendency in Germany had been for the municipality to
take over welfare work begun by private organizations, and with the
war this tendency increased. In Strassburg, for example, the city
undertook after the outbreak of the war to cover for the duration of
the war all the expenses which the private maternity- and infantwelfare societies were unable to meet.14 The desirability of coordina­
tion and cooperation between private agencies and public bodies was
continually stressed.
In order to stimulate the adoption of measures to protect infants
in communities where little or nothing was done, a movement was
u Zeitschrift für Säuglingsschutz, May-June, 1915, p. 207.
» Ministerialblatt für Medizinische Angelegenheiten, Sept. 2,1914.
u öffentliche Gesundheitspflege, vol. 3, No. 10, October, 1918, p. 350.


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GERMAITY.

115

begun in the spring of 1916 to form an imperial fund (deutsche Spende)
for the protection of infants and young children throughout Germany.
Donations made in each State to this fund were to be received by the
State infant-welfare association for work in the State, or, if no asso­
ciation existed, the money was to be used in forming one.18
As late as March, 1917, a new infant-welfare association was estab­
lished in the Grand Duchy of Mecklenburg-Schwerin.16 In May of
the same year Württemberg created the Landesausschuss für Säug­
lings und Kleinkinderschutz, a national committee for the protection
of infants and young children.17 This committee included repre­
sentatives of the Württemberg ministry of the interior and of the
medical profession. In Saxony, where a State infant-welfare asso­
ciation had existed since 1907, organized work for infants was made
obligatory18 upon its districts, combinations of districts, and munic­
ipalities not belonging to any district. Each district was to have
a committee consisting of representatives of infant-welfare work,
both public and private, and a State committee was to be formed to
serve as a central organ for all the work in Saxony. The funds were
to be derived from a private foundation yielding 125,000 marks
annually, to which the State was to add 187,000 marks.19 Prussia in
the 1919 budget of the minister of the interior for the first time
provided 500,000 marks for infant-welfare work.20
Widespread criticism was directed against the lack of uniformity
and coordination in infant-welfare work resulting from the varietv
of Federal and State laws and of local police and public-health regu­
lations. It was thought that a Federal law establishing children’s
bureaus would prove a coordinating agency and would provide a
framework of minimum requirements, the details and extent of
which would be determined by the federated States.21 During 1918
a bill embodying this measure for Prussia was introduced into the
Prussian House of Deputies, but late in the summer of 1918 it had
not been passed.
In 1915 and again in 1916 the Empire appropriated 100,000 marks
for the work of the Empress Augusta Victoria House, which before
the war had never received more than 60,000 marks annually from
the imperial treasury for its work of “ combating infant mortality in
the German Empire.” 22
16Zeitschrift für Säu jlingsschutz, July, 1916, pp.
ing th^6Wa^pT 1 3

Govemment

433-436.

Board>intelligence Department. Intent Weiterem Germany dur-

17Zeitschrift für Kinderschutz und Jugendfürsorge, April, 1918, p. 107.
18Ibid., August-September, 1918, p. 8 3 4 .
19Zeitschrift für das Armenwesen, July-September, 1918, p. 146.
90Zeitschrift für Kinderschutz und Jugendfürsorge, August-September
21Soziale Praxis, Sept. 26,1918, col. 814.

1918 p 227

’

IV Re^ hahaushaltsetats iür daa Rechnungsjahr, 1914, Pt. I V , p. 58; for 1915, P t. I V , p.


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44;

for 1916,

Pt.

116

IN F A N T -W E L F A R E W O R K I N

E UROPE.

THE WAR SPONSORSHIP MOVEMENT.

During the war a number of infants and young children were
aided by well-to-do people in connection with the war sponsorship
movement (Kriegspatenschaft). This was a plan introduced by the
lied Cross in the early days of the war (October, 1914), in order to
relieve those women who were not in receipt of any State allowance.
A well-to-do person made himself responsible for the care of a mother
and child and thereby became “ war sponsor” to the child. The
unique feature was the practice of keeping mother and child together.
In a few cases, both went to live with the sponsor; in others the
sponsors merely pledged a sum of money to maintain mother and
child while the child needed the care of the mother, especially during
the* period of nursing. The mothers of children thus cared for were
obliged to attend the infant-welfare center in their district. Dr. Leo
Langstein, director of the Empress Augusta Victoria House, believed23
that allowances such as these to enable mothers to retain their chil­
dren should be continued after the war.
INFANT-WELFARE CENTERS AND HOME VISITING.

During the first year of the war, the Empress Augusta Victoria
House sent out a questionnaire on infant-welfare work to 375 com­
munities with a population of more than 15,000 each and with 788
infant-welfare centers and 266 institutions caring for infants, ex­
pectant mothers, and mothers. Three hundred and four communi­
ties replied. In 268, activities had continued as before the war; in
30, activities had increased; and in only 6 had activities decreased.
Welfare centers reporting a decrease in their work were usually
private ones; the work of the public centers on the whole continued
unimpaired or increased. Two hundred and twenty-five centers, both
public and private, reported a higher attendance, and 20 new ones had
been established.24 Six centers were opened in Munich.2* In some
places, as in Posen for instance, centers were established for the first
time.26 Many of the centers were entirely municipal. In Berlin, by
1918, 9 centers were operated by the city; in Cologne, 13; in Leipzig,
6.27 The budget of the Prussian ministry of the interior for 1919
makes specific provisions for the aid of welfare centers.28 The bill
of May 30, 1918, regulating welfare work in Saxony, provides for the
establishment of centers in charge of physicians “ receiving an
adequate salary.” 28
»Zeitschrift für Säuglingsschutz, February, 1915, p. 43.
m Zeitschrift für Säuglingsschutz und Jugendfürsorge, May-June, 1915, p. 209.
* Blätter für Säuglingsfürsorge, June, 1915, p. 254.
» Öffentliche Gesundheitspflege, vol. 3, No. 8, August, 1918, p. 260.
27 Groat Britain, Local Government Board, Intelligence Department, “ Infant Welfare in Germany
during the W ar,” 1918, p. 13.
23
Zeitschrift für Kinderschutz und Jugendfürsorge, August-September, 1918, p . 227.
» Ibid., p. 234.


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GERM ANY.

117

Some cities show an increase in the number of children receiving
care at the centers. Neuköln, for example, is said to have cared for
66 per cent of all the children born alive in that city in 1916-17 as
compared with 38.1 per cent in 1913-14.30 Many places, however,
speak of the decrease in attendance, and this was thought to be due,
as in other countries, to the low birth rate. In general, workers found
that in order to secure a regular attendance it was necessary to
give premiums for breast feeding. The work in Hesse is said to
have suffered greatly because of the unwillingness of the Hessian
authorities to put this custom into practice.31
. The work of the center was extended in a variety of ways. Many
centers opened clinics for the examination of pregnant women, and
a large number extended their care to the child of preschool age. In
Berlin, it is said, nine new centers for children from 1 to 6 years old
were functioning.32 In some cases, especially when the centers were
under municipal control, they were charged with the distribution of
ration cards for young children and for nursing and expectant
mothers. The centers in Munich served as depots for supplies of
food intended especially for children. The greater part of the milk
for babies and mothers was given out or sold through the welfare
stations. Even before the war milk kitchens were commonly a part
of the welfare center; during the war almost no center was without
one.
A decrease in attendance at milk stations, however, noted by the
end of 1915, was thought by some to be due to the work of the centers
in teaching the importance of breast feeding.33 In this connection,
the work of home visitors in carrying to the mothers advice and in­
struction as to breast feeding is said to have been invaluable.
An extension of home visiting seems to have taken place during the
war, though some centers reported an interruption in the visiting
due to the scarcity of workers. A number of towns, for example,
Strassburg,31 which before the war had made provision only for
children born out of wedlock and orphans, extended the visiting to
include all children and in some cases pregnant women. Munich in
the fall of 1914 doubled the number of its visitors.35 Supervision of
boarded-out children was in some communities transferred from the
police and public health authorities to the home visitors connected
with a center. Trained public home visitors to work with private
agencies were provided for in Saxony by the infant-welfare law (May
30, 1918). In many German towns trained workers visited infants
born out of wedlock, in connection with the public guardianship
system, whereas volunteers visited the other children.
*° Vorwärts, Jan. 5,1918.
n Zeitschrift für Säuglingsschutz, May-June, 1915, p. 209.
“ Vorwärts, Aug. 2, 1917.
w Blätter für Säuglingsfürsorge, June, 1915, p. 282.
w Öffentliche Gesundheitspflege, vol. 3, N o. 10, Oct. 19,1918, p. 350.
* Blätter für Säuglingsfürsorge, June, 1915, p. 297.


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IN F A N T -W E L F A R E W O R K I N

E UROPE.

TRAINING OF WORKERS.

The rapid extension of the work created a demand for workers
difficult to meet. In practically all large cities, short courses in
infant care were introduced, usually under municipal direction, for
the training of both paid and volunteer workers. The instruction
in most cases lasted only a few weeks; for example, in Frankfort on
the Main in October, 1917, a 10-day course was given.36
In Bavaria, at the request of the minister of the interior, infant
asylums and other institutions gave brief courses in infant care to
midwives, rural nurses, public-health visitors, and other persons
qualified to enter inf ant-welfare work. Half the expense of board
and tuition was defrayed by State funds.37 The Prussian Govern­
ment in the spring of 1917 instituted an examination for infantwelfare workers, following a year’s course of training prescribed by
the minister of the interior. Infant-welfare workers who previous
to the publication of these regulations had satisfactorily completed
five years of practical work were not required to take the examina­
tion.38 The Empress Augusta Victoria House trained a few workers.
In the year 1915-rl6 it accommodated 60 students. The number of
applicants for training was 1,228.39
PRENATAL CARE.

Prenatal care has not been well developed in Germany. In ad­
dition to the examinations and advice offered to expectant mothers
attending centers, however, certain other types of prematernity
welfare were engaged in here and there. Various women’s societies,
for example, cooperating in some cases, as in Magdeburg, with city
authorities, provided hospital accommodation for sick pregnant
women. Homes for pregnant women were opened in a few cities by
private societies, such as the Deutscher Bund für Mutterschutz
(German association for the protection of mothers), and in these
homes the mother was trained in housekeeping, manual work, and
the care of the infant. In rare cases, it was stated, such homes were
subsidized by the municipality.40 Private agencies also gave various
forms of assistance, including the services of a midwife, to expectant
mothers.41
In some places, as in Berlin, through the women’s patriotic society,
the expectant mother was given a money benefit during the last
months of pregnancy. Throughout the war influential bodies,
official and private, recommended or petitioned the extension of the
s® Concordia, Aug. 15,1917, p. 219.
« Das Österreichische Sanitätswesen, Feb. 25, 1915, pp. 239-241.
w Archiv für Frauenarbeit, September, 1917, pp. 160-164.
» Zeitschrift für Kinderschutz und Jugendfürsorge, July, 1917, p. 182.
« Die neue Generation, September, 1915, p. 316; Concordia, July 15,1918, p. 166.
« Zeitschrift für Säuglingsschutz, January, 1915, p. 28.


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preconiinement rest period, with a corresponding extension of the
pregnancy relief granted in accordance with the maternity insurance
law.42
MIDWIFERY PRACTICE.*

Before the war the German industrial code provided that midwives
might not practice without a certificate. Most of the other regula­
tions concerning midwifery were made by the individual States.43
Instruction was given in special schools connected with the universities
or with lying-in homes. On November 6, 1917, the Federal council
of Germany prescribed regulations for the training and practice of
rnidwives throughout the Empire. Accörding to these regulations,
only women between 20 and 30 years old, after evidence of good
character has been presented and an examination in elementary
school subjects passed, should be admitted to the courses; the
courses should last at least nine months (six months had been the
average length of training before the war); instruction should in­
clude practical as well as theoretical work and should be completed
by oral and written examinations; repetition tests should be held at
least every two years, and continuation courses for those who fail
twice in the repetition course should be provided; to all other mid­
wives a continuation course should be given every 10 years; all mid­
wives should be placed under the constant supervision of a publichealth physician.44
On April 18, 1919, a bill modeled on these standards was introduced
into the Prussian House of Representatives. In addition to the
regulations mentioned above it provided for the employment of
midwives in sparsely* populated districts, where midwives were
scarce, by public authorities. Here, according to the bill, they
were to be paid a salary.45 This bill had not become a law by the
autumn of 1918. There was some agitation also for the creation of
salaried midwives throughout the country, partly because only in
case a midwife were assured a salary would she be likely to favor the
removal of a patient to a hospital, no matter how unsuitable for
confinement home conditions might be.46
Early in the war (June 17, 1915) Berlin instituted repetition tests
and continuation courses for midwives.47 Some cities supplied free
midwifery service, especially for the wives of soldiers.
_________________________________ ___________ _______ ______ ■
42 Sozialistische Monatshefte, Oct. 31,1917, p. 1130; Die neue Generation, September, 1915, p. 316. Pos­
sibly as a result of these petitions a new law providing much more generous maternity benefits was
enacted on Sept. 26,1919.
48 H . J. Meyer; Konversations-Lexikon, vol. 9, “ H ebam m e,” p. 21.
44 Archiv für Frauenarbeit, June-September, 1918, pp. 104-108.
46 Deutsche Medizinische Wochenschrift, June 20,1918, p. 693.
46 Vorwärts, May 16,1918.
47 Das Österreichische Sanitätswesen, Aug. 5-12,1915, p. 1041.


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IN F A N T -W E L F A R E W O R K

IN E UROPE.

LYING-IN ACCOMMODATIONS.

Outside the great cities, lying-in accommodations .were generally
considered unsatisfactory. On May 18, 1915, the Prussian minister
of the interior issued4* to the provincial authorities a circular in
which he stated that admission to the maternity ward of hospitals
might not be refused because of alleged lack of room to a needy
woman about to be confined, unless another place could be found by
the institution and a physician or midwife in the institution declared
after examination that labor was not imminent and that further
travel would not harm the mother. The circular recommended the
reservation in lying-in homes of several beds for needy women. Dr.
Brennecke, a Magdeburg physician, who for many years had been
working for reforms in midwifery practice, urged the establishment
of numerous public lying-in homes, “ purely in the interests of public
health, so that even the poorest mothers and children could benefit
by the blessings of antiseptics and the most advanced obstetrical
science.” These, he thought, might become the center of the mater­
nity work of a district.4*
SPECIAL FOOD REGULATIONS.

As milk became more and more scarce, steps were taken by various
municipalities to insure fair distribution of the supply. Some towns
bought or hired cows, reserving the milk for infants and young chil­
dren. Such action was taken in March, 1917, by Frankfort on the
Main.49 Municipal milk depots, with which dealers cooperated
through the holding of shares, were started early in the war in some
cities, among them Mannheim, Strassburg, and Cologne.50 In some
places grants were made to owners of dairy farms, providing they
supplied the town with a certain quantity of milk. Almost all cities
made some arrangements for supplying first the needs of mothers and
little children.
A Federal order of November 11, 1915, required the larger towns
and enabled the smaller ones to control the milk supply and to give
preferential treatment to nursing and expectant mothers and young
children. The imperial fat control office fixed (Oct. 3, 1916) the
quantity to be allowed each class of persons and restricted the use of full
cream milk to children, invalids, nursing mothers, and pregnant women
during the last three ^months before confinement. On November 3,
1917, earlier regulations went out of force. The new Federal order
of that date restricted the use of unskimmed milk by sick persons to
« Vorwärts, May 16,1918.
« Das Österreichische Sanitätswesen, N o. 24-28, June 17 to July 15,1915, p. 883.
« Zeitschrift für Kinderschutz und Jugendfürsorge, April, 1918, p. 97.
n

Great Britain, Local Government Board, Intelligence Department. Infant Welfare

during the W ar. pp. 35-36.


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those who could present a certificate from a public-health official but
continued to allow it as before to all children under 6, nursing mothers,
and pregnant women.
Special regulations in favor of mothers and babies were made with
regard to foodstuffs other than milk. Many towns took steps to
secure additional rations for mothers and little children. Where
necessary the ration of other persons was cut down to furnish the
extra supply to mothers. Imperial action followed municipal meas­
ures. On October 4,1916, an order of the imperial fat control office
prescribed the minimum food allowance for artificially fed infants
or for the nursing mother. On May 25,1917, the war food board issued
instructions to local authorities on the nourishment of expectant
mothers, infants, and children. Again, on January 7, 1918, the war
food board pointed out the significance of sufficient nutrition for these
classes of the population and fixed minimum rations. But the ability
of the municipal authorities to carry out the Government regulations
was conditioned upon the amount of food which they could get, and
this differed in different places.
EXTENSION OF WORK TO RURAL DISTRICTS.

Considerable attention was directed to the ways and means of
reaching mothers and babies in the country, where it was considered
to be a more difficult problem than in cities.
The State infant-welfare association in Bavaria, for instance, re­
ceived from the State commission for the care of soldiers’ families the
sum of 20,000 marks to be spent on infant-welfare work among the
dependents of soldiers, on the condition that the money be spent
only in communities with a population of less than 50,000.61 In
Württemberg, too, the State committee for the protection of infants
and young children opened summer day nurseries and summer
kindergartens in rural districts. It also appointed infant nurses for
these districts and sent out trained lecturers to speak on infant care
all through the country. The plan was financed partly by contribu­
tions from private sources, especially from large industrial and com­
mercial companies, and partly by funds from the committee.52 The
new Prussian mid wives’ bill (1918) proposes to guarantee midwifery
service for scattered populations by its provision for the payment of
rural midwives from State funds. The advocates of children’s
bureaus considered the reaching of rural districts one of the chief
advantages of their scheme.
Local efforts wore made to reach rural families. Late in the war,
for example, a few cities endeavored to extend their work, especially
the visiting of infants, to the surrounding country. Chemnitz was
•* Blätter für Säuglingsfürsorge, October, 1915, p. 16.
MZeitschrift für Kinderschutz und Jugendfürsorge, April, 1918, p. 107.


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I N F A N T -W E L F ARE W O R K I N

EUROPE.

one of these towns. The little town of Benneckenstein, it is said,
appointed after the beginning of the war three women welfare
workers, provided free medical treatment and free milk for a large
number of children, and organized a course of lectures on infant care
by the public-health physician.63 Doctors were instructed in some
localities to give advice and leaflets on baby hygiene to mothers
when they brought their infants for compulsory vaccination. In
other places the midwife continued to visit the infants among her
cases and to report on their progress to the district health authority,
receiving a small fee for each case.
EDUCATION OF MOTHERS AND YOUNG GIRLS IN INFANT CARE.

