Not to have these things means a handicap. Not to have that very watchful feeding and attention at first means a loss of nutrition, a retarding of growth, that will either never be recovered or will be recovered later at the expense of mental development or physical strength. The early handicap may also involve a derangement of the digestion, a liability to stomachic and other troubles, that may last throughout life. Not to have the singing and talking, and the varied interest of coloured objects and toys, means a falling away from the best mental development, and a taciturn nurse, or a nurse with a base accent, means backwardness and needless difficulty with the beginning of speech. Not to be born within reach of abundant changes of clothing and abundant water, means—however industrious and cleanly the instincts of nurse and mother—a lack of the highest possible cleanliness and a lack of health and vitality. And the absence of highly-skilled medical advice, or the attentions of over-worked and under-qualified practitioners, may convert a transitory crisis or a passing ailment into permanent injury or fatal disorder.
It is very doubtful if these most favourable conditions fall to the lot of more than a quarter of the children born to-day even in England, where infant mortality is at its lowest. The rest start handicapped. They start handicapped, and fail to reach their highest possible development. They are born of mothers preoccupied by the necessity of earning a living or by vain occupations, or already battered and exhausted by immoderate child-bearing; they are born into insanity and ugly or inconvenient homes, their mothers or nurses are ignorant and incapable, there is insufficient food or incompetent advice, there is, if they are town children, nothing for their lungs but vitiated air, and there is not enough sunlight for them. And accordingly they fall away at the very outset from what they might be, and for the most part they never recover their lost start.
Just what this handicap amounts to, so far as it works out in physical consequences, is to be gauged by certain almost classical figures, which I have here ventured to present again in graphic form. These figures do not present our total failure, they merely show how far the less fortunate section of the community falls short of the more fortunate. They are taken from Clifford Allbutt's System of Medicine (art. "Hygiene of Youth," Dr. Clement Dukes). 15,564 boys and young men were measured and weighed to get these figures. The black columns indicate the weight (+9 lbs. of clothes) and height respectively of youths of the town artisan population, for the various ages from ten to twenty-five indicated at the heads of the columns. The white additions to these columns indicate the additional weight and height of the more favoured classes at the same ages. Public school- boys, naval and military cadets, medical and university students, were taken to represent the more favoured classes. It will be noted that while the growth in height of the lower class boy falls short from the very earliest years, the strain of the adolescent period tells upon his weight, and no doubt upon his general stamina, most conspicuously. These figures, it must be borne in mind, deal with the living members of each class at the ages given. The mortality, however, in the black or lower class is probably far higher than in the upper class year by year, and if this could be allowed for it would greatly increase the apparent failure of the lower class. And these matters of height and weight are only coarse material deficiencies. They serve to suggest, but they do not serve to gauge, the far graver and sadder loss, the invisible and immeasurable loss through mental and moral qualities undeveloped, through activities warped and crippled and vitality and courage lowered.
Moreover, defective as are these urban artisans, they are, after all, much more "picked" than the youth of the upper classes. They are survivors of a much more stringent process of selection than goes on amidst the more hygienic upper and middle-class conditions. The opposite three columns represent the mortality of children under five in Rutlandshire, where it is lowest, in the year 1900, in Dorsetshire, a reasonably good county, and in Lancashire, the worst in England, for the same year. Each entire column represents 1,000 births, and the blackened portion represents the proportion of that 1,000 dead before the fifth birthday. Now, unless we are going to assume that the children born in Lancashire are inherently weaker than the children born in Rutland or Dorset—and there is not the shadow of a reason why we should believe that—we must suppose that at least 161 children out of every 1,000 in Lancashire were killed by the conditions into which they were born. That excess of blackness in the third column over that in the first represents a holocaust of children, that goes on year by year, a perennial massacre of the innocents, out of which no political capital can be made, and which is accordingly outside the sphere of practical politics altogether as things are at present. The same men who spouted infinite mischief because a totally unforeseen and unavoidable epidemic of measles killed some thousands of children in South Africa, who, for some idiotic or wicked vote-catching purpose, attempted to turn that epidemic to the permanent embitterment of Dutch and English, these same men allow thousands and thousands of avoidable deaths of English children close at hand to pass absolutely unnoticed. The fact that more than 21,000 little children died needlessly in Lancashire in that very same year means nothing to them at all. It cannot be used to embitter race against race, and to hamper that process of world unification which it is their pious purpose to delay.
It does not at all follow that even the Rutland 103 represents the possible minimum of infant mortality. One learns from the Register- General's returns for 1891 that among the causes of death specified in the three counties of Dorset, Wiltshire, and Hereford, where infant mortality is scarcely half what it is in the three vilest towns in England in this respect, Preston, Leicester, and Blackburn, the number of children killed by injury at birth is three times as great as it is in these same towns. Unclassified "violence" also accounts for more infant deaths in the country than in towns. This suggests pretty clearly a delayed and uncertain medical attendance and rough conditions, and it points us to still better possibilities. These diagrams and these facts justify together a reasonable hope that the mortality of infants under five throughout England might be brought to less than one-third what it is in child-destroying Lancashire at the present time, to a figure that is well under ninety in the thousand.