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He proceeds to speak of the almost national advantages which would flow from schools of trained nurses.
In a paper by Mr. Samuel Brown, contributed to the Assu. Mag. in 1853 [vol. iii. p. 171, On the Influence of the Ages of the Parents at the Time of Marriage on the Sex of Children, and on the Prolificness of Marriages, there is the following:
The average period of childbearing is not more than 30 years, and may, for the sake of limiting the term of inquiry, from the date of marriage, be taken to terminate with the age 45 on the side of the female. On the side of the male the period may extend for 20 years longer, which accounts for the fact of there being more second marriages of males than of females. It is a wise provision of nature that in countries where the period of female prolificness commences at an earlier age, it terminates much earlier in proportion, or the constitution of the mother might be exhausted, and the children of later lite be born only to die of debility and disease.
In the 13th Report of Reg.-Gen., pub. 1854, Dr. Farr returns to the subject, "The great loss of women in the prime of life is the result of negligence and ignorance in many cases, and would be diminished by the education of the nurses and midwives who attend the poor."
From the Swedish returns (1776-1855), it appears that 100 childbearings produced 10162 children, viz. 2:82 stillborn, 98 80 quickborn; consequently 100 quickborn children imply 101 21 childbearings. In the year 1852 in England 624,012 children were born alive by 617,902 mothers; of whom 6036 bore twins, 37 bore triplets. So 99 mothers bore 100 live children; or 100 live children implied 99 childbearings. To these should be added the childbearings yielding still-births unregistered.-Dr. Farr. Dr. Farr said in the 17th Report of Reg.-Gen., pub. 1856, It may be probably assumed that the child-bearing women of a pop. are, in the language of ins. offices, "select lives," -at least, select in a certain sense; but it can only be determined by further researches whether they are less or more liable than other women to be attacked or to die by the diseases not incident to childbirth. It is only well known that when they are attacked by zymotic diseases, such as cholera and smallpox, they succumb in unusually high proportions. In the 20th Report, pub. 1859, the learned Doctor says, "The happy decrease of the danger of childbearing continues; 42 mothers died to every 10,000 children born alive in 1857; in 1847 the proportion was 60; in 1848 it was 61; and since that date the mort. has regularly declined year by year, leaving the average loss in the ten years, 51 mothers to every 10,000 children born alive."
In the Medico-Chirurgical Trans., 1864, Dr. Brodie, of Queen Charlotte's Hospital, Lond., gave some valuable statistics regarding deaths from childbirth in various Lond. institutions. He found that in Queen Charlotte's Hospital, while the deaths of married women were only 18 p. 1000, the deaths of single women were 35 p. 1000-or nearly double. He says, "A great mort. among unmarried women on their passage through the puerperal stage has always existed." He considers the depressing circumstances necessarily incident to their unfortunate condition furnishes a solution. Speaking of the outpatients of St. George's Hospital, he says, "Women delivered at their own habitations, as I know by experience, are often living in the greatest filth and poverty, with only one room to accommodate the wants of a whole family; and yet, as will be seen, those patients do infinitely better than those who are removed to a spacious, well-ventilated building, with every comfort and attention that can be desired." This is certainly a very startling statement, and it was at one time believed that the only solution of it was that the worst cases went to the Hospitals. That theory has since been dispelled.
No. of Cases No. of Deaths of Childbirth.
Soon after his accession to office (1866), Mr. Gathorne Hardy, as President of the Poor Law Board, moved for a return of the number and mort. of child-bearing women in the metropolitan workhouses. It appeared there were 39 workhouses in the metropolis, that during the year 1865 the num
St. George's, Southwark...
ber of cases of childbirth was 2728, and that the deaths from that cause amounted to 16 in the same year. These deaths occurred in nine workhouses only. The facts may be summarily expressed by naming only those places which experienced any mort. Taking the aggregate number of both series, we find that the death-rate in childbirth for all the metropolitan workhouses was 6 p. 1000 cases. Is this a small or a large ratio? To discover the means of a very exact comparison-so exact that all the conditions of the problem shall be rigidly alike-is difficult, and in Lond. perhaps impossible. Some test, however, is supplied by the experience of one or two of the larger lying-in hospitals. Dr. Brodie, in the work already mentioned, gave the mortuary statistics of Queen
Charlotte's Hospital, and of several kindred establishments. From it the following figures are drawn:
Of the four in-door establishments named, the London workhouses exhibit the lower death-rate. It is only when we reach the out-door cases of St. George's Hospital that we discover a death-rate yet lower. The heavy mort. of Queen Charlotte's Hospital Dr. Brodie assigns to very special causes. Foremost is the great number of single women received there, the mort. of the unmarried being far beyond that of the married women in childbirth, as already stated. At the Rotundo Hospital, where the death-rate is fully four times that of the Lond. workhouses, the authorities "profess only to admit married women." The British Hospital approximates closely to the Lond. workhouses by its low death-rate. This institution restricts its benefits to married women, and to "these in not larger numbers than about 120 annually." The eight years' practice of the out-door midwifery department of St. George's reveals a death-rate exactly one-half that assigned to the British Hospital, and rather more than half that which occurred in the workhouses. The death-rate in Queen Charlotte's Hospital was more than sixfold that deduced from the workhouse data of 1865. The subject clearly requires further investigation.