“ To train the mother and especially the mother in the country is
the chief work of the infant-welfare movement,” said a German
writer in discussing instruction in infant care in girls’ schools.54 Such
training through lectures, demonstrations, and courses continued
throughout the war in the face of some difficulties. The welfare center
seems in general not to have carried on the educational work character­
istic of the school for mothers in Great Britian. This more formal
type of instruction was generally left to local public-health bodies.
In Leipzig, for instance, in 1915, the association for public hygiene
organized a series of four-week courses in infant welfare 55for mothers.
In Stuttgart a school for mothers was opened in connection with a
home for children, and practical work was combined with lectures.58
Similar courses were given in a number of other towns.
The Empress Augusta Victoria House continued to publish its free
pamphlets and leaflets. One issued in November, 1915, dealt ex­
haustively with the care of pregnant women and women after confine­
ment.67 Another, issued in 1918, described in detail the methods of
care, not only of infants, but also of children up to the age of 6 years.58
In the summer of 1918 the Empress Augusta Victoria House brought
out an atlas of infant hygiene.59 The atlas was an attempt to repro­
duce for the benefit of a more extended public the traveling exhibits
which the Empress Augusta Victoria House had been giving in many
parts of the country. The articles and pictures making up the exhibit
were reproduced and 100 charts giving the most important points in
the hygiene of the baby and the small child were included.
In both large and small cities attempts were made to place in the
public-school curriculum more satisfactory instruction m child care.
** Vorwärts, Dec. 18,1917.
m Blätter für Säuglingsfürsorge, November, 1915, p. 34.
* Zeitschrift für Säuglingsfürsorge, July, 1915, p. 271.
w Blätter für Säuglings- und Kleinkinderfürsorge, October, 1918, p. 26.
0 Blätter für Säuglingsfürsorge November, 1915, p. 58.
« Zeitschrift für Kinderschutz und Jugendfürsorge, October, 1918, p. 255.
w Vorwärts, July 18,1918.


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Such courses were usually practical as well as theoretical and included
visits to day nurseries and infants ’ homes. In some places the courses
were given by the regular teachers of household subjects; in others, as
in Berlin, the teachers were trained for the work in infant institutions.60
In Kassel each girl upon graduation was given an “ infant primer”
embodying the principles learned in the compulsory course in infant
hygiene.61 Dr. von Behr Pinnow strongly advocated courses in con­
tinuation schools to teach girls whatever is necessary for successful
motherhood.62
PUBLIC FINANCIAL ASSISTANCE.
Separation allowances.

The increased cost of living combined with widespread unemploy­
ment during the first months of the war made for serious economic
distress. With a large proportion of fathers serving in the army,
women were obliged to cope single-handed with the difficulty of sup­
porting young children in the face of the soaring cost of the necessities
of life.
Separation allowances made by the Government to the families of
soldiers were very small. The law of August 4, 1314, granted to a
soldier’s wife 9 marks a month in the summer months and 12 marks
a month during the winter. Each child received in accordance with
this law 6 marks a month throughout the year.
As the war continued the amounts of the allowances were increased.
By November, 1918 (order of Federal council, Sept. 28, 1918), they
had reached 30 marks for the mother and 20 marks for each child
per month, although local administrative agencies were requested to
raise the amounts for their communities by local appropriation. These
allowances, small though they were, were not given without question
to the wife and children of every soldier. Necessity had to be proved,
though instructions were given to interpret liberally this clause of the
law. The receipt of maternity benefit by reason of membership in a
sickness insurance society did not exclude the woman from sharing
in the separation allowance.
In spite of increases in the allowances, however, and an extension
of them, wherever possible, they remained inadequate for the need.
Particular communities undertook to supplement the assistance thus
extended to families of soldiers. As early as 1914, 67 communities
of over 25,000 inhabitants provided relief out of their own funds,63
thus increasing the Government allowance; others like Berlin-Schoneberg took special measures, usually in the form of bonuses to families
with children.04
*° Zeitschrift für Kinderforschung, November-December, 1917, p. 9 1 .
61 Zeitschrift für Kinderschutz und Jugendfürsorge, Warph# 1 9 1 8 , p. 7 0 .
® Deutsche Medizinische Wochenschrift, June 13,1915, p. 683.
« Zeitschrift für Säuglingsschutz, M ay-June, 1915, p. 194.
14 Zeitschrift für Kinderschutz und Jugendfürsorge, April, 1918, p. 107.


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I F F A N T -W E L F A R E W O R K I F

E U ROPE.

Imperial maternity benefits.

With the outbreak of the war it was feared that the funds of the
sickness insurance societies would be so affected that it would be nec­
essary to limit the scope of the payments. Accordingly, by an im­
perial emergency law (Aug. 4, 1914), the payments of the insurance
societies in respect to confinement were limited to the compulsory
maternity benefits provided by law, while all additional benefits in­
troduced by the individual funds were ordered suspended during the
war. Benefits and medical attendance during pregnancy, and all
breast-feeding allowances, were thus cut off, and the women received
only the money allowance at confinement. In a short time, however,
it became apparent that the societies were not so hard hit as had been
at first feared, so that they could be permitted to continue with at
least a part of their work.
But the sickness societies generally covered only self-insured women,
and as these formed only a very small proportion of the women in
need of aid, it was soon perceived that the wives of soldiers at least,
whether themselves insured or not, must be reached.
The imperial grants were instituted by a Federal order, December
3, 1914. In detail the grants covered—
(1) A single grant of 25 marks to cover the expense of childbirth.
(2) A pregnancy grant of 10 marks for midwife’s or doctor’s ser­
vices, if such are necessitated by pregnancy complications.
(3) A maternity grant of 1 mark a day, including Sundays and
holidays, for 8 weeks, at least 6 of which must be after
the confinement.
(4) A nursing grant of 50 pfennigs daily for a maximum of 12
weeks, if the mother nurses the child herself.
Medical attendance and medicines might be substituted, if the woman
were willing, for the money grants during pregnancy and at confine­
ment.
The administration of the grants was intrusted to the local sickness
insurance society to which the woman or her husband belonged. The
women eligible for the benefits were the wives of insured soldiers,
whether they themselves were insured or not. Other women insured
in their own right were to receive from the funds of the sickness socie­
ties all the above benefits, except the eight weeks’ maternity grant.
A Federal order of June 6, 1917, raised the maternity grant from 1
mark to 1.50 marks a day. B y an order of the imperial council No­
vember 22,1917, the individual societies were for the first time allowed
to grant maternity benefit in higher amounts than sick benefit.
Various extensions to the first order were made as the war went on
(Jan. 28, 1915; Apr. 23, 1915; July 6, 1917). The grants finally
covered, in addition to the original classes, the wives o f seamen and
agricultural workers and of all Government workers, or wives who


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GERMANY.

were themselves employed in Government work; soldiers’ wives of
small means whose husbands were not insured; all soldiers’ wives
receiving separation allowances; and the unmarried mothers of
soldiers children. The cost of grants when neither the husband nor
tbe wife had been insured was defrayed entirely out of the imperial
treasury; m the case of insured persons not soldiers or in the Govern­
ment service the expense was borne by the sickness societies; in
other cases the cost was divided between the two. About 2 000 000
marks a month was expended by the imperial treasury during'the
hrst 15 months of the administration of the orders.65
The local sickness societies were charged with the administration
of the grants. Some paid directly to the mother, others to the mid­
wile m attendance. In most cases the presentation of a birth certifi­
cate was required before payment. Some sickness funds made preg­
nancy grants after the delivery.
—
.Supervision over breast feeding, which was necessary to establish
the fact of nursing when claim was made for the daily nursing grant
was m many instances felt to be inadequate. The mere word of the
midwife or even of the mother was often accepted in place of proof,
i t was found, too, that as soon as the 12 weeks were over the majority
of mothers immediately stopped nursing their babies. Experience
showed that where no supervision was exercised over the mothers
receiving the benefit the grants for breast feeding frequently failed
in their object to provide better food and care for the mother. The
expectations of those welfare workers who had believed that the imperiai grants would practically abolish artificial feeding were not
iulfilled.
Welfare centers, on the other hand, complained of a falling off
m attendance, due in part, they believed, to the imperial grants.
When they themselves had given aid in money or kind they had been
able to exact attendance as a condition of receiving such aid There
was a general demand for the centers to take over the administration
of the grants for breast feeding. The Imperial Government, while
it was not prepared to make the payment of grants conditional ux>on
attendance at a center, suggested66 throughthe ministry of commerce
that the welfare stations offer a premium of their own after the ex
piration of the three-month period, basing it upon attendance at the
center throughout the whole time. It also suggested that the sick­
ness societies should refer the mothers to the welfare stations for
help and advice and should notify each station of the mothers in its
district to whom nursing premiums were being paid.
This solution of the difficulty was finally settled upon in a number
of places, and the center continued the Government nursing grants
out of private or municipal funds and in some cases paid nursing
& Denksehriftiiber Wirtschaftliche Massnahmen aus Anlass des Krieges, No',225, Mar 12 1916 d 112
«ZeitsehriitfurSauglingsscbutz, February, 1 9 1 5 , p. 67.
Mar. u , im o, p . 1 1 2 .


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IF F ANT-WELFARE WORK IF EUROPE.

premiums and maternity benefits to mothers who were not eligible
for any imperial grant. Cooperation between sickness societies and.
welfare centers seems to have been general, especially in towns where
the infant-welfare work was already well organized and assisted by
the municipality. In Berlin,67 for example, when the nursing
mother claimed her grant she was referred to the welfare station in
her precinct and every week received from it the doctor’s certificate
that she was still nursing, upon presentation of which she received
the nursing premium.
The sickness societies made efforts to cooperate with other branches
of inf ant-welfare work. When they decided to introduce welfare
measures for the children of insured persons, they thought it best, in
order to avoid duplication, not to establish separate welfare centers
nor to engage their own physicians and welfare workers, but to utilize
the agencies already existing and refund to them money expended in
the care of the children of insured mothers.68 Insurance institutes68*
made agreements with maternity homes to receive mothers who
preferred to go to them rather than to accept the cash benefit. They
arranged for household helpers for the mother after confinement.
They appropriated money for the training of welfare workers. In
some places, as in Hamburg, they appointed visitors, generally mid­
wives, to certify that the mother was breast feeding her child and
to advise the mother at regular intervals.69
It was found that, in general, where the imperial grants were made
without the oversight of any infant-welfare agency, the number of
breast-fed infants did not increase, and the death rate among soldiers’
infants remained practically stationary. This happened in Danzig.
When, however, an infant-welfare association was started there and
had been working over a year in cooperation with the sickness so­
cieties, an increase of from 40 to 60 per cent was noted in the number
of breast-fed infants, and the death rate among legitimate infants
fell in, 1916,50 points as compared with the rate for the preceding
year.70 Most workers agreed with the director of the general local
sick fund of Berlin that “ the custom of bringing the mother and child
under proper supervision and of furnishing them the advice of the
infant-welfare station had apparently contributed to the favorable
results * * * not less than the fact of nursing.” 71
In general there was a striking increase in breast feeding among
children registered at the centers. It was found that very few moth­
ers, given suitable advice and care, were unable to nurse their infants.
According to investigations conducted by sickness societies in many
67 Zeitschrift für Säuglingsschutz, February, 1915, p. 82.
«Zeitschrift für Kinderschutz und Jugendfürsorge, February, 1918, pp. 38-39.
«* Organizations providing old-age and invalidity insurance.
® Zeitschrift für Kinderschutz und Jugendfürsorge, July, 1918, pp. 192-193.
7o Great Britain, Local Government Board, Intelligence Department.
Infant Welfare in Germany
during the W ar, 1918, p. 19.
n Vorwärts, Jan. 1,1918.


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different parts of the Empire in 1915,1916, and 1917, the proportion
of women receiving maternity benefit who nursed their infants at least
for a time was in some places from about 85 to 90 per cent; and some­
what over half of these continued to nurse beyond the three-month
period covered by the imperial maternity grants.72 In five urban
districts in Baden, for which figures for 1911 are compared with those
for 1915, the increase in the number of nursing mothers was from
85.4 per cent to 91.9 per cent.73 Even in districts where breast
feeding had been practically abandoned, as in Bavaria, there was a
noticeable return to it in 1915 and 1916. As late as June, 1918, the
condition of infants' health was said by the imperial health office to
be satisfactory, due, it was believed, to the greater frequency of
breast feeding.7* So strong was the testimony as to the excellent
effect of the grants on breast feeding that there was a very general
demand for their continuance after-the war.
In many cases where breast feeding ceased as soon as the Govern­
ment grants were no longer available, it was found that the mother
had weaned her child in order to go to work, for the demand for
woman's labor and the pressure of need grew greater as the war
continued.
P R O T E C T IO N

O P M O T H E R S I N IN D U S T R Y .

Between July, 1914, and July, 1918, the numbers of compulsorily
insured women in the 5,135 sickness insurance funds for which re­
ports were available rose from 3,519,871 to 4,600,651.75 These
figures applied only to about three-fifths of the persons employed in
.Germany, in the first place because not all employed persons were
included in the sick funds (though a majority of them were), and
secondly, because not all the sick funds had reported. The numbers
are, however, indicative of the actual increase. The increase of
women in industrial work alone was about three-quarters of a million.
By an emergency law passed on August 4, 1914, the chancellor
was given power to set aside the factory laws and regulations in force
for the well-being of women, young people, and children, and women
were employed on long shifts and in overtime and night work “ to an
extent never known before.” 76 On June 20, 1918, the Soziale Praxis
gave figures, taken from the Prussian factory inspection report for
1917, showing the extent of the exceptions to the legal limitation of
the working time of young persons and women. The figures show
an extensive transgression of the labor-code regulations. In 1913
for instance, overtime work for women amounted to 2,142,000 hours*
while in 1917 it reached 15,093,000 hours—more than seven times as
many, although the number of industrial workers had not doubled.78
W Vörwärts, Dec 25,1917 (quoting a memorandum b y Dr. A.Fischer pub. in Sozialhygienische Mitteilungenfur Baden, October, 1917); Vorwärts, Jan. 1,1918; Soziale Praxis, N ov. 2 1 ,1918 col 128
78 Vorwärts, Dec. 25,1917.
'
'
74 Soziale Praxis, June 20,1918, col. 589.
76 Reichsarbeitsblatt, January, 1919, p. 72.
78 Soziale Praxis, June 20,1918, col. 585.


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in f a n t

-w e l f a r e

w o rk

in

e ij r o p e .

Special Government measures were taken for the protection of women
night workers, and in a circular of January 8, 1918, the chancellor
made recommendations to the governments of the Federal States on
the working time of women, advising consideration for women and girls
in shifts and overtime work.77 In that circular it was explicitly
stated that “ pregnant and nursing women must not be employed on
night or overtime work. The rest period of eight weeks before and
after confinement must be observed under all circumstances.”
Welfare supervisors were recommended at first in all establish­
ments where women were employed to advise the women workers
in all matters pertaining to health, housing, and the care of Children.
Early in 1917 the appointment of a woman welfare worker was made
obligatory by the war office. At the order of the military authori­
ties two schools for women gave a course of several weeks’ duration to
women about to take up factory Welfare work,78 and this example was
followed by the establishment of special courses in many cities. By
November 1, 1917, 500 women welfare workers, of whom 325 were
specially trained, were engaged by 525 establishments havmg half
a million women workers.78
Agitation to reinstate the old standards for women workers was
widespread. Such bodies as the Reichstag committee on population,
the Greater Berlin war committee, and the trade-unions urged pro­
tective measures for women workers. But the emergency law of
August 4, 1914, was not repealed until after the war.
E S T A B L IS H M E N T

O F D A Y N U R S E R IE S A N D N U R S IN G R O O M S .

Soon after the outbreak of the war, a number of day nurseries,
often, it was said, improperly equipped and in unsuitable places, had
been opened, as a result of the prevailing opinion that women would
enter industry in large numbers.80 This was not found to be the case,
however, early in the war, and many of the nurseries were-soon closed.
Later, as the number of employed mothers increased and it be­
came more difficult to obtain women to mind the children, day
nurseries came rapidly into existence. Private child-welfare or­
ganizations and crèche associations were active in this work, but a
good many nurseries were opened also by municipal authorities.
Efforts were made especially in the case of municipal crèches to make
them a part of the general plan of infant-welfare work. As the Ger­
man nursery did not accept children over 3 or 4 years of age many
day centers were opened for the older child of preschool age as well
as for school children.
T;‘ /
In 1915 the Deutscher Ausschuss für Kleinkmderfursorge (im­
perial committee for the care of small children), a private society,
was organized for the purpose of consolidating all activities for the
Reichsarbeitsblatt, Mar. 25,1918, p . 217.
ii Concordia, Mar. 15,1917, p. 84.
n Soziale Praxis, Aug. 29,1918, col. 746.
so Zeitschrift für Sâuglingsschutz, May-June, 1915, p. 212.

v


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welfare of cliildren from 1 to 5. years of age. This committee pub­
lished several pamphlets, among which were “ Educational Problems
of the Kindergartens during the War,” “ Plans for War-time Day
Nurseries,” and “ Care of the Health of Small Children during the
War.” 81
Early in 1917 the society combined with the imperial association
for tne care of infants, the imperial nursery association (Deutscher
Krippenverband), and the union of German day nurseries (Verband
Deutscher Kinderhorte) to work out a plan for the carrying out of
various measures for the care of young children. They submitted
plans of work to the committee on woman’s work, connected with
the war office and formed in 1917, and agreed to supply the main office
with the names of persons qualified to undertake the local organiza­
tion of the work. When the war office established its committee on
woman’s work it pointed out that besides measures to increase the
efficiency of the women action must also be taken for the welfare of
the women’s families. The committee, realizing that the efficiency
and willingness to work of the women employed in the war industries
depended on the care which their children received, made every
effort to stimulate activity on behalf of cnildren left without their
mother’s care.82
The imperial committee for the care of small children also initiated
an investigation into the extent and nature of the problem of caring
for the children of working mothers. A partial investigation in
Frankfort on the Main (December, 1916), covering two munition
factories, the post office, the railroads, and the street car lines,
disclosed the fact that large numbers of children were entirely
neglected while their mothers were at work.82
As the war continued committees were formed in a number of
German cities to organize welfare work for these children.
The Greater Berlin war committee for the protection of uncaredfor children, for instance, gave advice and financial aid to various
child-welfare organizations interested in establishing nurseries,
kindergartens, day centers, and infants’ homes.83 In one year
(1917-18) they helped to establish 21 institutions of this kind and
aided in extending 24 already in existence. For this purpose they
spent 115,500 marks, the greater part of which came from city
funds.81 Düsseldorf, an industrial center, by the summer of 1918
had opened over 100 nurseries and centers for children.85
In order to accommodate women ^who were working on night
shifts many of the nurseries kept children both day and night.
n Deutscher Reichsanzeiger, Aug. 23,1917.
ö Concordia, Mar. 15,1917, p. 85.
» Internationale Korrespondenz, Mar. 8,1918.
m Vorwärts, Feb. 7,1918.
* Öffentliche Gesundheitspflege, vol. 3, July, 1918, p . 230.

173389°— 20----- 9


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INFANT-WELFARE WORK IN EUROPE.

