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96
When it is kept in mind that two other classes of infants—those who die after twelve months, and those
who survive with more or less damaged constitutions—are probably fed on similar lines, it becomes a question
whether the present implicit belief in the suitability of breast-feeding for all sorts and conditions of infants should
not be modified. If it is accepted that environmental conditions can so affect a mother that her infant at birth
is lacking in vitamins, it seems likely that her breast milk will be similarly lacking. Could a more unsuitable
person be found to breast-feed this particular infant?
ATROPHY, DEBILITY AND MARASMUS.
"Marasmus" Group.
In these cases the proportion of Class C incomes is larger than in the Bronchitis group, and this must be a
factor in causing the lowered vitality found in these cases. It is suggested, however, that in addition to that,
there are other important contributory factors. There is a large proportion of small families, and this suggests,
early marriages and, therefore, young parents, or marriages late in life. In collecting these statistics, " Income "
was estimated as average or usual income, and not merely a temporary lack of income through unemployment.
Other things being equal, habitual lack of employment, or poorly paid employment, in a young man or woman,
suggests lack of physical or mental ability, or both. Is it to be wondered at if the offspring show lack of vitality ?
Table III contains only particulars of cases where the income is "good" or "fairly good." It will be seen by
comparing the 2nd and 3rd lines of the Table that the proportion of unsatisfactory factors is greater in the
Marasmus cases than in the Bronchitis cases. This is also shown in Table V and Table II. Table VII shows that
in a family where a legitimate baby dies from marasmus there are 50 per cent. more bad environmental factors
than in a family where a legitimate baby dies from broncho-pneumonia. Table IV shows that only 5 out of 31
cases of " Marasmus " are without a "C" entry (16 per cent.), while in "Bronchitis" 23 cases are left out
of 61 (38 per cent.)
The difference between the figures under "Size of Family" in Marasmus and Bronchitis cases may be contrasted
more easily by increasing the Marasmus figures by 50 per cent., giving A 32, B 9, C nil; compared with
Bronchitis : A 33, B 18, C 5. It is interesting to speculate on the reasons for these differences. Does poverty
cause marasmus in the children of young parents, and broncho-pneumonia in the children of more mature parents ?
Does low vitality of the parents produce a marasmic child and also a small family ? Is there any evidence of
a gradual decline in vitality from one generation to the next ? That is, do instances occur of healthy grandparents,
parents who suffered from rickets and broncho-pneumonia in their youth (with consequent lack of
vitality), and marasmic children in the third generation ? Is the lack of vitality in parents and offspring due in
both cases to poor feeding ?
Altogether, the "Marasmus" group of cases gives the impression of immaturity of parents, possibly of bad
stock, lack of earning capacity, or poor management of domestic affairs. A number of cases of miscarriage,
premature birth, and marasmus may be manifestations of the fusion of unsuitable elements from a genetic point
of view.
GASTRITIS AND ENTERITIS.
"Enteritis" Group.
In this group there are a number of cases where the home conditions are very unsatisfactory. For instance,
among the 12 legitimate cases there are four which have each "C" entries under "Income," "Feeding," and
"Size of Family." Three of these have also "C" entries under "Housing" and "Maternal Care." These four
cases and three illegitimate cases comprise all the cases in this group with "C" incomes. Particulars of the remainder
of the "Enteritis" cases are given in Table III.
From Table IV it will be seen that 40 per cent. of the "Enteritis" cases are without a "C" entry, as compared
with the "Marasmus" cases where only 16 per cent. pass this test. These figures may be contrasted with those
for "Enteritis" and "Marasmus" in the first two columns of Table VII, which show that the average number
Df " C " entries for each case of either disease is substantially the same.
The explanation appears to be that there are two types of case in the "Enteritis" group—one in which the
very bad environment and the clinical findings are like those in "Marasmus" cases, and one where, the environment
being quite satisfactory, the cause of illness and death must be further enquired into. This is borne out to
a certain extent by the figures for "Enteritis" in Table II.
Can the deaths shown in Tables III, IV and V be attributed to any of the factors mentioned? The only
two that invite comment are the large proportion of " B " families and of " B " methods of feeding.
Three out of the four fairly large families, however, have " A " incomes, so that their home environment
probably compares favourably with that of other families of similar size in the Borough.
From a clinical point of view frequent changes of diet is a common cause of gastric disturbances in infants ;
unsuitable food or lack of cleanliness may lead to enteritis. Whether these cases had difficulties while still being
breast fed, and continued to have them when other methods of feeding were tried, or whether the trouble began
only when artificial feeding was instituted is not known. There seems little doubt, however, that bad feeding,
chiefly artificial, is the chief cause of death in this group, and this is shown from the figures in Table I.
Measles.
As this is a small group the Committee do not feel justified in drawing very definite conclusions from the
statistics. Three out of the four fairly large families have poor incomes. The proportion of poor housing conditions
is high. There is no case without a "C" entry—that is this group would not appear at all in Table IV.
It is interesting to find that bad home conditions are shown by the statistics of these cases, because clinically
serious illness and death are seldom found to supervene unless the infant has a poor constitution already. (See
findings under " Bronchitis.")
Whooping Cough.
In this very small group the conditions are unsatisfactory throughout. Clinical experience suggests that
poor constitution is the chief cause of death in these cases.