Statistics collected for the French Government, and pub. by Dr. Le Fort, of Paris, in 1867, give the following results. Among 888,312 women confined in the principal lying-in hospitals of Europe, including those of Gt. Brit. and Ireland, France, Denmark, Russia, etc., and 934,781 cases, collected from the same cities and medical schools, of poor women confined in their homes as out and dispensary patients, the proportions of deaths were as follows: Of the 888,312 hospital patients, 30,394 died; while out of the 934,781 external or home patients, 4405 died. The result is most startling. For out of all the women delivered in hospitals, I in 29 died; whilst of all those delivered at their own impoverished and often wretched homes, only 1 in 212 died. This is not to be accounted for by the worst cases only going to the hospitals. It is believed to be the result of the crowding and sympathetic and contagious influences. See Sir James Simpson's Address on Public Health, Social Science Congress, 1867.
In the 30th R. of Reg.-Gen., pub. 1869, Dr. Farr returns to the subject, having before him statistics much more complete than any previously available. Hence we learn that in England the mort. by childbirth to every 10,000 women living, in the four decenniads of age from 15 to 55, was 3'96, 8.96, 8.66, and o'65 in the period from 1855-67; in the preceding period it was higher at all ages. The excess in the middle age 25-35 is due to the great proportion of married child-bearing women at that age, and to the number of pregnancies then occurring. The excess of violent deaths among males of 15 and under 35 does not raise the mort. from all causes to the same pitch as the mort. of females. At the age 25-35 the deaths to 10,000 living men are 95'5, while the mort. of women at the corresponding age is 987; the excess is 32, with which the mort. by childbearing, 8.96, may be compared.
The mort. by childbirth is much less under the age of 35 in the healthy districts than it is in Lond. and the large towns; but after 35 the women in the country die by childbearing in larger numbers than the women in the towns. In towns they are more exposed to puerperal fever; in the country many, probably, perish for want of skilful help. During the ten years 1851-60, to 10,000 births in the Eastern Division (Essex, Suffolk, Norfolk), 41 mothers died in childbirth; in Lond. 49; in Lancashire and Cheshire 54; in Wales and Monmouthshire 61. In the healthy districts the mort. in childbearing was 43, in the large towns 49. Nothing in England approaches the fatality to mothers in Wales, where they must be greatly mismanaged.
In the English and Welsh healthy districts the mort. at the ages 15-45 of women is higher than the mort. of men from all causes: thus, of 1000 living at the age 25-35, the men die at the rate of 8.18, the women at the rate of 8'94; the excess on women is 0.76; and the excess is nearly the same through the whole of the procreant part of life. The humane Doctor, impressed by these facts, asks:
How can the dangers of childbearing, which have been traced to various causes, be alleviated? This question was asked many years ago, and was answered by the establishment of lying-in hospitals. Many of the mothers are poor married women; and some of them unmarried, abandoned, inexperienced, repudiated by society, incur double dangers. What seemed more likely to save these women in travail from peril than the maternity? Unfortunately, experience has proved that the assemblage of child-bearing women under one roof gives rise to fatal epidemics of childbirth fever; and the mortality is almost invariably in excess of the mortality in detached dwellings. No help is to be expected from maternities. There is hope, however, to see the mortality sensibly reduced by the progress of midwifery.
The utmost care on the part of medical men who practise as accoucheurs is indispensable. That puerperal fever has been transmitted from patient to patient is deplorably true. No precautions can be too great. Then the contagion of scarlatina evidently in some cases lights up a puerperal disease, which has not yet been distinguished from puerperal fever. So does erysipelas, and so do perhaps other diseases. The dangers of a general hospital to puerperal women have been revealed by recent experience. Students cannot study in the dissecting room and at the same time practise midwifery without risk. Nurses are often mediums of disease.