Some nurseries took care of more children than was considered advis­
able, 80 or 90 children in one nursery being not uncommon. Dr.
Rott, in August, 1917, declared that 40 was the maximum number
of children that should be received by one nursery. He stated also
that not more than 5 or 6 infants, or 8 or 10 young children should be
cared for by one person.88
As an example of day-nursery standards actually in operation an
order issued by the district president in Dusseldorf (Sept. 30, 1917)
may be cited. According to this order permission for the opening of
a day nursery or day center must be obtained from the police authori­
ties. The plans of the quarters must be submitted, with a statement
as to the purpose of the institution and an account of the person in
charge and of the head physician. A bathroom and milk kitchen
are required as" part of the premises. A special observation room
must be provided for newly admitted children in order to determine
their state of health, and also a special room for children whose condition suddenly becomes such as not to permit their stay in the
institution. Sick children must not be admitted and a child taken
sick at the nursery must be removed to a hospital. Each nursery
must have a physician, preferably a pediatrist, whose duties must be
explained in a contract. He must examine each child applying for
admission, and all children at least twice a week; he must also take
the necessary measures in case of sickness. In each institution
there must be for every 20 children one infant-welfare worker, hold­
ing a State diploma for infant-welfare work. Records of all the
children must be kept. Nurseries must have no connection with the
rooms occupied by the centers for older children.
A few nurseries in industrial cities, chiefly municipal ones, set
aside a room to which the factory mother might come and breast
feed her child. Many infant-welfare workers recommended the pas­
sage of a Government regulation to establish nursing rooms in facto­
ries and to compel the employer to permit nursing periods without
loss of pay to the women. This was not done, however. The war
office urged individual employers to take action of this kind, but
comparatively few either established nurseries in their own factory
or contributed toward the establishment and support of a neighbor­
hood nursery.
The imperial war office appropriated money toward the salaries
of superintendents of crèches opened for women in war industries.87
It also permitted grants given,to the States for expenditure on war
relief to be spent, among other infant-welfare arrangements, on
crèches if they were established as a necessity of war.88 The various
States themselves contributed toward the support of crèches estab88 Zeitschrift für Säuglings- und Kleinkinderschutz, July-August, 1917, pp. 396 and 399.
87 Great Britain, Local Government Board, Intelligence Department, Infant Welfare in Germany during
the W ar, 1918, pp. 20-21.
88 Deutsches Reich, Massnahmen aus Anlass des Krieges, No. 44, p. 32.


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GERM ANY.

fished for women employed in State workshops. A part of State
funds appropriated for infant-welfare work was available for nurs­
eries. Municipal funds, private gifts, especially from insurance
societies,89 and the small charges which the mothers themselves paid
also furnished financial support.
INFANT M ORTALITY RATES.

For 20 years or so there has been a decline, slow but steady, in the
infant mortality rate for the German Empire. In 1912, the lowest
infant mortality rate ever recorded in Germany was achieved (147
per 1,000 live births). This rose again slightly in 1913 (151 per
1,000 live births.)90 During the months immediately following the
outbreak of the war there was an abnormal increase in infant mor­
tality, which, it is generally believed, was due chiefly to the economic
disturbances that marked the opening weeks of the war, especially the
unemployment crisis. Mental stress of the mother is also mentioned
as partly responsible for the great number of infant deaths. When
the mother was well enough off to buy food for her child she was
frequently too excited and restless during that period of uncertainty
to give it the necessary attention. The 1914 rate was 13 points
higher than the rate for the year immediately preceding the war;
1915 and 1916, however, brought a notable decrease in the infant
mortality rate, which though it rose again in 1917 remained lower
than for any prewar year.
Table X V II gives the rates in periods since 1892 for the German
Empire as a whole, and for Prussia, Bavaria, Saxony, and Württem­
berg. The war years, so far as they are available, are given sepa­
rately.
T able

X V II.— Number o f deaths under 1 year per 1,000 live births.a

Period.

1891 1895............... ......................... .........................
1896-1900...................................................................
19Ò1 1905............................. ....................................
10(16 1010...................................................................
191Ì-1913...................................................................
1914 6 ..........................................................................
1915 6 ............................................................ '...........
1916 6 ..........................................................................
1917 b ..........................................................................
1918 6 ..........................................................................

German
Empire.

Prussia.

222.1
212.5
199.1
174.2
163.5
164
154
136
155

205.1
201.3
189.7
167.9
161.2
164
153
134
153
148

Bavaria.

272.8
257.2
240.4
216.6
194.2
193
194
175
186
203

Saxony.

280.8
265.3
245.7
197.7
180.8
171
147
200
153

Württem­
berg.

254.9
233.9
216.8
182.0
156.5
145
145
134
148

a For 1891-1901, the statistics do not cover the whole German Empire; a few of the smaller States were
omitted in the sources. The rates given were calculated from the number of live births and infant deaths
given in the following sources: Statistik des Deutschen Reichs, vol. 256, pp. 40* and 43*; Statistisches
Jahrbuch für das Deutsche Reich, 1913, p. 20; 1914, pp. 20 and 33; 1915, pp. 24, 26, and 40; 1916, p. 10.
Medizinal-Statistische Mitteilungen aus dem Kaiserlichen Gesundheitsamte, vol. 2, 1895, p. 238; vol. 3,
1896, p. 182; vol. 4, 1897, p. 66*; vol. 5, 1898, pp. 2* an<J. 64*; vol. 6, 1901, pp. 106* and 198*; vol. 7,1903, p.
2*; vol. 8, 1904, pp. 2* and 68*. Sonderabdruck aus den Medizinal-Statistischen Mitteilungen aus dem
Kaiserlichen Gesundheitsamte (no date given) pp. 2*, 64*, 106*, 198*.
6 Preliminary figures. Sonderbeilage zu den Veröffentlichungen des Reichsgesundheitsamtes, Feb.
11, 1920, p. 102.

89 Vorwärts, Sept. 25,1917.
"Statistisches Jahrbuch für das Deutsche Reich, 1916, p. 10.


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INFANT-WELFARE WORK IN EUROPE.

Cities enjoyed in general a more favorable position with respect
to infant mortality than did rural areas. The decrease in towns
began after the inauguration of infant-welfare measures, and it has
been attributed by German writers to that work. A comparison of
the rates in Tables X V III and X I X with those for the entire Empire
will show the part played by cities in keeping down the infant mor-.
tality rate.
T able

X V III. — Number o f deaths under 1 year per 1,000 live births.1

Period.

Berlin.

1891-1895...........................................................
1896-1900...................................................
1901-1905...................................................
1906-1910...................................................
1911-1913 ..................................................................
1914.........................................................
1915.............................................................................
1916.............................................................................
1917......................................... ....................
1918.........................................................................

Hamburg.

242.5
218.2
202.0
164.6
150.9
156.0
140.7
129.2
157.4
138.1

226.0
181.9
173.4
150.4
133.3
126.0
111.1
118.0
114.9
115.5

Leipzig.

240.9
233.7
227.7
173.3
172.6
167.9
132.1
119.2

Munich.

Dresden.

124.7
122.4
103,9

130.5

i Calculated from number of live births and infant deaths given in the following sources: Statistik des Deut­
schen Reiches, vol. 266, p. SO; Statistisches Jahrbuch für das Deutsche Reich, 1916, p. 10; Statistisches Jahr­
buch Deutscher Städte, vol. 10,1904, pp. 101-102; vol. 15,1909, pp. 52-63; vol. 16,1910, pp. 29-30- vol 17 1911
pp. 3<>-39; vol 18,1912, pp. 26-29; vol. 19,1913, pp. 46-49; vol. 20, 1914, pp. 50 and 58; Veröffentlichungen;
des Kaiserlichen Gesundheitsamtes, vol. 16, pp. 156 and 176; vol. 17, pp. 300 and 494: vol 18 n 190:
vol. 19, p. 198; vol. 20, pp. 161, 162, 356, 759, and 760; vol. 21, pp. 260 and 440; vol. 22, pp 364 440 and 883'
vol. 23, pp. 396 and 460; vol. 24, pp. 432, 636, and 794; vol. 26, pp. 302 and 878; vol. 27, pp. 115 and 634- vol!
29, pp. 694 and 1200; vol. 30, pp. 692 and 1001; Statistisches Jahrbuch der Stadt Berlin, 1898, p 85-1903
pp- J 3>,r,4’A ^ i 2v Hambur£er Statistik, vol. 22, p. 73; Statistisches Jahrbuch der Stadt Dresden, 1909’
p. 45; Vierteil ahrshefte für Statistik des Deutschen Reiches, 1907, Part I, pp. 158 and 165; Statistisches
A m t der Stadt München, Mitteilungen, vol. 23, pp. 4-5. Jahrbücher für Nationalökonomie und Statistik
October, 1916, pp. 548-554. Veröffentlichungen des Kaiserlichen Gesundheitsamtes, vol. 36, d d . 1087 ff *
vol. 37, pp. 823 ft.; vol. 38, pp. 747 ff. öffentliche gesundheits pflege, Heft. 9. 1919, p. 308. Calculated
from number of Uve births and infant deaths. Veröffentlichungen des Kaiserlichen Gesundheitsamtes
l?14,p p . 754, 757, 1010; 1916, p. 332. Zeitschrift für Bevölkerungspolitik und Säuglingsfürsorge. Band
11, Heft. 1, June, 1919, p. 9.
6
T able

X I X .—Number o f deaths under 1 year per 1,000 live births.1

Period.

1891-1895..........................................................
1896-1900..........................................................
1901-1905..........................................................
1906-1910..........................................................
1911-1913..........................................................

Cities -with
a popula­
tion of 15,000
and over.

231.9
219.8
202.3
169.5
157.3

Year.

1914.............
1 9 1 5 ..........
1 9 1 6 ..............
1917 .
1918. .

Cities with
a popula­
tion of 15,000
and over.

155
144
133
143
139

—

i Calculated from the number of live births and of infant deaths, Veroffentliehungen des Kaiser
lichen Gesundheitsamte vol. 20,1896, p. 354; vol. 25,1901, p. 368; vol. 36, p. 1096; vol. 37,1913, pp. 392 and
833; vpl 38, p. 757; and Soziale Praxis, June 20, 1918, col. 589. Sonderbeilage zu den Veroffentlichuneen
des Reichsgesundkeitsamtes, Feb. 11, 1920, p. 102.
6

Table X X , which gives the rural and urban rates in Prussia, shows
how the urban rates led until after 1905. Beginning with 1907 they
are smaller each year than the rates for country districts.


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GERM ANY.

T ablb X X .—Number o f deaths under 1 year per 1,000 live births.1
Prussia.

Prussia.
Year.

Year.

Urban
communi­
ties.

Rural.

197.15
192.94
199.15

192.21
179.44
197.39

166.04
170.33

169.97
174.07

1903...................................................
1904...................................................
1905...................................................
1906 *.................. ............................
1907...................................................
1908...................................................

1909...................................................
1910...................................................
1911...................................................
1912...................................................
1913...................................................
1914...................................................

Urban
communi­
ties.

158.52
153.00
187.47
141.62
144.69
160.12

Rural.

167.14
160.44
187.89
148.79
153.86
166.95

1 Prussia, Statistisches Landesamt, Medizinal-Statistische Nachrichten, vol. 1,1909, pp. 324 and 330; vol.
3,1911, p. 188; vol. 5,1913-1914, p. 178; vol. 6,1914-1915, p . 186; and vol. 7,1915-1916, p . 165.
2 N ot available.

SUM M ARY.

Infant mortality rates in Germany were high, with a slight advan­
tage in favor of rural districts in Prussia, until after 1905, the year in
which organized infant-welfare work began to operate chiefly in the
larger cities. After that year city rates were generally lower than
rural. The rate for the country as a whole was declining slowly be­
fore 1905, but during the five-year period 1906-1910 a striking de­
crease is recorded. During the war the infant-mortality rate, which
rose at first, gradually settled down to the prewar level. In some
places the rate fell even below that of peace times.
Infant-welfare work in Germany was carefully organized, as far as
possible on a national scale, during the first decade of the present
century, through the cooperation of local, political, and public-health
authorities and private agencies. Money was appropriated for the
work by imperial and State governments and by municipalities.
In 1909 a national league, the imperial association for the care
of infants, was formed, uniting all the State associations, or, where
a State organization did not exist, -uniting provincial societies.
A national institute, the Empress Augusta Victoria House, was
erected at Berlin for purposes of investigation, education, and train­
ing of workers. Owing to political and social differences existing in
different parts of the Empire, the degree of progress made in carrying
out plans for infant welfare varied widely. Urban communities were
more advanced in this work, as in all other measures for the public
health.
The most important activity was the opening of infant-welfare
centers. Nearly 800 had been established before 1914. Milk kitch­
ens were usually connected with the centers. Nursing premiums to
encourage breast feeding were given at practically all centers. Edu­
cation of the mother in baby care was carried on by means of lectures,
pamphlets, and exhibits. There was little home visiting.


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INFANT-WELFARE WORK IN EUROPE.

The mother at work was protected by a law (1878) forbidding her
to work in factories during three weeks following confinement. The
law was amended (1908) to extend the rest period to eight weeks.
Maternity benefits, first provided by the insurance law of 1883, were
made much more generous in 1911. Day nurseries were numerous
and there were a few factory crèches. It was customary for mothers
to board out their children, and boarded-out children were subject
in most cases to supervision by local authorities. A few States had
laws providing for such supervision.
Midwifery practice was regulated by the individual States. Na­
tional legislation was confined to a few general measures, such as the
prohibition of practice without a certificate.
Though the early months of the war .witnessed a decrease in the
work for mothers and infants, after the first excitement of war had
abated the work was taken up with renewed vigor. This revival
was due in part to the stimulus of the leaders in infant-welfare activ­
ity, who protested against the withdrawal of doctors and nurses from
child-welfare work for war service and against the conversion of
infants’ homes and clinics into military hospitals. Their criticism
received especial significance in the sudden and alarming rise in the
death rate among babies during the first months of the war.
The great expansion in the work generally took the form of the
establishment of new infant-welfare centers. Not only did the
centers increase in number in' almost every city and town, but their
work also was greatly extended. Some centers were opened solely
for the use of children above the age of infancy. A number of
infant-welfare associations made a special point of looking after the
child from 1 to 5, the food conditions rendering the needs of the older
children especially prominent. In spite of efforts to increase the
work for expectant mothers, and in spite of some progress in prenatal
work, that phase of the struggle against infant mortality remained
somewhat undeveloped. The most characteristic work of the German
infant consultation centered around the matter of nutrition. Prac­
tically every center distributed milk, in many cases free of charge.
In many cities the centers took over practically all the work con­
nected with special government provisions for food for mothers and
children. In some places no food could be bought for small children
except through the welfare stations. The centers, almost without
exception, paid nursing premiums to encourage breast feeding.
Where this had been done before the war, as in many places, every
effort was made, despite a shrinking in funds, to increase the allow­
ances and to extend them over a longer period.
The imperial maternity grants for confinement and breast feeding,
declared throughout Germany by such a leader as Dr. Rott, of the
Empress Augusta Victoria House, as “ undoubtedly the most important


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GEKM ANY.

135

social act of the w a r/’91 were generally found to be of doubtful
value, unless they were administered in cooperation with the infantwelfare centers. The advice of trained welfare workers was found
to be as indispensable to the success of breast feeding as the economic
assistance made possible by the grants. Generally some agreement
was entered into between the welfare centers and the sickness socie­
ties whereby a greater measure of success was obtained than was the
case when the sickness societies worked alone.
Some sickness societies and insurance institutes undertook special
work of their own among mothers and babies, probably as a result
of the imperial maternity grants. They appointed visitors, generally
midwives, to advise the mothers in their homes, and in some cases
they furnished domestic assistance during the lying-in period. They
also made arrangements with hospitals and maternity homes to
receive cases in which they had an interest, and in which assistance
in kind was substituted for a part of the money benefit or supple­
mented it.
In some places attempts were made to extend the work to rural
districts. That a great deal remains to be done in that branch of
the work is generally acknowledged.
There was considerable demand expressed during the war for
the appointment of salaried midwives, especially for rural districts.
In November, 1917, the Federal council of Germany issued improved
standards for the regulation of midwifery practice. In 1918 a bill
closely following these regulations and including the provision of
midwives for less populous areas was introduced into the Prussian
House of Deputies, but late in the fall of 1919 it had not been
passed. Some of these regulations had already (1915) been put into
force by the city of Berlin.
There was an increase in day nurseries owing to the influx of married
women into factories. State funds were appropriated to some
extent for the establishment and maintenance of day nurseries for
the children of munitions workers, but neither State nor Imperial
Government made the establishment of factory nurseries obligatory
with employers. There was an endeavor on the part of welfare
workers to connect the day nursery with the infant-welfare movement
as a whole. Municipal crèches were common and were under the
direction of local infant-welfare associations.
The tendency on the part of the municipality to take over all
activities relating to mothers and children grew more pronounced
with the war. A greater uniformity in the work throughout the
Empire was sought through an agitation for children’s bureaus,
which should regulate all the child-welfare work of a district or com­
munity. Organized infant-welfare work in Saxony was assured by
•i Zeitschrift für Säuglingsschutz, May-June, 1915, p . 204.

I

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INFAN T-WELFARE WORK IK EUROPE.

the passage of a law in May, 1918. One or two of the Federal States
either created new State infant-welfare associations or extended the
functions of their prewar organizations.
More and more the State came to feel its responsibility in the
matter of maternal and infant welfare, and to realize that the care
of mothers and babies was too vital a matter to the nation to be left
to haphazard or sporadic efforts of benevolent individuals or volun­
tary societies. “ It is an urgent necessity/’ said Dr. Rott, “ for State
and community permanently to include the economic condition and
care of mother and child in the group of the most important socialhygienic problems. Infant-welfare stations must not arise as the
result of humanitarian impulse, nor must their maintenance depend
more or less on the good will of a few individuals.” 92
According to Prof. Langstein, director of the above institution,
child-welfare work, which applied to from 10 to 15 per cent of the
children of Germany, must be extended to include from 70 to 80 per
cent of them. “ Cities,” he says, “ have done altogether too little
preventive work for children. During the war the situation became
better, and the fire must not be allowed to burn out.” 93
Zeitschrift für Säuglingsschutz, July, 1915, p. 216.
* Vorwärts, N ov. 27.1917.

K


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ITALY.
INTRODUCTION.

The problem of infant mortality is complicated in Italy by the
custom of placing out children with wet nurses. Not only do the
foundling asylums of the Kingdom maintain wet-nursing centers but,
either for the sake of going out to work or in order to nurse for money
another infant, many poor mothers also put their babies out to
nurse, frequently in a wet-nursing center. According to Italian
authoritiesl these centers represent “ a constant and most serious
menace to the health of the Italian people and to the lives of all the
children.” 1 The mortality rate among these babies was said to be
about 80 per cent; and, as the custom of wet nursing is extensively
developed, the infant mortality rate for the whole country is high.1
In 1912 Italy occupied the seventh place among the principal coun­
tries of Europe, with a rate of 128 per 1,000 live births.2
While the birth rate, on the other hand, was also high, it was
even before the war gradually declining, as in all other civilized
countries.8 The first year in which the war could have affected the
number of births (1916) shows a striking decrease in the birth rate,
as Table X X I, which gives the birth rates for selected cities, indicates.
Table

X X I .—Number of live births per 1,000 of the population fi
City.

1914

Milan..............................................................................
Padua............................................................................................
Bologna.............................................................................
Florence........................................................................
R om e.............................................................................
Naples............................................................................................

20.8
31.0
20.9
19.5
26.6
27.1

1915

18.3
31.5
19.0
18.4
25.3
25.7

1916

13.9
24.6
15.0
13.7
21.0
22.9

1917

1918

12.1
23.1
13.2
11.4
19.1
21.8

11.4
15. 8
11.2
12.0
16.5
19.6

6 Report of the commission for tuberculosis, American R ed Cross in Italy, Rom e, 1919, p. 101.
1 Rassegna della Previdenza Sociale, January, 1919, p. 55.
a Statistisches Jahrbuch für das Deutsche Reich, 1915, pp. 20*, 21*, 40.
* The birth rate for Italy as a whole is not available after 1915.
comparison with those of other countries:
N um ber o f live births per
1905.
1906.
1907.
1908.
1909.
1910.

32.67
32.14
31.70
33.67
32.74
33.29

T h e following prewar rates are given for

1,000o f the p opulation .a
1911..................................
1912...................................
1913..................................
1914...................................
1915..................................
1916..................................

« Movimento della popolazione nell’ anno 1914, p. X V , 1916, p. V I ; Annuario Statistico Italiano, 1915,
p. 34.

137


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INFANT-WELFARE WORK IN EUROPE.

The question of population was rendered acute by the war. But
other motives for conserving infant life have not been lacking- in
recent infant-welfare work in Italy. In the words of Prof. Guiseppe
Tropeano, an Italian pediatrician:
I n order to obtain a decrease in the general morbidity and mortality it is necessary
to diminish infant morbidity and mortality; in order to prolong the average length of
life

*

*

*

it is necessary to assure life to children; in order to improve the race

it is necessary to bring up the children in good physical and mental health.

A ll the

achievements of experimental hygiene and public health are involved in this problem.4

INFANT-WELFARE W ORK BEFORE THE W AR.
LEGISLATION.

Italian legislation for the protection of motherhood and infancy
was confined with one exception to the industrial worker. On June
19, 1902, the employment of women in mines, factories, and work­
shops was prohibited during the month following confinement. Eight
years later (July 17, 1910) a national maternity insurance system
was instituted, the first of its kind to be established in the world.
While in England, Germany, and other countries maternity insurance
is provided as part of a system of compulsory sickness insurance, in
Italy, because of the urgency of the problem, maternity insurance
alone was introduced. All industrially employed women between
15 and 50 were compelled to be insured. The premium, which con­
sisted of 1 or 2 lire per annum, according to the age of the woman,
was paid one-half by the woman herself and one-half by her em­
ployer. Up to 1917 a benefit of 40 lire was paid at the time of con­
finement; of this 30 lire were given by the insurance fund and 10 lire
by the State.
#
The Italian law (No. 242, June 19, 1902) also required factories
employing 50 or more women to provide nursing rooms.
The State, by a decree of February 10, 1876, regulated the training
of midwives. Each school of midwifery is conducted under the
medical department of a university with which a maternity hospital
is connected. Each applicant for the training must have-completed
the first three years of an elementary school and must be between
the ages of 18 and 36. The course lasts two years and includes a
year of theoretical and a year of practical instruction. The student
must pass an examination at the end of each year. If she is success­
ful she receives a diploma entitling her to practice anywhere in the
Kingdom.5 Before entering upon her practice she must, according
to the public-health law of December 22, 1888, register in the com­
mune where she is to work, and must obtain permission from the
Rassegna della Previdema Sociale, January, 1919, p. 61.
s Primo Trattato Complete) di Diritto Amministrativo Italiano, edited by V . E . Orlando, vol. 4,
4

'part 2, pp. 750-761.


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public-health authorities of the Province. Although regulations
have been issued (Feb. 23, 1890) prescribing in detail the duties of a
midwife, and providing penalties for the neglect of these duties, there
is apparently no systematic control of midwifery practice.
Communes are required by the law of 1888 to engage a midwife
to give free aid to indigent women; if there is already a practicing
midwife in residence, the commune may make arrangements with
her for the care of poor patients.
MUNICIPAL AND PRIVATE WORK.

According to an Italian pediatrician, Prof. E. Modigliani, infantwelfare work along modern lines has been fragmentary and irregular
and left solely to private initiative.® It has been, he stated, com­
paratively recent and applied exclusively to cities, the rural districts
of the country being entirely neglected, although they furnished the
larger part of the infant population.
On the other hand, there were a number of private societies, some
of which dated back 40 or 50 years, which gave cash assistance to
poor mothers who could not breast feed their children, to enable
them to place out the infants with wet nurses. Many municipalities
also aided mothers to hire nursing. The foundling asylums widely
distributed over the country (123 in number) were centers of wet
nursing.1 These asylums not only cared for motherless and aban­
doned children, but also took in to nurse the infants of working
women; in some instances nursing mothers with their babies were
admitted. In spite of the prevalence of placing out children, no
national legislation had been enacted for their protection. The
asylums were entirely in the hands of communal and provincial
authorities, and the communes and Provinces bore the expense of
their maintenance.7
Regulations had before the war been issued by some municipal
authorities and prefects. In Rome,8 for instance, an ordinance of
the prefect (1903) provided for the control and physical examination
of all women intending to take care of infants coming from institu­
tions, and for the monthly physical examination of both nurse and
child by public-health officers ; in 1905 a municipal ordinance re­
quired that all wet nurses in Rome, whether for private families or
institutions, must first undergo a physical examination and obtain a
certificate.
In 1898, the first Italian mutual maternity-aid society was formed
in Turin; others follò wed in Milan, Naples,9 Rome, Brescia, Florence,
1 Rassegna della Previdenza Sociale, January, 1919, p. 55.
• La Riforma Medica, Aug. 3,1918, p. 616.
7 L . Franchi: Codici e Leggi Usuali d'Italia, voi. 2, Legge comunale e provinciale, May 4, 1898, seo.
299.
» Gazzetta Medica Lombarda, Dee. 10,1917 p. 205.
* L ’Attualità Medica, voi. 4,1915, p. 496.


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INFANT-WELFARE WORK IN EUROPE.

and Bergamo. The societies are very similar in constitution. In
Turin any mother, by contributing to the fund a small sum (from 35
to 65 centisimi a month) throughout her pregnancy, may obtain a con­
finement benefit of 1.50 lire a day for 30 days, or in case of compli­
cation for 45 days. The benefit is conditional upon the mother’s
ceasing work during its receipt. The societies are not self-sup­
porting and are aided by private gifts. In addition to money bene­
fits, some societies furnish medical supervision and instruction in
personal hygiene during pregnancy.10
Modern infant-welfare work, which emphasizes the care of the well
baby, its diet, clothing, and daily routine, and the supreme impor­
tance of intelligent mothering, did not succeed in replacing entirely
the nursing subsidy, which Italian pediatricians were unanimous in
considering old-fashioned and even harmful to nursing.11 By 1915,
however, both milk stations and infant consultations were well de­
veloped, and were functioning in large towns and cities. Milk stations
were more numerous and widely distributed than the infant consulta­
tions. At the beginning of the war they were to be found in at least
15 cities,12 mostly large cities, but the list also included Capua with
a population of less than 15,000. Many milk stations, it would seem,
merely dispensed milk, and made no attempt to supervise the devel­
opment, weight, feeding, and general hygiene of the infant who
received it.13 On the other hand, some milk stations, as in Naples,
had found it advisable to supplement the distribution of milk by
instruction to mothers in infant hygiene, and by a general medical
supervision of the babies. Some infant consultations, or welfare
centers, had come into existence in this way.14
Infant-welfare centers, resembling very closely the French consul­
tation centers, were maintained in all the principal Italian cities, and
in some of the smaller towns, such as Mantua and Parma.18 In 1915
Naples had 1 center,16 open 6 hours a day; Milan, the chief manufac­
turing city of Italy, had 6;17 Turin, 1, with several branches in remote
workingmen’s districts;18 Mantua, 3.19
Private organizations opened and supported the majority of the
consultation centers. In some cases, the municipality or province
aided those already established, or, more rarely, established public
10 Henri Scodnik: L ’ Institution des Caisses pour la Maternité en Italie, Congrès International des Acci­
dents du Travail et des Assurances Sociales, Dusseldorf, 1902, pp. 667-680; and L ’Assurance Maternelle et
les Caisses pour la Maternité, Congrès International des Assurances Sociales, Rome, 1908, vol. 2, pp. 487-488.
Also, Twenty-fourth Annual Report of U . S. Commissioner of Labor, 1909, Workingmen’s Insurance in
Europe, pp. 1850-1854.
n Rivista di Clinica Pediatrica, vol. 15,1917, p. 571.
i* L ’Attualita Medica, vol. 4,1915, p. 499, and La Nipiologia, vol. 2,1916, p. 19.
i® La Nipiologia, vol. 2,1916, p. 20.
i< Ibid., pp. 20-21.
is L ’Attualita Medica, vol. 4,1915, pp. 494-495, and La Nipiologia, vol. 2,1916, p. 89.
i® La Nipiologia, vol. 1,1915, p. 57.
it L ’Attualita Medica, vol. 4,1915, p. 494.
is La Pëdiatria, vol. 25,1917, p. 643.
i® La Nipiologia, vol. 2,1916, p. 89.


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welfare centers. Thus in Turin, the center had been for several
years under the “ moral and economic protection” of the city, and
the municipal office of vital statistics sent, at the birth of each child,
a printed invitation to the mother to visit the center.18
In Home the pediatrician charged by the public authorities with
the supervision of placed-out children was obliged, as a part of his
duties, to conduct infant consultations.20
In Milan five out of six centers had been established by the public
charities board.21 The institute of infant care of Naples was sub­
sidized by the Province.22 A physician was invariably in charge of
the welfare center. Some centers held consultations for pregnant
women as well as for young babies. A number gave premiums in
money or kind to stimulate attendance. A few gave courses for
mothers or distributed leaflets on infant hygiene. None appear to
have employed visitors to teach the mothers in their homes how to
care for their babies, although some volunteer visiting was done,
chiefly by infant-welfare students.
Several centers established lunch rooms for nursing mothers. A
few restaurants of this kind, however, had been established in Rome
many years before infant-welfare centers had come into existence.
As early as 1879 a private charitable agency opened the first one;
and several years later a second one was established.23 In 1915 there
were in Rome five lunch rooms, established by the public charities
board of the city, each one of which accommodated about 100
mothers.24 Between 1906 and 1915 lunch rooms for mothers were,
opened also in Mantua, Bologna, Verona, and Rimini. In Rome in 1915
a philanthropic woman established a consultation center for infants,
in connection with which over 100 meals a day were given to nursing
m others;26 and in the same year a mothers’ lunch room with a capac­
ity of 450 was added to the infant-welfare activities of Naples.16 In
some places only one meal a day was served, in others two. Mothers
were requested by some lunch rooms to bring their infants to be
weighed, in order that the effect of the feeding on maternal nursing
might be observed.
Although maternal nursing was encouraged among industrially em­
ployed mothers by the law requiring factories to maintain nursing
rooms, as a matter of fact little attention was paid to the law. Nurs­
ing rooms in factories numbered, in 1915, only eight, five of which
were in Government tobacco factories.26
M La Nipiologia, voi. 1,1915, p. 57.
i* La Pediatria, voi. 25,1917, p. 643.
*> L ’Attualità Medica, voi. 4,1915, p. 501.
M Ibid., p. 494.
“ La Nipiologia, voi. 2,1916, pp. 93-94.
** Rivista de Clinica Pediatrica, voi. 15,1917, p. 578.
M L ’Attualità Medica, voi. 4,1915, p. 500.
* Rivista di Clinica Pediatrica, voi. 15,1917, pp. 578-579.
M L ’Attualità Medica, voi. 4,1915, p. 491.


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INFANT-WELFARE WORK IN EUROPE.

Day nurseries or nursery schools for children of preschool age were
common, and were subsidized by the Government as educational
institutions. They were opened during the working day and com­
bined kindergarten instruction with care and feeding of the children.27
Day nurseries of the regular type were comparatively rare in Italy.
In 1915 there were, said to be only 36 in the whole country. This
does not include several which were opened in connection with insti­
tutions of child care, functioning in several cities.28 A day nursery
of this kind in Naples was opened in 1915 and accommodated 110
children between the ages of 2 weeks and 3 years.28 Breast-fed in­
fants and artificially-fed children were kept in separate rooms. A
physician was in charge of this nursery, assisted by one nurse for
each 5 breast-fed infants and for each 10 weaned children. In addi­
tion there were three women to do the kitchen and general house­
work, and one to take* care of the bathing. The nursery regulations
required each child to be examined by a physician before admission
and excluded all but those in normal health. They also required the
keeping of daily records concerning each child.
In addition to its nursery functions, this nursery was intended to
serve as a school for the mother, who was required to be present from
time to time at her child’s physical examination and bath, and always
at the lectures on infant care, which were given regularly by the
institute.29
Largely through the influence of Prof. Ernesto Cacace, a leading
pediatrician, institutes of infant care, unifying the work of infantwelfare agencies, were established before the war in several Italian
cities. He felt that only through cooperation and coordination of
all branches of infant-welfare work could the maximum results be
accomplished. The first institute was founded by him in Capua in
1905, a second in Naples in 1908 (organization completed in 1915),
a third in Mantua in 1912.30 The institute at Naples consisted of—
(1) Agencies giving assistance, such as consultations for infants,
milk stations, day nurseries, maternity homes.
(2) Educational agencies, such as schools for infant hygiene and
care, a school for mothers, traveling courses in infant
hygiene, exhibits.
(3) Thrift agencies, such as maternity funds and other forms of
mutual matérnity aid.
(4) Scientific agencies, such as laboratories for the testing of
milk and for the biologic and hygienic study of the infant.31
16 L ’Attualità Medica, vol. 4,1915, p. 491.
» F . Buisson, Dictionnaire de Pédagogie, Pt. I, vol. 2, p. 187*.
18 La Nipiologia, vol. 2,1916, pp. 28 and 46.
» La Nipiologia, vol. 2,1916, p.-46.
*° La Nipiologia, vol. 1,1915, pp. 21 and 50; vol. 2,1916, p. 89.
» La Nipiologia, vol. 3,1917, pp. 167-168.


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It is said that the institute at Naples had served as a model for
the institutes of child care in Paris and for the Empress Augusta
Victoria House in Berlin.32
The schools of infant hygiene and care conducted as part of the
institutes were attended by young women students. In many cases
the students were teachers of little children. Some were volunteer
workers who duHng and after their training assisted in the consul­
tations and milk stations, or under the direction of the head of the
institute conducted infant-welfare propaganda in small towns and
villages.33
Instruction in child care to growing girls was given in Rome at a
school founded for that purpose in 1911. The school was located in
a foundling asylum where there was also a consultation center; and
the students received their practical training both in the asylum and
in the homes of the mothers who attended the consultations.34
INFANT-WELFARE W ORK DURING THE W AR.
PROMOTION OF INFANT HYGIENE.

The war caused in Italy as in other countries a decrease in the out­
lay for charity, so that the normal development of consultation cen­
ters and other agencies for infant welfare maintained, with few
exceptions, by private beneficence, was arrested.35 Work for the
protection of war orphans and for the children of men called to the
colors occupied public attention to a marked degree. This work, as
an Italian pediatrician pointed out, had nothing in common with
the work of hygienic protection of infants.38
Nevertheless there are indications even in the meager sources which
are available that the hygienic protection of infants in normal circum­
stances continued to some extent. In Capua, for instance, the insti­
tute of infant welfare maintained in 1916 and 1917 a consultation for
infants, traveling courses in child care, and a school of inf ant hygiene.
In 1916 there were 84 students in attendance at the school, while in
1917 the number reached 95.37 The commune of Padua in 1916
hired a midwife to assist the physician at the infant-welfare center,
where the number of infants under observation rose from 1,289 in
1915 to 1,425 in 1916.38 In Padua also during 1916-17 a course in
child care was given at the People’s University.39 The war commit­
tee of medical propaganda of the Province of Lombardy issued leaf,s La Nipiologia, vol. 3,1917, p. 16S.
w La Nipiologia, vol. 1,1915, p. 23.
M Bivista di Clinica Pediatrica, vol. 15,1917, p. 391.
“ Ibid. , p. 594.
** La Reforma Medica, Aug. 3,1918, p. 615.
*TLa Nipiologia, vol. 3,1917, p . 142;
" Ibid., pp. 105 and 108.
‘ »Ibid, p. 109.


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IN F A N T -W E L F A R E W O R K I N

ETJROFE.

lets to mothers on the care of children.40 They were prepared by
child specialists and emphasized especially the mother’s duty to breast
feed her baby. The foundling asylum of the Province of Milan began
in 1917 to give nursing premiums of 30 lire a month to mothers to
persuade them to nurse their babies in their own home in place of
putting them out to nurse. As a result of - this step, it is said,
the number of mothers willing to breast feed their infants was in
1917 five times as great as formerly.41
A definite step in the regulation of wet-nursing throughout the
country was taken in a viceregal decree of August 4, 1918. A wet
nurse is required to obtain a certificate the conditions of which are
prescribed by the minister of the interior, and no agency for hired
nurses may be maintained unless authorized by the prefect of the
Province. Each child before being placed out must be certified by
a physician as free from syphilis, and all other measures prescribed
by the minister of the interior for preventing the spread of disease
must be observed.
In accordance with the decree regular supervision will be main­
tained by the authorities over wet-nursing agencies and wet nurses.
The regulations also provide that—
W ithin the lim its of the appropriations contained in the budget of the minister of
the interior for the prevention of infectious diseases, special subsidies or premiums
m ay be given b y way of encouragement to child-welfare institutes, infant consulta­
tions, and sim ilar agencies, which m ay be deemed worthy because of the favorable
results achieved b y them in the protection of the health of the children intrusted to
them, especially as regards syphilis.

A sum of 100,000 lire was also to be provided annually by the
minister of the interior to midwives in public service who showed by
good results that they had cooperated in the enforcement of the
special measures for the protection of children’s health, particularly
in regard to the prevention of syphilis among infants put out to nurse.
PROTECTION OF MOTHERS IN INDUSTRY.

Shortly after Italy’s entrance into the war (May 24, 1915) the cen­
tral commission on industrial mobilization started propaganda among
employers in favor of substituting women for men.42 Whereas in
May, 1915, there were a few thousand women in war industries, by
the end of the year there were 23,000. By the end of 1916 this
number had increased to 89,000, which in another year was almost
doubled. In August, 1918, 198,000 Italian women were engaged in
war industries.43
« Revue Philanthropique, August, 1916, pp. 204-206.
La Nipiologia, vol. 4,1918, p. 186.
« Le Donne d ’ltalia nelle Industrie di Guerra, Supplement to the Bollettino del Comitato di Centrale
di Mobilltazione Industriale, 1918, p. 3.
« I b i d ., pp. 48,61.


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During the summer of 1917 factory inspection and a system of
hygienic and sanitary supervision began for the first time to function
in Italian munition factories.44 Medical supervision was extended,
in the munition factories at least, to pregnant women. Factory
physicians kept a careful watch over the health of the expectant
mother, making urine tests monthly. Beginning with the sixth
month they recommended that the mother be put on the day shift
and on easier work, if possible in a sitting position. Some employers
gave special premiums to pregnant women.45
The munitions factories also provided nurseries for infants and
for children of preschool age. These nurseries were under the
supervision of a physician and in charge of experienced women.46
In response to a demand on the part of medical men, a day nursery
was opened at the Government tobacco factory in Bologna.47
Although a prewar law required the establishment of factory nurseries
wherever 50 or more women were employed, few such nurseries had
actually been provided.
Maternity insurance continued to function during the war. On
February 17, 1917, the State contribution to the funds was raised
from 10 lire to 12 lire for each insured woman. A year later (Jan. 10,
1918) a second viceregal decree was issued providing an additional
10 lire for each maternity benefit, making the sum paid at con­
finement 50 lire. By a viceregal decree of March 27, 1919, to take
effect on January 1, 1919, the benefit was raised to 60 lire, the increase
to continue for a year after the conclusion of peace.
PROPOSED BILL FOR THE NATIONAL PROTECTION OF INFANTS.

In the early months of 1918 Dr. Tedeschi, an Italian pediatrician,
was invited by the minister of public instruction to prepare a bill
which should provide for a national system of protection for infants
and young children. The bill when prepared provided for courses
in pediatrics for physicians and for special schools where, in addition
to infant pathology, students might be taught the moral, social, and
economic value of the child. It also provided for the establishment
of infant-welfare agencies to protect the health of mothers and babies.48
The ninth congress of the Italian society of pediatrics which met in
Rome (June 3 and 4, 1918) unanimously adopted the following
resolution with respect to the proposed bill:
The Italian Society of Pediatrics

*

*

*

convinced that the most useful measure

of social reconstruction m ade necessary b y the war is one directed toward the decrease
** Le Donne d’ Italia nelle Industrie di Guerra, Supplement to the Bollettino del Comitato di Centrale
di Mobilitazione In d u strial, 1918, p. 25.

« La Vigilanza Igienico-Sanitaria negli Stabilimenti Ausiliari, issued by the Ministero per le Armie
Munizioni, 1918, p. 87.
48 Ibid., p. 88.
a La Nipiologia, vol. 2,1916, p. 45.
48 La Riforma Medica, August 3,1918, pp. 615-616.

173389°— 20----- 10


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INFANT-WELFARE WORK IN EUROPE.

of infant mortality

*

*

*

and toward assuring to infants better conditions of

growth; and convinced that this aim can not be achieved unless there is established in
the country a suitable national agency for the protection of infants, and that such an
agency can be really effective only if the State assumes the protection of infants,
calls upon the Government to pass a law for the protection of infants, w hich, besides
establishing the fundamental p rinciple that the protection of children is the d u ty of
the State, would prescribe the establishment of a national agenpy for the protection
of infants

*

*

*

it asks the Government to revise the regulations concerning

abandoned infants and foundling asylums; to perm it the application to the pro­
tection of children of the new achievements of science and h yg ien e; it asks the Gov­
ernment to make provision for popular instruction in child care and hygiene; also
to supervise infants nursed b y other women for pay, and to m odify and rearrange,
according to modern methods, the measures dealing w ith children contained in
previous State laws-49

Early in October, 1918, similar proposals were made by the com­
mittee on public health of the royal commission for the study of
measures necessary for the period of transition from war to peace.50
This body, too, emphasized the supreme national interest and im­
portance of the problem, and urged its solution as “ the greatest
duty of the State toward the people and toward itself.” 51
In the resolutions adopted by the committee it was stated that
“ public opinion has already been formed, and it is deeply convinced
as to the urgent necessity of making provisions with the greatest
generosity and energy, and it will now accept any reform which in
other times it would have considered wild and impracticable.” 51
The committee, in defining the scope of the national work which it
advocated, declared that not only sick children, but also those in
perfect health, should be considered as in need of sanitary and health
work, which should begin from the time of conception and extend
not only through infancy, but also up to the beginning of school life.
It reiterated the need of care during pregnancy in these words:
Mothers should be carefully protected b y similar organizations from the beginning
of their pregnancy and watched and assisted b y women nurses and instructors. 59

The resolutions declared that the State should be made the organ­
izer and promotor of the work and should encourage it by grants.
It detailed specific reforms in the laws touching children and made
suggestions for the administration of all the new State-directed
child-welfare work. In closing, the committee urged that “ these
laws be drafted in a very explicit and detailed form, since they rep­
resent a great general plan for a clear and systematic development
of all those agencies which are to assure a harmonious, strong, and
praiseworthy structure of the new- Italian life, and that they be
approved by the Chamber of Deputies with the greatest possible
speed.” 53 These resolutions have been reported in all the political
and medical papers and widely discussed.
® La Nipiologia, April-September, 1918, p. 117.
60 Rassegna della Previdenza Sociale, January, 1919, pp. 54-63.
*l Ibid., p. 56.
os Ibid., p. 57.
os Ibid., p. 63.


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ITALY.

INFANT MORTALITY RATES.
Each period given in Table X X I I from 1891 up to the beginning
of the war showed a decline in the infant mortality rate.
T able

X X I I .—Number o f deaths under 1 year per 1,000 live births. 1

1891-1895
1896-1900
1901-1905
1906-1910

..................................................

184.5
168.3
167.4
152.1

Rate.

Period.

Rate.

Period.

140.8
130.3
146.8
166.3

1911-1913..............................................................
1914............................................ ..........................
1915........................................................................
1916........................................................................

1Movimento della popolazione nell’ anno 1914, p. L 5 X I I ; and Annuario Statistico Italiano, 1916, p. 32.

The rates for the larger cities also decreased and were in general
considerably lower than those for the country as a whole, as
Table X X III, which gives rates for Florence and Milan for corre­
sponding periods, indicates.
T able

X X I I I .—■Number of deaths under 1 year per 1,000 live births.
M ilan.1

Period.

Florence.2

158.6
147.3
147.8
128.2

1891-1895..
1898-1900
1901-1905
1906-1910.....................................

3 152.6
151.0

Period.

M ilan.1

Florence.2

123.1
106.6
132.4

120.8

1911-1913.....................................
1914................. ............................
1915...............................................

1 Calculated from the number of live births and of infant deaths. Comune di Milano, Dati Statistico,
1912, vol. 29, pp. 93 and 167; and Comune di Milano Annuario Statistico, 1915, pp. 42 and 77.
2 Calculated from the number of live births and of infant deaths.
Comune di Firenze, Annuario Statistieo, vol. 1, 1903, pp. 56 and 98; vol. 2, 1904, pp. 28 and 66; vol. 4, 1906, pp. 28 and 70; vol. 7, 1909, pp.30
and 84; vol. 9, 1911, pp.-29 and 72; vol. 11, 1913, pp. 23 , 82.
3 This rate is for 1903-1905. Figures for the entire period were not available.

With the beginning of the war the infant mortality rate began
to rise. The rates for the group of cities, including Turin, Milan,
Bologna, Ravenna, Florence, and Palermo, rose steadily during the
war, as follows:54
1914................................................................................ 107.7
1915................................................................................ 130.7

1916................................................................................. 143.6
1917................................................................................. 171.2

With the exception of Rome, which until 1918 appeared but
little affected, the rates for the individual cities show a similar
tendency, as Table X X IV shows.
Table

X X IV .—Number o f deaths under 1 year per 1,000 live births.a
1914

City.

107
146
92
120
124
154
a

1915

132
176
121
131
122
155

Report of the Commission for Tuberculosis, American Red Cross in Italy.

1916

1917

6 141.3
228
136
186
131
169

6 152.8
167
134
188
122
186

1918

b

154.2
230
195
232
144
230

Rom e, 1919, p. 103.

6 Cettà di Milano, Bolletlno Municipale Mensile, Dec. 31,1919, p. 486.
u

Great Britain Local Government Board.

Minutes of discussion at an informal conference to consider

generally the subject of pediatrics, 1919, p. 47.


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INFANT-W ELFARE WORK IN EUROPE.

In Perugia infant mortality increased from 115 per 1,000 live
births in 1914 to 269 in 1918.54 Great as these increases were, how­
ever, they were slight as compared with the rise in the rates for cities
on the Adriatic coast. The following increases, which, however, were
said to be exceptional, are recorded for Fano and Pesaro:54
T a b l e X X V .— Number o f deaths per 1,000 live births.

1914

City.

1915

172
161

1916

258

1917

424
371

1918

575
637

SUMMARY.
Infant mortality rates in Italy were comparatively high before the
war and from the first year of Italy’s entrance into the war increased
steadily in all cities for which figures are available, except Rome. The
greatest increase seems to have been in cities along the Adriatic coast.
Prewar legislation in favor of mothers and young children consisted
of a law on confinement rest, a provision for maternity insurance, a
requirement that factories maintain nursing rooms, and laws regu­
lating midwifery. The State gave no subsidies or grants for infantwelfare work, except to day nurseries. Such work was left solely in
the hands of private agencies and local authorities. The chief form
of assistance to mothers which antedated the twentieth century was
in the form of money to enable the working mother to hire nursing
for her infant. This aid was given by municipal authorities and by
private societies. The practice of placing out children was com­
mon. Wet-nursing centers were numerous and, except in rare cases,
were entirely unsupervised. A number of mutual maternity-aid
societies had been formed, furnishing a benefit at confinement.
Infant consultations and milk stations were instituted during the
first decade of the new century and operated in the larger cities and
towns. A few were municipal undertakings, or received assistance
from the city. The majority were established and maintained by
private funds. Lunch rooms for the nursing mother had been opened
in at least five cities, the earliest one dating back to 1879.
There were only about 36 day nurseries in Italy and, in spite of the
law, very few factory nursing rooms.
Institutes of infant care uniting all the agencies at work for infants
existed in several cities. They usually also gave courses in infant
care to teachers and volunteer workers, arranged popular courses
for mothers, and maintained in some cases exhibits in child hygiene.
64 Great Britain Local Government Board.

Minutes of discussion at an informal conference to con­

sider generally the subject of pediatrics. 1919, p. 47.


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ITALY.

149

Instruction in the care of children was given girls of school age in
some places. In Rome, for instance, in 1911, a school was founded
for this purpose.
The war, by decreasing private subscriptions to infant-welfare
enterprises, caused in general an arrest in the development of the direct
work for babies. There are evidences, however, that in some places
the work continued in full force and even increased.
Several national measures were passed for the protection of mater­
nity and infancy. With the increase in the number of women
employed in factories a system of factory inspection and sanitary
supervision was established in the munitions factories. In the Gov­
ernment munition factories special consideration was accorded preg­
nant women. Nurseries were provided in the factories for babies
and children up to 6 years of age.
The maternity benefit from the national insurance fund was raised
through State appropriation from 40 to 50 lire in January, 1918, and
a year later was increased to 60 lire.
By a decree of August 4, 1918, wet nurses and wet-nursing centers
were brought under Government supervision. Women hiring out as
nurses were required to obtain a certificate. Midwives and infantwelfare agencies were promised subsidies from the Government if
they achieved especially favorable results in protecting the health of
infants in their care.
A growing realization of the national importance of infant protec­
tion came to Italy, as to every other country, during the war. Dis­
satisfaction with uncoordinated work and with the lack of Government
recognition was frequently expressed. In 1918 Prof. Tedeschi, a lead­
ing pediatrician, was invited to prepare a bill for the national pro­
tection of infants. A bill proposing radical measures on a comprehen­
sive scale for the conservation of infancy, and providing for Govern­
ment assistance, was presented to the Chamber of Deputies in the
early part of 1918, and its speedy passage was widely advocated


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SOURCES CONSULTED,
GREAT BRITAIN.1
O F F IC IA L
B

o ard op

A

g r ic u l t u r e a n d

REPORTS

AND

LAW S.

F is h e r ie s .

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op

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Memorandum in Regard to the Regulations of the Board of Education for the
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1 Since this report went to press the following list of sources has been prepared by the American Red
Gross: ‘ Annotated Subject Index and Order List of Books and Pamphlets Including the Local Govern­
ment Board, Board of Education, and other Government Reports on Maternity and Child Welfare ia
England and W ales.”

151


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152
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ocal

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E

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London, H . M. Sta­

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Part I I I .

(Cd. 7611.)

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(Cd. 8153.)

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(Cd. 8332.)

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ment Containing the Report of the M edical Officer.
Office, 1916.

Supple­

London, H . M. Stationery

(Cd. 8423.)

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ment Containing the Report of the M edical Officer.
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Part I I I .
Supple­

London, H . M. Sta­

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Part

Supple­

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Authorities and Voluntary Agencies in England and Wales.
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Circular, A ug. 9, 1918.

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(Cd. 1917.)

Report b y M edical Officer of H ealth as to Edinburgh Schem e for M aternity
Service and Child Welfare Under the Notification-of-Births Acts, 1907 and
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L

ondon

M in is t r y

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of

London, H . M. Stationery Office.

M u n it io n s .

H ealth of M unition Workers Committee Memoranda. No. 4. E m ploym ent of
Women. London, H . M. Stationery Office, 1916. (Cd. 8185.)


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

153

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ealth

I nsurance.

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u l l in g ,

A

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e g is t r a r

W

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lexander.

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in

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M.

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Seventy-n in th A nnual Report of the Registrar General of Births, Deaths, and
Marriages in England and Wales, 1916.
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E igh tieth A nnual Report of the Registrar General of Births, Deaths, and Marriages
in E ngland and Wales, 1917.
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e g is t r a r

G

eneral

for

London, H . M. Stationery Office, 1919.
"

(Cd.

Ireland.

F iftieth Annual Report of the Registrar General for Ireland, Containing a General
Abstract of the Numbers of Births, Deaths, and Marriages Registered in Ire­
land during the Year 1914.

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(Cd. 7528.)

Fifty-fourth Annual Report of the Registrar General for Ireland, Containing a
General Abstract of the Numbers of Births, Deaths, and Marriages Registered
in Ireland during the year 1917.
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R

e g is t r a r

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for

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Sco tlan d .

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sented to the Joint Committee on Labor Problems after the War. T he Position
of Women after the War.

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Jan. 1-Ju n e 12, 1919.

Manchester Guardian, The, Ju ly 1, 19 17-D ec. 31, 1918.
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1898,

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Österreichische Statistik,

Aus der Kaiserlich-Königlichen Hof- und Staats­
Kaiserlich-Königliche
Ministeriums des

Alfred Holder, Wien.

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schrift über wirtschaftliche Massnahmen aus Anlass des Krieges. A n den Reichs­
tag.
Kaiserliches Gesundheitsamt.
Springer, Berlin.

Medizinal-statistische M itteilungen, 1893-1912.

Kaiserliches Gesundheitsamt.
Veröffentlichungen,
Puttkam m er und M ühlbrecht, Berlin.

1891-1919;

Nos.

Kaiserliches Statistisches A m t. A bteilu n g für Arbeiterstatistik.
blatt, 1917-18. C. H eym an, Berlin.

1-14 ,

J.

1920.

Reichs-Arbeits­

Kaiserliches Statistisches Am t. Statistik des Deutschen Reiches, vols. 223, 227, 236,
246, 256 and 266. Puttkam m er und M ühlbrecht, Berlin.
Kaiserliches Statistisches Am t. Statistisches Jahrbuch für das Deutsche Reich,
1892-1916. Puttkam m er und M ühlbrecht, Berlin.
Kaiserliches Statistisches A m t. Vierteljahrshefte für Statistik
Reiches, 1907. Puttkam m er und M ühlbrecht, Berlin, 1907.

des

Deutschen

Königlich-Preussisches Statistisches Landesamt. M edizinal-statistische Nachrich­
ten, 1909, 1911, 1913-14, 1914-15 and 1915-16. Verlag des K öniglichen Statis­
tischen Landesamtes, Berlin.
Reichsam t des Innern.
1918. Berlin.
Reichsam t des Innern.

Deutscher Reichsanzeiger, A ugust 1, 1917-D ecem ber 24,
Reichsgesetzblatt, 1878, 1884, 1908, 1914-1918.

Berlin.

Reichstag. Entwurf des Reichshaushalts-État für das Rechnungsjahr, 1914, 1915,
1916. Reichsdruckerei, Berlin.
Reichs-Versicherungsamt.
Berlin, 1917.

A m tliche

Statistisches A m t der Stadt Berlin.
Berlin, 1900.

Nachrichten,

June 15,

1917.

Statistisches Jahrbuch, 1898.

P . Stankiewicz,

Statistisches A m t der Stadt Dresden.
Jaensch, Dresden, 1911.

Statistisches Jahrbuch,

Statistisches A m t der Stadt München.

M itteilungen, X X I I I . Band.

Jahres Übersichten für 1909.

1909.

Zahn und
Münchener

J. Lindauersche Buchhandlung, München, 1910.

Statistisches Bureau der Steuerdeputation.
22. Band. Otto Meisner, Hamburg, 1904.


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Federal Reserve Bank of St. Louis

G. Behrend,

Statistik des Hamburgischen Staates,

158

IN FAN T-W ELFAR E WORK IN EUROPE.
U N O F F IC IA L P U B L IC A T IO N S .

A rch iv für Frauenarbeit, 1917; Jan.—Sept., 1918.

Berlin.

Ä rztliche Rundschau, 1915. München.
Blätter für Säuglingsfürsorge, 1915. M ünchen.
Blätter für Säuglings- und Kleinkinderfürsorge, 1915; Jan .-O ct., 1918.

Stuttgart.

Concordia, Feb. 1, 19 17 -F eb . 15, 1919. Berlin.
Deutsche M edizinische Wochenschrift, Apr., 1915; June, 1915; March 14-June 20,
1918. Berlin.
H ilfe, Die, A ug. 16, 1917-D ec. 26, 1918. Berlin.
Internationale Korrespondenz, Jan. 18, 1918, to A ug. 5, 1918. Berlin.
Jahrbücher für Nationalökonomie und Statistik, Feb ., 1918-June, 1919.
Münchener Medizinische Wochenschrift, 1915; Mar. 14—June 20, 1918.
Neue Generation, Die. Berlin, 1915.
Öffentliche Gesundheitspflege, July, August, and October, 1918.
Soziale Praxis, 1915-1918. Leipzig.
Sozialistische Monatshefte, Aug. 15, 1917—Mar. 12, 1918.

Jena.
München.

Braunschweig.

Berlin.

Vorwärts, Aug. 1, 19 17-D ec. 27, 1918. Berlin.
Zeitschrift für Ä rztliche Fortbildung. Jena, 1915.
Zeitschrift für Säuglingsfürsorge, 1914-15; January, 1916.

Leipzig.

Zeitschrift für Säuglingsschutz, January, 1915-M ay, 1916.

Berlin.

BO O K S.
III.

Internationaler Kongress für

Säuglingsschutz,

Berlin,

Berlin, 1912.
Keller, A ., und Klum ker, Chr. J.: Säuglingsfürsorge und

1911.

Georg Stilke,

Kinderschutz in den

Europäischen Staaten. Julius Springer, Berlin, 1912.
Meyer, H . J.: Konversation-Lexikon, vol. 9. Bibliographisches Institut, Leipzig
und Wien.
Neefe, Dr. M.: Statistisches Jahrbuch Deutscher Städte, 1904-1914.

W . G . Korn,

Breslau, 1905-1915.
F O R E I G N P U B L IC A T IO N S .
PUBLIC REPORTS.

Austria.

Sanitätsdepartement des Kaiserlich-Königlichen Ministeriums des Innern.

Das Österreichische Sanitätswesen, 1913-1917.
France.

Alfred Holder, Wien.

Ministère du Travail et de la Prévoyance Sociale.

Librairie Armand Colin, Paris.
Great Britain. Local Government Board.
fare in Germany during the War.

B ulletin .

Intelligence Department.

1917-18.

Infant W el­

H . M. Stationery Oflice, London, 1918.

UNOFFICIAL PUBLICATIONS.

B u lletin der Studiengesellschaft für Soziale Folgen des Krieges, No. 3, Mar. 15. 1917.
D ie Bevölkerungsbewegung im Weltkrieg.
Charity Organization R eview , July, 1918.

Kopenhagen.

London.

Christian Science Monitor, J u ly 3, 1918. Boston.
Journal of the American Medical Association, 1915 and 1916.
Manchester Guardian, Nov. 21, 1917.
Russkiia Viedomosti.

Moskwa, 1915 and 1916.

Survey, The, April, 1918. New York.
Zeitschrift für Kinderschutz und Jugendfürsorge.


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Federal Reserve Bank of St. Louis

Chicago.

Manchester.

January, 1917-M arch, 1919.

Wien.

159

SOURCES C0N 3U LTED .

ITALY.
O F F IC I A L R E P O R T S A N D L A W S .
Cogliolo, P ., e Majorana, A .
Firenze, 1901.
Comune di Firenze.

Codice Scolastico del Regno d ’Italia.

Annuario Statistico, 1903-1913.

Tipografia Barbera, Firenze.

Comune di Milano.
e C., Milano.

Annuario Storico-Statistico, 1915 and 1916.

Comune d i Milano.

D ati Statistici, 1912.

Stucchi, Ceretti,

Stucchi, Ceretti, e C., Milano, 1913.

G azzetta Ufficiale del Regno d ’Italia, Jan. 1, 1917-Ju n e 30, 1919.
Mantellate, Roma.
Ministero per le Arm i e Munizioni.

Tipografìa delle

Bollettino del Comitato Centrale di Mobilitazione

Industriale, January-Septem ber, 1918.
Roma.
Ministero per le Armi e Munizioni.

G. Barbèra.

“ L ’U n iverselle” Imprimerie Polygìotté,

Bollettino del Comitato Centrale di Mobilitazione

Industriale. L e Donne d ’ Italia nelle Industrie d i Guerra.
Internazionale d ’Agricoltura, Roma, 1918.

Tipografia d e ll’ Istituto

Ministero per le Arm i e Munizioni. L a Vigilanza Igienico-Sanitaria negli Stabili
menti Ausiliari. Tipografia d e ll’ Istituto Internazionale.
Ministero per l ’Industria, il Commercio, e il Lavoro.
Statistica. Annuario
Roma, 1918.

Statistico

Italiano,

1916.

Direzione Generale della

Tipografia

Ministero per l ’Industria, il Commercio, e il Lavoro.

Nazionale

Bertero,

Direzione Generale della Sta­

tistica e del Lavoro. Movimento della Popolazione n ell’ Anno 1914.
D itta Ludovico Cecchini, Roma, 1917.

Tipografia

Orlando, V . E . Primo Trattato Completo d i Diritto Amministrativo Italiano.
cietà E ditrice Libraria, Milano, 1905.
R accolta Ufficiale delle Leggi e dei Decreti del Regno d ’Italia.
Roma, 1888.

So­

Stamperia Reale,

U N O F F IC IA L P U B L IC A T IO N S .
L ’A ttualità Medica, 1915-16.

Milano.

G azzetta M edica Lombarda, La, 1916-17.

Milano.

Giornale della R eale Società Italiana d ’ igien e, La, 1916.
Medicina Nuova, La, 1915.
Nipiologia, La, 1915-1918.
Nuova Antologia, La.

Milano.

Roma, Milano, Firenze.
Napoli.

Ju ly 1, 1917-June 1, 1918.

Pediatria, La, 1916-17; January-October, 1919.

Roma.

Napoli.

Rassegna d ’ Ostetrica e Ginecologia, La, 1915-1917.

Napoli.

Rassegna della Previdenza Sociale, La, 1918 and January-March, 1919.
Riforma Medica, La, A ug. 3, 1918; Jan. 1 -O c t. 4, 1919.
R ivista di Clinica Pediatrica, La, 1915-1917.

Roma.

Napoli.

Firenze.

R ivista di Igiene e di Sanità Pubblica, 1916-17.

Parma.

R ivista Internazionale, La, January-April, 1919.

Roma.

R ivista Italiana di Sociologia, La, July-D ecem ber, 1918.
R ivista Ospedaliera, La, 1918; Jan. 1-M ar. 31, 1919.

Roma.

Roma.

F O R E I G N P U B L IC A T IO N S .
A ctes du V i l i 6 Congrès International des Assurances Sociales.
de J. Bertero et Cie., Roma, 1909.

Imprimerle National e

Buisson, F . Dictionnaire de Pédagogie et d ’Instruation Primaire.
Librairie H achette et Cie., Paris, 1887.


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Federal Reserve Bank of St. Louis

Part I, Voi. I.

160

IN FANT-W ELFARE WORK IN EUROPE.

B u lletin de l ’Office International de l ’H ygièn e Pu blique, 1916 and 1917.
Congrès International des A ccidents du Travail et des Assurances Sociales.
1902.

Paris.
D üsseldorf,

C. T . Wiskott, Breslau-Berlin, 1902.

England. Local Government Board. Minutes of discussion at an informal confer­
ence to consider generally the subject of pediatrics. London, 1919.
Keller, A ., und Klum ker, Chr. J. Säuglingsfürsorge und Kinderschutz in den Euro­
päischen Staaten.

J. Springer, Berlin, 1912.

Report of the Commission for Tuberculosis.

American R ed Cross in Italy, Tïpografia

Nazionale Bertero, Roma, 1919.
R ev u e Philanthropique, La, 1891-1919.
Survey, The, A pr. 5 ,19 1 9 .


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

New York.

Paris.

INDEX
Page references indicate the different sections of the report, as follows: Introduction, pp. 7-14; Great
Britain, pp. 15-51; Austria, pp. 53-70; Belgium, pp. 71-79; France, pp. 81-108; Germany, pp. 109-136;
Italy, pp. 137-149.

Page.
Academ y of Medicine, discussion in ......... . 97,98,99
resolutions adopted b y ....................
98-99
A ct. S e e Law.
Agencies, cooperation among. 70,110,114,125,126,133
cooperation of factories w ith.........................
10 0
coordination of....................................... 110,114,133
private, activities of..................9,10,11,18,19,20,
25,36,49,55,57-59,63,69,70,72-74,79,84,
86,96,107,110,113-114,116,118,139,140,148
cooperation of central office for the
assistance of mothers and infants
with.......................................................... 88,107
cooperation of public agencies with 25,49,70
decrease in centers supported b y . . . 25-26
inadequate funds for............................
25
increase in................................................ .
50
infant mortality investigations b y .
69
maintenance of............. 13,14,18,21,43,44,70,
72,73,79,83,87,88,108
requirements of, for obtaining grants
27
supervision over...........................— . . . . 64-65
work of national children’s bureau
in relation t o ...........................................
77
public, activities of....................... 70,72,73,85,116
cooperation of private agencies w ith. 25,
49,70
increase in ........ ....................
50
maintenance of. 13,18,21,43,72,73,79,83,87
supervision of............................................... 64-65
work of , national children’s bureau
in relation t o ...........................................
77
Agencies dealing with children of preschool
age, consolidation of........................ 128-129
American Bed Cross, activities o f. ........... 44,92,107
war sponsorship movement introduced b y
116
Areas, rural, efforts to meet needs of.................
28
establishment of centers in . 50,58,69-70, 111
extension of work in___ 23,28,60,92,121,135
grants for......................................................
Ill
grants for midwives in .......... ..................
31
health visiting in ........................... 12,23,32,58
infant mortality rate in........................ 46,104
insanitary conditions i n ........................
Ill
need of lying-in accommodations for.
10 ,
12,51,120
need of welfare work in ...........................
139
traveling exhibits in .......................... 12,33,93
Asile Michelet. S e e Michelet refuge.
Ashe St. Madeleine. S e e St.Madeleine refuge.
Assistance publique. S e e Department of
public Telief.
Association des mères de famille. S e e Or­
ganization of mothers of families.
Association of metallurgical industries, pro­
tection of mothers in industry
endorsed b y ........................................
99
B abies’ welcomes.. S e e Feeding.
Baby clinics. S e e Clinics.
Baby week campaigns, activities of...............93,107
Bar, Dr.:
Approximate number of expectant and
nursing mothers doing factory
work during the war............................
97
Birth rate, comparison of infant mortality
rate w ith..................................................
53
decline in.................................
15,81
by period.....................................................
109
by year..................................
71,137
by year and c ity........................................
137

173389— 21-

-11


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Federal Reserve Bank of St. Louis

Page,
Birth rate, decline in, by year and province..
54
82
methods of encouraging increase in ...........
Births, early notification of, requirement of. 11,17,22
registration of, to public guardians............
60
Boards of education, grants by. S e e Grants.
Bonnaire, Dr.:
Opposition to prohibiting factory em­
ployment of expectant and nursing
98
mothers.......................
Breast feeding. S e e Feeding, breast.
Brennecke; Dr.:
Establishment of public lying-in homes
urged........................................................
12 0
Budin, Dr. Pierre:
Establishment of consultation centers. . .
85
Value of an infant consultation...................
26
Budin Foundation, Pierre, maintenance o f . .
86
object of...... ............................
86
Byers, Sir John:
Infant mortality compared with war
mortality in Great Britain......
16
Cacace, Prof. Ernesto:
Establishment of institutes of infant care.
142
Campbell, Dr. Janet M.:
Need of day nurseries.....................................
19
Canteens, activities of................. 9,12,73,74,76,85,90
establishment o f................................... .73,74,91
extension of....... ................................................. 76,79
maintenance of...................................... 14,77,79,85
for expectant and nursing mothers........
85
Cantines maternelles. S e e Canteens.
Centers, consultation, activities of. 72-73,75,86,141
direction of.............. , .................................
86
indorsement of obligatory attendance
a t.................................................................. 90-91
establishment o f......... 77-78,86,107,142,143
in factories....... ..................................
99
in rural areas.......................................58,111
extension of......................... 60,74,79,85,86,90
inclusion of, in St. Paneras School for
mothers....................................................
19
increase i n ............................. 69,73,91,140,148
maintenance of. . . 14,72,73,77,79,86,87,144
replacement of milk stations b y ......... 1 0 , IS
requirements of, for obtaining grants
42
resolutions respecting..............................
92
day, activities of...............................................
113
establishment of............................ 113,128,129
infant-welfare, activities o f..................... 8 ,11,33,
34,50,57,63,111,117
cooperation of, with sickness so­
cieties............................................ 125-126,135
establishment of.......................... .. 9,50,55,57,
59,69,110, 111, 116,133,141
in rural areas................................ 50,69-70
extension of................. 11,25-30,50,57-60,134
maintenance of...................... 25-26,44,57,144
origin of........................................................ 8,107
reestablishment of....................................
91
replacement of milk stations b y . . . 8,10,18
requirements of, for obtaining grants.
42
standards required of..............................
27
traveling, establishment of..................... 12,60,92
wet-nursing, maintenance of............ 137,139,144
menace of.....................................................
137
supervision of......................................... 144,149
Central commission on industrial mobiliza­
tion, activities of....................................
144

161

162

INDEX.

Page references indicate the different sections of the report, as follows: Introduction, pp . 7-14; Great
Britain, pp. 15-51; Austria, pp. 53-70; Belgium, pp. 71-79; France, pp. 81-108; Germany, pp. 109-136;
Italy, pp. 137-149.
Page.
Central

midwives’ hoard. S e e Midwives’
hoard, central,
Central office for the assistance of mothers
and infants, cooperation of, with
other societies...................................... 88,107
establishment of___ . . . «
88, 107
maintenance of.......................... i *.» it........... 88,103
object of.................. ............... . . .......... -...........88,107
work accomplished b y .................... . . ...........
89
Certificates,priority,for supplying food .. . . . . . 117,
120,121
Chamber of Representatives, Belgian,national
children’s bureau established b y . . .
14
Chambres d’allaitement. S e e Nursing rooms.
Child-welfare institutes,instruction of mothers
b y ...............................................................
86
Children, feeding of.63.72,76,78,87,113,117,120,121,122
health visiting of............................. 8,20,21,58,121
home nursing for...............................................
21
hospital treatment for................... 20,21,22,28-29
maintenance of, from home, during lyingin period of mother........................ 21,30,51
8,
medical supervision of....................................
20,22,76,84-87,92,107,122,140-142,144
national protection of, resolutions advo­
cating ...... ..................................... 145-146,149
Children, delicate, establishment of colonies
for............................................................... 78,79
feeding o f ..................................................... 76,79
89
incubators far....................
Children, dependent,legislation dealing w ith. 81-82
provision for................................................
56
Children, placed-out, supervision of..............: .
78,
81-82,106,113,117,134,139,141,144
Children, rural, problem presented for care

of.

12

Children at birth, relation of prenatal care of
mothers to health of............................
84
Children bom out of wedlock, home visitation
of.................................................................
11
protection of......................................... 55-56,57, 111
Children of preschool age, centers for............ 117,134
feeding of...................................... 12,35,36,62,70,90
health visiting o f............................................... 20,25
kindergartens for...............................................
113
medical supervision of. 11-12,20,21,57-59,72,117
nurseries for.........................................................
70
nursery schools for............................................
142
Children erf school age, day centers for.............
128
Children’s bureau, district, functions of..........
64
59
municipal, functions of...................................
national, creation of................................... 14,77,79
77-78,79
provisions of....................
provincial, functions o f . . . .............................
64
Children’s bureaus, need f o r . . . . .............115,121,136
Climes, maintenance of.......................................... 21,44
dental, extension of..........................................
28
maintenance o f..........................................
28
prenatal,, establishment of___ 20,26,44,110,117
for treatment of children................ 20,26,110,117
Colonies for delicate children, establishment.
of...................................................................78,79
maintenance of..........................................
79
Comité National de Secours et d’ Alimenta­
tion. See National commission for
food relief.
Commission.de 1’ alimentation de 1’ enfance.
See Commission for the feeding of
children; see also National com­
mission for food relief.
Commission Permanente de Preservation,
Contre la Tuberculose en France.
See Society for the prevention of
tuberculosis in France.
Commission for the feeding of children, func­
tions of...................................................... 74-75
Committee on the health of munitions work­
ers, suggestions by, regarding em­
38
ployment of mothers............................
Committee on public health, national pro­
tection of infants advocated b y . . . .
Committee on woman’s work, functions o f..
10 1
recommendations b y ....... ................... ..


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Federal Reserve Bank of St. Louis

Page.
75.78.79
Committees, local, appointment o f.. .
74.78.79
functions of........................... .
. . 75,79
provincial,appointment o f . . . . . .
79
funetioiis.of..................................................
Confinement. S e e Mothers in confinement;
, see also Mothers after confinement.
Congenital debility. S e e Diseases.
Consultation centers. S e e Centers, consulta­
tion.
Consultation des nourrissons. S e e Centers,
consultation.
Convalescent homes. S e e Homes, convales­
cent; see also Homes, maternity.
“ Cottage midwife.” S e e Midwives.
Crèches, S e e Nurseries, day.
D a y centers. S e e Centers, day.
Day nurseries. S e e Nurseries, day.
Death rate. S e e Mortality rate.
Department of Hautes Alpes, establishment
of traveling consultations b y .......................92
Department of public relief, central office
established b y ..................................... 88,107
direction of consultation centers b y ..........
86
direction of maternity hospitals b y ..............84,85
work accomplished b y ...................................
89
Deutsche Spende. S e e Imperial fund.
Deutsche Vereinigung für Sauglingsschutz.
S e e Imperial association for the
care of infants.
Deutscher Ausschuss für Kleinkinderfürsorge. S e e Imperial committee for
.the care of small children.
Deutscher Bund für Mutterschutz. S e e Ger­
m an association for the protection
of mothers.
Deutscher Krippenverband. S e e Imperial
nursery association.
Developmental diseases. S e e Diseases.
Diarrhea. S e e Diseases.
Die Bereitschaft. S e e Preparedness society.
Dietrich, Prof.:
Preventive work, encouragement o f ..................... 110
Relation of infant mortality to mortality
in later life...............................................
109
Diseases:
Congenital debility, infant mortality
rate from, b y year..........................
106
Developmental and wasting diseases, in­
fant mortality rate from, by yea r..
46
Diarrhea, decline in infant mortality
from, in industrial center...................
78
Diarrhea and enteritis, infant mortality
rate from, b y year.............................. 46,106
Gastric and intestinal, infant mortal ty
from...............................................
53
Infections, control of........................................
16
Infectious, infant mortality rate from, by
year.......................... - i .- l - v ,....................46,100
S e e also Laws.
.
.. j
Miscellaneous, infant mortality rate from,
by year.................................
46,106
Puerperal fever, maternal mortality rate
from.......................................................47,48
Respiratory, infant mortality, rate from,
by year...... ....................... . . . ........... ..
106
Tuberculous, infant mortality rate from,
b y year.........................
46
Dispensaries, maintenance of..............................
21
for children of preschool agei................
20
District sick fund. S e e Grants from district
sick fund.
Domestic assistance. S e e “ Home helps.”
Dufour, Dr.,
establishment of m ilk station b y ........
87
Ecole centrale de puericulture. S e e School of
child care, central.
Ecole des mères. S e e School for mothers.
Ecoles gardiennes. S e e Nursery schools.
Ecoles maternelles. S e e Nursery schools.
Edinburgh Royal Maternity Hospital, weekly
clinics in connection w i t h . . . . . . . . . .

26

INDEX.

163

Page references Indicate tbe different sections of the report, as follows: Introduction, pp. 7-14: Great
Britain, pp. 15-51; Austria, pp. 53-70; Belgium, pp. 71-79; France, pp. 81-108; Germany, pp. 109-136:
pp. 137-149.
x
f

I t a ly ,

i Education act. S e e Laws.
Page.
Page.
Employers, protection of mothers in indusGrants, public.................. 9,10,12,13,14,64,70,88,110
I ^
try b y ...................................................... 99,100
S e e also Grants [specified],
Empress Augusta Victoria House, activi­
by Board of Education of England and
ties of......................110,112,116,118,122,133
W ales.....................
11,13-14,
maintenance of..................................................
115
19,33-34,39,41,42-43,49-51
S e e also Imperial association for the care
by Boards of Education of Scotland and
of infants.
Ireland...............................................................4 9
Enteritis. S e e Diseases.
by central office for the assistance of
Epstein, Prof.:
mothers and infants...................
88
Extension of training and course in infant
by city................................................................;
59
care for midwives..................................
61
60,66,69,73,74,87,88,91,108,110,111
Examination, physical. S e e Medical super­
112,114,118,125,129,131,133,140,148
vision.
by district sick fund........................................ 65 63
Examination, of infant-welfare workers___ 33,118
by general workers’ sick fund........
*
’ 65
of m idwives............................................................ 1 1 9 13 8
by government...........................9,10,13,14,19,20,
periodical...............................................................9 ’1 1 9
32,37,41,56,57,65-67,70,79,84,86,91,101
ofw etnu rses............................ . ............... .
’ 13 9
103,107,110,115,116,123,124,130,133,142
Exhibits, establishment o f............................. Î42 148
by insurance institutes...................................
12 6
functions o f ....................... 8,33,61,93,107,112’, 133
by Local Government Board of England
results of...............................................................
93
and W ales...... .............................
12-14
Exhibits, traveling, establishment o f .!'.! ¿3,58,122
18,21,27,29-31,35,36,39-44,49-51
functions of........................................ 93,107,112
by Local Government Boards of Scotland
government measure for establishing.
63
and Ireland....................................... 2 2 , 4 4 5 1
results of........................................... 33,61,93
by mothers’ mutual aid societies................
’ 95
Expectant mothers. S e e Mothers, expectant.
by National B aby W eek Council...............
44
Experimental work, grants for...... .....................
21
b y national commission for food relief.. ii, 7 7 , 7 9
by national war relief fund.........
36
Factories, cooperation of, with agencies...................... 100
by Province.............................n o , Ill,'i3 9 ,'i4 0 ,141
inspection of.................................................... 1 4 5 1 4 9
by public guardians................................... 59,60,66
requirement of nurseries i n ...............! 67,145* 149
9
by public health bodies..........
requirement of nursing rooms in ................
14 1
by State.. 14,63,64,72-74.79,83-85,87,88 91,95,
Factory act. S e e Laws.
103,107,108,110, 111, 115,118,
Factory and workshop act. S e e Laws.
121,130,131,133,135,138,149
Fathers' conferences, inclusion of, in St. Panby war committee for protection of un­
eras School for Mothers, L ondon.. .
19
cared-for children..................................
129
Federation des cantines maternelles. S e e
Federation of mothers' canteens.
Federation of mothers' canteens, establish­
H ealth measures, improved, relation of, to
m ent of canteens b y ............................
85
16
infant m ortality............................. . . .
Feeding, artificial, causes necessitating-..................... 5 3 Health visiting, development of...............! ! ! ! !
n
relation of, to mortality from gastric
establishment o f......................................... j V
23
and intestinal diseases........................
53
extension of..........................................IÜ 25 50 117
breast, encouragement of___ 1 0 , 18, 28, 5 5 , 56,
importance of......................................... '
’ 2i 24
63,65,70,72.73,75,84,86,89,90,96,99,
inclusion of, in St. Paneras school for
’
108, 111, 112,117,124-127,134,141, 144
mothers, London..................................
19
10
importance of.............................................
instruction of mothers through............... ! ! 5 9 84
increase in................................................ 126-127
local, merging of, with general county
influence of industrial employment of
scheme......................................................
23
mothers upon.........................................
39
relation of notification-of-births acts to . !
23,
relation of, to infant mortality............. 58,126
24
25 50
supervision over.................................... 1 2 5 ,126
Health visiting by counties.................................’ 23^-24
relation of. to cause of death.............. 58,105,126
by voluntary workers........................... ..
7 5 86
Feeding of children.................................. 12,36,63 70
Health visiting of children.................. 8,20,21,58 121
75,76,78,87,90,100,112,113,117,120-122
of children born out of wedlock..................
’ 11
of expectant and nursing mothers......................... 9,
of expectant mothers................................ ! 9 20 50
12,19,21,28,36,39,50,63,70,
Health visitors. S e e also Laws.
„
,. .
73,74,76,78,90,100,141,148
appointment o f........................... . ................... 2 3 50
Fees, midwife. S e e Midwives, fees for.
approval of, by local government board
’
Food supply, regulation of............................... 121,134
required....................................................
24
Foundling asylums, functions of............ 137,139,144
county, cooperation of official visitor with
25
“ Friends of children," establishment of nurs­
duties of........................... 17,24.25,27,117,126,135
eries b y ..........................................
67
increase in, employed by local authorities
24
Funds. S e e Grants; see also Imperial fund.
maintenance o f..................................................
21
municipal, cooperation of official visitor
Garderies. S e e Nurseries.
w
i
t
h
........................................................
25
Gastric and intestinal diseases. S e e Diseases.
number of, in relation to number of
General workers’ sick fund. S e e Grants.
births........................................................
24
German Association for the Protection of
official, cooperation of county and muni­
Mothers, functions of...............•
ns
Gouttes de lait. S e e Milk stations.
cipal visitors w ith................................
25
function o f ................................................
25
Governmental grants. S e e Grants by Gov­
ernment.
training for........................................ 1*24,"¿3,"i0 7 ,118
volunteer, supervision of...............................
25
Governmental measures for advancement of
infant-welfare w ork.............................63,70
Hecker, Prof.,
for protection of mothers in indu stry.. . ioO- 1 0 1
institution of traveling exhibits b y ..........
112
Grant-aided schemes, promotion o f............ 20-23 , 4 9
Hergott, Prof.,
Grants, imperial maternity, establishment of.
13,
establishment of institution for ex­
124-126
amining babies b y ......................
85
national importance of....................
14
Heubner,
private............................. 10,19,59,67,69,70,73,85,
preventive work encouraged b y .................
110
86,87,91,110,115,121,125,131,140,148
Home, maternity, in Liverpool, success o f . ..
30
S e e also Grants [specified].
nurses’ training, prenatal care given i n . .
26


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164

INDEX,

Page references indicate the different sections of the report, as follows: Introduction, pp. 7-14; Great
Britain, pp. 15-51; Austria, pp. 53-70; Belgium, pp. 71-79; Franoe, pp. 81-108; Gennany, pp. 109-136;
Italy, pp. 137-149.
Page.
“ Hom e helps,” maintenance o f . . . ^ . . . . . . 21,30,51
30
training f o r . .. .......................... .-............ .........
for mothers in confinement.. _ , . . . . 85,126,135
H om e visiting. S e e Health visiting. •
Homes, maternity, establishment o f .. . . . . 9,10,21,
44,57,84,85,118,126,135,142
m a i n t e n a n c e c i....... . . . . . . . . . . . . 21.30,51
Homes for obildren, during confinement of
mother_____ . . . . . . . . . . . . . . . . . . . . . . . .
85
21
during convalescence____ _______ . . . . . . . .
during employment of mother.............. ..
129
Hope, Dr. E . W .:
Importance of notification-of-births a c t.. .1 7
Hospitals, accommodation for children i n .. 20,21,
22,28-29
accommodation for mothers in .............. 9,10,20,
21,28,29,49,84,107,118,120,135
maternity, cooperation of central office
for the assistance of mothers and
infants w ith............................................
88
direction of.................................................... 84-85
establishment of.......................... 84,88,89,110
extended accommodation in ................
88
increase in .................................
91
29-30,85
maintenance of.....................
. Housing. S e e also Laws.
16
regulation erf..............................
Hygiene, infant, promotion oi...........................143-144

Page. 1
701
Infant-welfare workers, demand for..................
duties of............ ............... ..
57,58,73,75,86,113J
factory, increase i n ..................... . . .................
10 1
national baby week for..................................
33
standard required o f . . . . . . . . ................... 11,34
supervision of......................... . . .......... 34,35,49,50
training for............................ , ........ 11,33,34,60-62,
70,93,94,107,118,126,148
traveling, maintenance ci.................................58-59
Infants. S e e Children.
Infants’ nurses. S e e Nurses, infants'.
Infectious diseases. S e e Diseases.
10 1
Inspectors, factory, increase in . . . .....................
31
Inspectors of midwives, duties o f.......................
24
health visitors acting as..................................
higher standard advocated for.....................
22
maintenance of...................................................
21
142
Institutes of infant care, establishment o f___
functions of............................................. 142,143,148
141
maintenance o f..................................................
Institution for advancement of infant-wel­
fare work, functions of........................
56
Instituts de puériculture. S e e Child-wel­
fare institutes.
Instruction of mothers. S e e Mothers, in­
struction of.
Insurance law. S e e Laws.
Iron manufacturers’ society, protection of
mothers in industry indorsed b y . . .
99

Illegitimate children. S e e Children bom
out of wedlock.
Katholische Frauenorganisation für Nieder­
Imperial association for the care of infants, co­
österreich. S e e Society of Catho­
ordination of, with other organiza­
lic women of Lower Austria.
tions ...........................................................
129
Kinderfreunde. S e e “ Friends of children.”
maintenance of..................................................
HO
Kindergartens, establishment o f........................
129
purpose of. T.................................................... 110,133
in rural areas..............................................
12 1
S e e also Empress Augusta Victoria House
113
functions of.........................................................
(headquarters).
Kriegspatenschaft. See W ar sponsorship
Imperial committee for the care of small
society.
children, coordination of, with
other organizations.......................
129
129
publication of pamphlets b y ........................
ÏAbor-code regulations, violation of..................
127
purpose of...... ................
128-129
Landesausschuss für Säuglings und KleinImperial crèche association, purpose of........................113
kinderschutz. S e e National com­
Imperial fat control office, regulation of food
mittee for the protection of infants
distribution b y ......................................
12 1
and young children.
regulation of m ilk distribution b y ......................... 12 0
Langstein, Dr. Leo.:
Imperial fund, purpose of.....................................
115
Encouragement of preventive work..........
110
Imperial institute for the protection of
Need of preventive work for children-----136
mothers and children, funotions_of. 60,70
Sponsorship movement, advocated con­
Imperial maternity grants. S e e Grants, im­
tinuance of, after the war..................
116
perial maternity.
Laws:
Imperial nursery association, coordination of,
agencies,
cooperation
of
(Germany—de­
with other organizations.....................
129
cree, 1905)...............................
110
Incubators for delicate infants.............................
89
aid for families of enlisted men (France,
Infant consulations. S e e Centers, consula1914—
amendment,
1917)....................
96
tion.
aid for needy families (France—amend­
Infant schools. S e e Nursery schools.
ments,
Aug.,
1917;
NdtL,
1
9
1
8
).....
96
Infant-welfdre association, activities o f............ 110,
birth rate, methods of encouraging in­
111, 112,115
crease
in
(France,
1913)1.................
82
establishment of................................................ _ 115
children, provision for national protec­
maintenance of.............................................. Ho, 121
tion
of
(Italy—
bill,
1918)............
145,149
Infant-welfare centers. S e e Centers, infantchildren, placed-out, supervision
of
welfare.
(France—decree, 1897). „....................
82
Infant-welfare department of the national
children’s bureau, national, creation of
commission for food relief, creation
...
..........
........
77,79
(Belgium,
1919)..____
of........................................................... 74,77,79
children’s bureaus, establishment of
maintenance of.................
77
(Austria—bill, 1918)......................... 14,115
Infant-welfare work, coordination of----- 49,142,148
education (England, 1918) : ...............
51
extension o f . ........................... 43,44,49,50,117,134
education
( France—bil 1,1917).....................
94
government measures for advancing.........
63
emergency law limiting insurance society
maintenance of.........................................
107
payments
to
maternity
benefits
government measures for coordinating.. .
64
(Germany—Aug. 4,1914)...................
124
health visiting a function of.........................
H
emergency law setting aside factory laws
influence of, upon infant mortality............. 78,79
(Germany. 1914)................................
127
nationalization of.............................................. 13,14
factory act (Austria, 1885).............................
54
organization of....................... 109-111,115,135-136
factory and workshop (England, 1901 )...
16
preventive measures a modern develop­
food
distribution,
regulation
of
(Ger­
ment of..................... ! .............................
8
many, 1916).....................
121
promotion of scheme for.................................
20
health visitors provided for private agen­
special department for.............................
44
cies (Germany, 1 9 1 8 ) ...;...................
117
11-12
through preschool age......... ..
housing ( E n g l a n d ) , . . . . . . . . . . . . . . . . . . . . .
16
S e e also Laws.


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INDEX,

165

Page references Indicate the different sections of the report, as follows: Introduction, pp. 7-14- Great
ttaly Xp’ P137-U91: Au stna' PP- 53_70: Belgium, pp. 71-79; France, pp. 81-108; Germany, pp. 109-136;
Page.
Industrial code (Austria— amend­
ment, 1917 ).,..........................................
65
infant-welfare work, organization of (Ger­
m any).......................
135-136
provision for department in ministry
of health covering (England)...........
44
regulation of (Germany— hill, 1918)..
116
16
in fectious diseases (England)......................
maternity benefits—
Austria— amendment to sicknessinsurance law, 1917................................. 65,70
England, 1914.............................................
37
France, 1913—amendment, 1917.......... 94,108
bills........................................................
95
Germany, 1883—amendment, 1911.. 112,134
Germany, 1914— amendments, 1915,
1917.......................................................... 13,124
Italy—-decrees, 1917,1918,1919............
145
maternity insurance, national (Italy,
1910)....................................................... 138,148
maternity and child-welfare act (Eng­
land, 1918)...................
22,49
maternity and child-welfare acts (Eng­
land)..........................................................
16
midwives’ acts—
England, 1902................................. 16,17,48-49
England, 1918...........................................9,32,50
France, 1916................................................
9
Germany, 1915...........................................
9
Ireland, 1918..............................................9,32,50
Prussia, 1918 (b ill).............................. 9,121,135
Scotland, 1915........................................ 9,32,50
midwives, final examination prescribed
for (Belgium, 1908)...............................
72
registration of (Italy— public health
law , 1888)............................................. 138,139
regulation of practice of (Belgium,
1908)...............................................
72
Prussia, 1919 (bill)............................
119
supervision of (Belgium, 1884)............
72
training of (Italy— decree, 1876) . . 138,148 '
m ilk distribution, regulation of (Ger­
m any, 1915,1916,1917).................... 120,121
m ilk supply, supervision of (E n gland).. .
16
mothers in industry, confinement rest
for—
Austria, 1885 ....................................... 69,70
Belgium, 1889 .....................................
71
France, 1909 ........................................
82
France, 1913 ................................ 82,97,106
Germany, 1 8 7 8 — amendment,
1 9 0 8 .............................................. 112,134
I t a l j , 1902........................................ 138,148
periods to breast feed their infants
allowed (France. 1917).............. 13,101,108
mothers in munition industry, needs of,
to be ascertained (France—decree,
1917)........................................................ .
10 2
mothers and children, protection of, dur­
ing the war (Germany, 1914)............
114
national insurance acts (England, 1911,
,
1 9 1 3 ).......... ............................................ 16,48
notification-of-births act ( E n g l a n d ,
1907)......................................... 11,17,23,25,49
notification-of-births extension act (Eng­
land, 1915).................................... 11,17,22,49
amendment, 1918......................................
22
nurses, wet, supervision of (Italy— ordi­
nances, 1903,1905)................................
13 9
nursing, wet, regulation of (Italy—de­
cree, 1918)............................................ 144,149
nursing bottles with long tubes, abolition
of (France, 1910)....................................
82
nursing premiums—
Austria— amendment
to sickness
insurance law, 1917.................................65,70
France, 1913................................................
82
amendment, 1917............... 14,94,108
b ills........................................................
95
decree, 1918..........................................
95
nursing rooms, requirement of, in fac­
tories ( I t a ly )............................. 138,141,148

Laws:


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Page.
Laws: Publications, distribution of, toparents
registering births (Germany—de­
cree, 1905)..............................
ii2
Roussel law (France, 1874).......... . . . ” I ’. ’. I
81
separation allowances—
Austria— amendment to prewar law.
Mar. 3 0 ,1 9 1 7 .................................
6 6 70
Austria— July 27,1917 ............................. 6 6 ’ 70
Germany, 1914,1918.................................
Î2 3
sickness insurance law (Austria, Î 8 8 8 ^amendment, 1917) .•............ 13,54,65,69,70
societies, preference of State aid to cer­
tain (France— decree, 1909)...............
83
League for the prevention of infant mortality^
activities of.................. 86,87,92-93,100,107
funds for Provinces intrusted t o .............
91
Lesage, Dr.:
w ork accomplished b y nursing hom es.. .
89
Ligue contre la mortalité infantile. S e e
League for the prevention of infant
mortality.
Ligue Nationale pour la Protection de FEnfance du Premier Aige. S e e N a­
tional league for the protection of
infants.
Local authorities, extension of welfare work
. b y ..................................................................23,26
m amtenaneeof.................................................. 4 3 4 4
powers of, increase in ............................................ ’ 2 2
in England and Wales, comparison of,
with Scotland and Ireland...............
22
Local committees. S e e Committees, local.
Local Government Board of F.nginnH and
Wales, efforts of, to decrease infant
is
mortality.......................................
grants by. S e e Grants by Local Govern­
ment Board.
plan by, for promoting maternity and
child-welfare work..............................
20
standards required of centers b y ___ 27
supervision of, over centers......................
26-27
Local Government Boards of Scotland and
Ireland, grants b y. S e e Grants b y
Local Government Boards,
similarity of, activities of,' to those of Eng­
land and W ales........................................21-22
supervision of, over centers........................
26-27
London County Council, courses for midwives
b y ...............................................................
31
Lucas, Dr. W m . Palmer:
Infant mortality in certain parts of Bel­
gium..........................................................
73
Progress of infant-welfare work during
war.............................................................
71
Lunch rooms. S e e Canteens.
Lying-in. S e e also Mothers in confinement.
Lying-in accommodations, in specified cases.
29
increase in ...............................................
88
need of............................. 10,12,27,29,30,51,*85,120
provision for.......................................................
49
Lying-in homes. S e e Homes, maternity.
M allet, Sir Bernard:
Influence of diarrhea upon infant mor­
tality rates...............................................
46
Maternal nursing. S e e Feeding, breast.
Maternity benefits, establishment of................ 16 43
extension of................... 13-14,94,108,119,124-Î25
increase i n ....................... 95,112,124,134,145,149
need of expert advice in conjunction
w ith ........................
13
provision for................................................... *.
14 2
provision for, lack of.................................."
71
provisions of........................... 16,54,65,84,124,125
requirement of, from sickness societies. . .
65
restriction of certain classes from........
16
scope of................................................................... 51,65
for mothers in confinement...........................
10 7
for mothers in industry........................... 65,66 69
through maternity aid society................ 140 148
through women’s patriotic society.............
118

166

INDEX.

Page references indicate the different sections Of the report, as follows: Introduction, pp. 7-14; Great
Britain, pp. 15-51; Austria, pp. 63-70; Belgium, pp. 71-79; France, pp. 81-108; Germany, pp. 109-136;
1'
Italy, pp. 137-149.

Page.
,
Page.
131
Mortality, infant, causes of. . . . . > 1.......................
Maternity benefits. S e e also Laws: National
69
investigation in to .X iW ..................
insurance acts.
Ill
in rural areas.......... .................... .. .
Maternity homes. S e e Homes, maternity.
.
7,18
efforts to decrease.. . . a W . .
—
Maternity insurance, national, provisions of 138,148
126
influence of breast feeding upon......... .
Si« also Maternity benefits.
influence of improved health meas­
Maternity and child-welfare act. S e e Laws.
ures
upon......................
1
.
.....................
16
Maternity aid societies, establishment o f.. . . .
139,
influence of welfare work upon..........
79
140,148
methods
of
combating...................
6
6
provisions of......... ......... ....... . . . — ......... -i
140
relation of, to mortality in later'life. 7,15,109
Maternity-welfare work, promotion of scheme
7,15
to
social
welfare.................................
20
for......... . . . ’............. .................................
relation of artificial feeding to..............
53
Meals. S e e Feeding.
relation of ignorance t o ...........................
35
Medical supervision of children......... 8,22,27,28,76,
relation of poverty to . : ...........................
35
84,85,86,87,92,107,122,140,141,142,144
relation
of
wet-nursing
t
o
.
.
...................
137
of day nurseries...... . . ................. - .................
32
from gastric and intestinal diseases.. .
53
of mothers............ 8-9,27,28,50,76,86,89,107,145
Mortality rate, infant, comparison of, in city
Michelet refuge, increased preconnnement
and rural areas............... 53,55, 111, 132,133
work in...........................
89
with war mortality, in Great
Midwifery practice. S e e also Laws.
Britain..............................................
16
Midwives, health visiting b y, in rural areas..
12
53
comparison of birth rate with..............
examination for......................... 9,16,55,72,83,119
decline
i
n
.
.
:
................................................
44,
fees for................................................................... 9,12,
46,48,58,78,79,104,105,106,126,147
31,50.56.119,121,122,124,135,144,149
by area........ .........................................
46
in relation to infant-welfare work............
9
by cause of death.. . . .............. 46,78,106
increased demand for........................................ 31,32
104,132,147
by
city
and
period................
nursing, for rural areas...................................
32
by p e r io d ........................................ 44,104
practice of........................................................ 138,139
b y period (B e lg iu m ).....................
78
extension o f . . . . . .........
138,139
31
by state and period........ ........... . . .
regulation o f.. . . . . . . . . 72,78,83,119,134,135
in
rural
areas........
.............................
46,104
registration of................. ................................ 55,138
in Austria as compared with other
standard required o f................... 16,17,50,92,107
53
countries..................................................
supervision of............................
9,16-17,20,
increase in............ ..
16,71,105,134,147,148
22,48,50,54,55,69,72,107,119
causes
o
f................
.
.
..........................
105
training for......................................... 9,16-17,31-32,
105
b y city and y e a r . ....................
54,56,61,72,83,110,118,119,138
in 1915............................................ 45,48,105
for rural areas............................................. 31,121,135
in specified industrial center..................... 78
Midwives’ act. S e e Laws.
variation in ...................
45,131,132,133,147
Midwives’ board, central, courses in mid­
by city and period............................
69
wifery to be approved b y ..................
31
68
by
province
and
period..................
creation o f...................................................
16
maternal, decline i n . . . . ___ ' . .......................
44
functions o f.................................................
16
from
causes
other
than
puerperal
Military government of Paris, provision of
fever, increase in— : .................... ..
47,48
motors fiir hospital cases b y ..............
89
by locality and period — .............
48
Milk, testing erf..........................................................
142
from puerperal fever, decline in .........47,48
Milk certificates, priority, issuance of.................. 35,62
.
.........
47
by
locality
and
period........
Milk stations, activities of............ ..................... 87,112
Mothers, home nursing for...................................
21
establishment of. 18,72,73,86,87,91,107,110,142
hospital
accommodation
for..........9,10,20,21,28,
extended sam e o f............................................. 10,18
29,49,84,118,135
extension o f . . . . . . . . . . . . . . . 74,79,85,87,140,148
industrial em ploym entc of, discussion
maintenance of.......................... 14,72,73,77,79,87
relative t o ...............
97,98
purpose of.................... .......................................10,18
effect of, upon breast feeding...............
39
18
replacement of, b y babies’ welcomes___
evil effects o f................................................. 39,97
b y infant consultations..........................
18
instruction
of..................
8,11,12,19,35,49,56,58,
by infant-welfare centers.................... 8,10,18
59,61,62,70,84,86,89, 92, 93, 94, 107,
by schools for mothers............................
18
110,112,117,133,135,140,141,142,148
unpopularity of.................................................
18
through publications. . . 12,56,61,62,73, 74,
Milk supply, conservation of...............................
62
82,110,112,122,129
control o f.............................................................
16
medical supervision o f . . . .
........................
76,
distribution of............... 10,18,55,58,70,72,75,87,
84,86,92,107,140,141,145
90,100,112,120,121,122,134,140
national protection of, resolutions advo­
increase in..............................................................35,76
cating___ ................................................. "146
inspection of.......................................................
75
obstetrical care of___ _ Jt
. . . 10,20,21,29,49
reduced cost of, for specified cases........................ 35
need
o f.— . —
.................. 9 ,1 0 ,2l
requirements for obtaining............................ 10,18
Mothers, expectant, benefits for.--------- 19,37,69,145
shortage i n .......................................
90.
confinement rest for,'extension o f .. 118-119
sterilisation o f . . . . . .........
75,100
consultation centers for..........................
86
supervision of....... ................................... 75,120-121
dental treatment for...................
28
S e e also Laws.
effect of factory employment u p o n ... 38-39
Ministry of health, department covering in­
feeding
o
f................
A
.............................
..
9,12,
fant-welfare work in ........ ...................
44
21, 28, 35,36,39,50,62,63, 70,
functions o f................... ; ....................... 64,65,66,70
73,74,76,78,90, 117,120, 121
Ministry of the interior, issuance of pamphlets
health visiting a t .......................9.20,25,50,117
b y ................................................................
62
homes for................ 9.21,26,30,51,84,118,135
training in infant-welfare work ordered
hospital accommodation for. 9,20,84,118,135
by, for m id w ir e s ...............................
61
medical
supervision o f . . ......................... 8-9,
for physicians............................................
61
20,21,22,26,27,49,50,84,88,89,107
Ministry of munitions, establishment of com­
protection for, in factories..................... 39,99
mittee on woman’s work under___
10 0
need o f................................... .............
91
Ministry of social welfare, functions of............... 64,65
special centers f o r i . . . . . ...............
9,50
Modigliani, Prof. E .:
Mothers, nursing, benefits for............................. 13,69
N eed of infant-welfare work in rural areas
139
feeding o f . . . 12,19,21,35,36,62,63,70.73,74,
Moll, Dr. Leopold:
76,78,90,100,117,120,121,141,148
53
Causes necessitating artificial feeding.......
medical supervision o f.'.: ................ .
22,84
Establishment of mothers’ consultations
premiums to .................... 124,125-126,127,134
in neglected areas___ . _. . . . . ____. . .
i
supervision
over....................................
125,126
Extension of inf ant-welfare centers. . . . . .


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INDEX,

167

Page references indicate the different sections of the report, as follows: Introduction, pp. 7 - 1 4 - Great
Britain, pp. 15-51; Austria, pp. 53-70; Belgium, pp. 71-79; France, pp. 81-108; Germany, pp. -109-136;
lia iy j PP* lo » —

Page.
Mothers, rural, care of, problem presented for.
12
Mothers after confinement, advice given.
20
54,103,107
benefit for................................
domestic assistance for................................ 126,135
Government allowance advocated for___ 19,37
hemes for............................................ 10,21,30,51,85
hospital accommodation for..........................
20
Mothers in confinement, benefits for . .
13,19,
37,51,69,84
home nursing for...............................................
10
homes for..............................................................
57
hospital accommodation for... ! 1 i(j, 2 0 , 2 Î, 28,29
lying-in accommodation in rural areas,
need of, fo r ............................................. 1 0 , 1 2
medical supervision of.............................. ié, 2 0 ’ 2 1
Mothers in industry, compulsory insurance
„ for...............................................................
112
confinement rest fo r ......... 13,16,38,39,48,54, 6 5 ,
69, 70, 71, 78, 82,97,99101,112,128,134,138,148
remuneration d u r in g ...___ 54,65,69,70,82
funds for hire of wet-nurses p rovided.. 139,148
increase i n .......................................... 96,127,135,144
nursing periods allowed........................
1 0 1 108
overtime work for........... ............... 9 7 iôô, 127’ 128
protection o f......................... 37-39,98-101,128’, 145
relation of, to artificial feeding....................
53
S e e also Laws.
Mothers’ canteens. S e e Canteens.
Mothers’ consultations. S e e Centers, consul­
tation.
Mothers’ relief society, activities o f................... 84 91
Mothers’ welcomes. S e e Feeding.
Municipal agencies. S e e Agencies, public.
Mutual-aid societies, activities o f...................... 84 8 6
. ,
.
91,95,’l07
maintenance o f............ .....................................
103
Mutualités Maternelles. S e e Mutual-aid so­
cieties.
National Baby Week Council, campaign b y . 32-33
44
grants b y ............ .................................................
National baby weeks, object o f........................... 32 3 3
National children’s bureau. S e e Children’s
’
bureau, national.
National commission for food relief, creation
of separate department under.......... 7 4 , 7 9
feeding of mothers b y ....................................
76
grants by. S e e Grants.
organization of welfare work u n d er.. . 7 4 7 5 7 9
National committee for the protection of infants and young children, estab­
115
lishment o f..............................................
National council of French women, recom­
mendations b y .......................................
10 1
National insurance acts. S e e Laws.
National League for Health, Maternity, and
Child Welfare, aid given, by Amer­
ican Red Cross.......................................
44
National league for the protection of infants,
activities o f.............................................
73
National maternity insurance. S e e Mater­
nity insurance.
National Society for the Prevention of Infant
Mortality, functions o f....................... 3 3 3 4
National society for the protection of children
and young people, extended scope
of.................................................................
5g
functions o f......................................................... 5 6 5 3
National Society of Day Nurseries, standard'
ization of day nurseries through. . .
19
National war relief fund, feeding of mothers
b y ...............................................................
36
Neumann children’s clinic, instruction to
mothers b y ..........................................
112
Newman, Sir George:
Relation of ignorance to infant mortality.
35
Relation of infant mortality to mortality
in later life...................*.........................
15
Standards demanded of day nurseries___
40
Newsholme, Sir Arthur:
Need of nursery schools..................................
<
Object of preventive work defined by___
Plan for maternity and child-welfare
work by.............. »...................................
;


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Newsholme, Sir Arthur— Continued.
Page.
Relation of ignorance and poverty to in­
fant mortality........................................
35
Relation of infant mortality to mortality
in later life...........................................
7,15
North Islington School for Mothers, training
ofm idw ivesby.......... ............................
31
Notification-of-births act, relation of, to home
visiting..................................... 23,24,25,49,50
S e e also Laws.
Nurseries, day, accommodations o f ..................
67
association of, purpose of.......................
113
establishment o f.......................... 55,67,70 87
110,128,129,135,’ l42
in rural areas......................................
12 1
factory, establishment o f................... 13 4 1
55,67,87,99,’ l03
inspection o f........................................
10 8
supervision o f ........................................... 4 4 5
functions o f....................................................
*4 4 2
increase i n ............ 12,39,51,67,87,'99,’ ioO, 108
maintenance of...................
13 19 3 9 4 1
44 51,77,79,87,103,113,130M31,135, i42,’ l48
need o f ........................................... ’
49
objections to, by Prof. Adolphe
l3i?ard .................................................... 1 3 ,402
provision for, m industrial establish­
m en ts............................................ 101,102,108
provisions for entrance t o ..........
10 0
regulations for.............................................. 3 9 / 4 0 43 9
requirements for matrons i n ..........
’ 40
standarization o f............................. 4 9
87
supervision o f .............................. " / 13, 82, ’l06
variance i n ................................................
49
Nursery schools, functions o f .........42
87
inclusion of, in public-school system " .! ! ! !
’ 87
maintenance o f ..........................
4 2 7 2 74 79 14 2
need o f .................................................... . ’ ' ’ 4 4
regulations for............................................................ 4 2
for children of preschool a g e .........
"1 2 'io i 1 4 2
Nursery society, day, standardization of day ’
87
nurseries b y .......................................... _
work accomplished b y ___ 1 1 1 1 1 1 1 1
89
Nurses, maintenance o f................
21
training for................................' 5 6 ,110
creche framed, duties o f ................................
40
infants’, training required o f...............” 1 1 1 "
11
rural, appointment o f ...................................."
12 1
traim ngfor.........................................................118
wet, supervision o f......................... " ” 1 3 9 * 1 4 4 4 4 9
Nurses’ training home. S e e Home, nurses’ ’
training.
Nursing, home, of children..................................
21
of mothers...................................................... 1 0 2 1
maternal. S e e Feeding, breast.
wet, extent o f ................................................ 1 3 7 1 3 9
regulation o f........................................” 1 3 9 ’ 1 4 4
relation of, to infant m ortality, i ......... ’ 1 3 7
Nursing fund for uninsured w om en.................. 6 6 70
Nursing premiums, extension o f ................ 14,94, ios
for encouraging breast feeding.................... 55-60,
65 6 6 , 70, 8 6 , 89, 96, 99, 100, 107,
XT
.
.
111,112,117,124-127,133,134,144
Nursing premiums, increase i n ............ 14,94 , 9 5 108
need of advice in conjunction w ith ............
13
requirement of sickness societies.......... ..
65
through membership du es............................
59
S e e also Laws.
Nursing rooms, establishment o f........................
12 8
factory, establishment o f.........................
99
101,102,108,130,138,141
increase i n .................................................. 99,100,108
inspection o f................
10 8
Obstetrical care. S e e Mothers, obstetrical
care of.
Office central de l’assistance maternelle et in­
fantile. S e e Central office for the assist­
ance of mothers and infants.
Organization of mothers of families, functions
of..........................

84

Physical examination. S e e Medical super­
vision.
Physicians, training of........................................ , . 56,61

168

INDEX,

Page references indicate the different sections of the report, as follows: Introduction, pp. 7-14; G r e a t
Britain, pp. 15-51; Austria, pp. 53-70; Belgium, pp. 71-79; France, pp. #1-108; Germany, pp. 109-136;
Italy, pp. 137-149.
Pinard, Prof. Adolphe:
Page.
Benefits resulting from preconfinement
work..........................................................
89
Decrease in inlant mortality from certain
main causes of death............................
106
Instruction of girls in infant care................
87
Need of immediate care of expectant
mothers.....................................................
88
Object of central office for the assistance
of mothers and infants.........................
88
Objections to day nurseries........................ 13,102
Protection of Infancy during the Second
Year of the W ar in the Entrenched
Camp at Paris.............................
97
Relation of prenatal care to condition of
84
infants at birth...................................
Urgent appeal for prohibition of factory
employment of expectant and nurs­
ing m others............................................ 97,98
Pouponnières. S e e Homes, maternity.
Preconfinement homes. S e e Homes, mater­
nity.
Pregnant women. S e e Mothers, expectant.
Prematernity homes. S e e Homes, maternity.
Premiums, nursing. S e e Nursing premiums.
Prenatal. Se e a l s o Mothers, expectant.
Prenatal consultations. S e e Centers, consultation.
Preparedness society, establishment of nur­
series b y ....................................................
67
Preschool age. S e e Children of preschool age.
Preventive work, encouragement of.................
HO
in case of expectant mothers.........................
27
need of...................................................................
107
object of, as defined by Sir Arthur Newsholme .........................................................
8
relation of, to infant mortality.....................
53
Private grants. S e e Grants, private.
Provident maternity club, inclusion of, in St.
Paneras School for Mothers, London
19
Provinces, infant-welfare work during the
w arin.....................
91
Provincial committees. S e e Committees,
provincial.
Public charities board, functions o f...................
141
Public grants. S e e Grants, public.
Public guardianship office, extended scope
of............. . . ......................................... 59,60,70
functions o f . . , ............................................. 59,60,62
Publications.................................................. 12,56,61,62,
73,74,82,110,112,122,129,133,141,143,144
Puerperal fever. S e e Diseases.
Raimondi, Dr. R .:
Increase in maternity homes through
private interest.......................
Rate, birth. S e e Birth rate.
mortality. S e e Mortality rate.
Ration cards. S e e Certificates, priority.
Refugees, infant-welfare work for...................
maternity benefit provisions for........... ..
Reichanstalt für Mutter und Säuglingsfür­
sorge. S e e Imperial institute for
the protection- of mothers and
children.
Rest homes. S e e Homes, maternity.
Rockefeller Foundation, activities of................
Rott, Dr.:
Importance of imperial maternity grants
Number of children to be received in each
nursery.................
State responsibility for care of mother and
child............................................
Royal Sanitary Institute, examinations for
welfare workers b y ...............................
Rural areas. S e e Areas, rural.

91

69
94

93
13413o
130
136
33

S t . Madeleine refuge, increased preconfine­
ment work in.....................................
88
St. Paneras School for Mothers (London).
S e e School for mothers, St. Paneras.
Sanitary authorities, health visiting through.
23
Sanitation, relation of, to infant mortality. 16,53,55
Säuglingscnutz. S e e Societies for the protec•
tion of infants.


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Page.
Süuglingsfürsorge. S u Society, infant-wel­
fare.
Schlossmann,
preventive work encouraged b y .................
110
School for Mothers, St. Paneras, activities o f .. 19,34
similarity of modern centers t o ........................ 28
School of child care, central, establishment of.
93
School lunches, maintenance of.................. 77,78,79
School, nursery. S e e Nursery schools.
Schools for mothers, establishment of.........122,142
functions of............................................. 31,34,36,87
increase in ......................t......... .........................
28
maintenance o f.................................................. 19,42
Scottish Union of W om en Workers, institu­
tion of trav eling exhibit b y ..............
33
Separation allowances, extension of..................
123
Increase in .............................................. 66,70,96,123
provisions of................................................. 36-37,66
Sickness insurance law. S e e Laws.
Sickness societies, cooperation of, with cen­
ters................................................. 125-126,135
requirements of.................................................
65
welfare centers established b y ....................
66
Social workers’ association, establishment of
milk station b y ......................................
18
Société d’ Allaitement Maternel. S e e Society
for the promoti r r of breast feeding.
Société de charité maternelle. S e e Mothers’
relief society.
Société des crèches. S e e Nursery society, day.
Société protectrice de l’enfance. S e e Societies
for the protection of infants.
Societies for the protection of infants, activi­
ties of....................................
91
establishment o f...............................................
84
functions of.................
55,84
55
Society, infant-welfare, function of....................
Society for the prevention of tuberculosis in
France, activities o f . ................... 92-93,107
Society for the promotion of breast feeding,
activities of....................................... 85,86,89
Society of Catholic women of Lower Austria,
establishment of centers b y ...............
59
Society of Pediatrics, Italian, national pro­
145
tection of infants advocated b y -----S e e also Agencies.
Strauss, D r. Paul:
Need of strengthening activities for pro­
tection of maternity.............................
94
Opposition to prohibiting factory employ­
ment of expectant and nursing
mothers....................................................
98
Proposition for creation of special organi­
zation for protection of mothers and
babies in Paris.......................................
88
Subsidies. S e e Grants.
Sugar supply, conservation o f . . . . . . . .................
62
Tedeschi, Dr.:
Preparation of bill providing national
protection of infants........................ 145,149
Training in infant-welfare work, for girls.. 8 ,11,
33-34,49,58,87,93,94,122,143,149
for health visitors.............................. 24,93,107,118
for “ home helps” ....................................
30
for infant-welfare workers....................... 11,33,34,
60,61,62,70,93,94,107,118,126,148
for mid wives....................................................9,16-17,
31-32,54,56,61,72,110,118,119
for mothers............................. 8,11.12,19,33,49,56,
58,62,70,86,92,93,94,107,110,
112,117, 122, 135, 140, 141, 142
for nurses............................... 11,56,60-61,110,118
for physicians.................................................... 56,61
Traveling centers. S e t Centers, traveling.
Tropeano, Prof. Guiseppe:
Relation of infant morbidity to morbidity
in general.................................................
138
Tuberculous diseases. S e e Diseases.
U nion of German day nurseries, coordination
of, with other organizations..............
Union of women of France, establishment of
infant-welfare school b y .....................

129
94

IN D E X ,

Variot, Dr.,
Page.
establishment of m ilk station by................
86
Vaterländischer Frauenverein. S e e W om ­
an’s patriotic society.
Verband Deutscher Kinderhorte. S e e U n­
ion of German day nurseries.
Voluntary agencies. S e e Agencies, volun­
tary.
W a r food board, regulation of food distribu­
tion b y ........................................
121
W ar sponsorship society, activities of.........’ 57 58 69
' Jjg
purpose of....................................
W asting diseases. See D iseases.......................
Welfare centers, government measure for establisning.........................................63
W elfare workers, factory, functions« ¿ 1 . ¡1 1 ^
isg

Page.
Welfare workers, factory, training of
128
.............
W et nurses. S e e Nurses, wet.
W et nursing. S e e Nursing, wet.
Wet-nursing centers. S e e Centers, wetnursing.
W om en’s Cooperative Guild, Government al­
lowance for confinement cases sug­
gested b y .............................................. _ 19,37
W om en’s patriotic society, maternity benefit
by............................................. ..
118
publication of leaflet b y ...........
112
Zentralstelle für Kinderschuts und Jugend­
fürsorge. S e e National society for
the protection of children and
young people.

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