Dr. Farr supplies (inter alia) the following Tables. The first shows the mort. among the women of England of the child-bearing age; the next that of mothers in childbearing. Mortality of Women by Childbearing at different Ages in England, in the 7 Years 1848-54, and in the 13 Years 1855-67:
15-25 1,746,854 1,893,742 411 *240 *171 25-35 1,417,298 1,588,756 986 *643 343 35-45 1,072,611 1,245,887 *981 *742 *239 45-55
782,010 893,779 15-55 5,018,773 5,622,164 645 435 *210 *589
Mortality of Mothers by Childbearing at different Ages in England, in the 7 Years 1848 54, and in the 13 Years 1855-67.
In 1870 Dr. J. Matthews Duncan, M. D., pub. a work on the Mort. of Childbed and Maternity Hospitals. One of the objects of the work was to refute the statement made by the French writer Le Fort, already quoted in this art., as to the proportions of childbed women dying in hospitals as against those dying at their own homes. Dr. Duncan pronounces this to be "a terribly erroneous statement." Dr. Farr [33rd R. of Reg.-Gen. P. 407] inclines to support Le Fort. Even Dr. Duncan goes so far as to say, "I dare say an hospital could be so constructed and managed as to kill all the inmates." He argues, however, that exceptional cases should be set aside, and that only well-conditioned maternities should be selected for argument. But he frankly adds, "It is well known that the best maternities are susceptible of vast improvements." Dr. Duncan draws a proper distinction between deaths in childbirth and deaths of childbirth. "Deaths in childbirth," he says, "are all deaths, from whatever cause, occurring within the four childbed weeks, including the period of labour." Dr. Farr admits the necessity of this distinction, and says it is adopted in the Regis. abstracts.
Dr. Duncan had a careful search made in the Scotch regis. of deaths in Edin. and Glasgow, and found that 153 mothers died out of 16,393, within six weeks after delivery; or I in 107. He also deduced from certain returns of private practice a rate of mort. among mothers not very different from this. From all his inquiries he draws the inference that no fewer than I in every 120 women delivered at or near the full time die within the four weeks of childbed." Dr. Farr considers that estimate too unfavourable. He analyses the data upon which it is founded, and adheres to the national returns, as shown in the reports of the Reg.-Gen. (See 1872.)
Dr. Duncan, in his work on Fecundity, Fertility, Sterility, etc., states that after a woman has borne 9 children, the pregnancies often follow each other in rapid succession; and that the danger increases. Advancing age is itself one of the dangers.
At present the mort. is greater among women whose lives are insured at the childbearing age than it is among men. And the prem. for the ins. of a pregnant woman is generally higher than the common tabular rates. The previous data show that the general risk of a first delivery in England is covered by a prem. of 16s. on £100, and of subsequent deliveries by a prem. of 8s. ; the prem. of 10s. for each of 200 deliveries taken indiscriminately covers the common risks.-Farr.
In the 33rd R. of Reg.-Gen. pub. 1872, Dr. Farr again reverts to this subject, but appears to treat it more hopefully than in any of his previous papers. Childbirth is (he says) a physiological process, and under favourable conditions, where the mother has previously been taken proper care of, is attended with little danger. Unfortunately English mothers do not escape scatheless; nor can this be expected under existing circumstances. But there is evidence of improvement. In the four years 1847-50 no less than 59 mothers died to every 10,000 children born alive; in the four years 1867–70 the deaths had sunk to 45. He adds:
The error of collecting poor lying-in women into hospitals has been discovered, and to some extent discouraged; medical men have adopted wiser measures; they have taken greater precautions against infection; and midwives have been better taught. Still there is great room for improvement.
He then proceeds to review the statements and conclusions in Dr. Duncan's work, which we have already noticed under date 1870. He says in reference to the distinction of Dr. Duncan's in and of childbirth :
Pregnant women are subject to diseases like other women; they may be killed by accidents, and may be attacked by smallpox and scarlet fever, which in them almost invariably prove fatal. Women suffering from phthisis or heart disease, or other chronic diseases, bear children, and in the abstracts [of Reg.-Gen.] the deaths are referred to these fatal causes, to which, rather than to incidental childbirth, their deaths are attributable. Thus in add. to 3875 deaths from puerperal fever and the various accidents of childbirth [in 1870], 719 women died soon after childbirth-231 of smallpox or some other zymotic diseases; 138 of phthisis; ror of heart disease; 41 women, who were returned as pregnant, prob. in the early stages also died of various diseases.
He says Dr. Le Fort's T. of the death-rate of women delivered at home, viz. 4'7 p. 1000, differs but little from the general English rate. For, while in 17 large English towns the mort. rate is 4'9, in 64 healthy country districts it is 4.3 in 1000. He quotes the results of obs. by various private practitioners. Thus Mr. J. Clarke reports the loss of 22 mothers by death on 3847 deliveries; Dr. Churchill, of 16 on 2548; and, as a set-off against these, he gives the result of the record compiled by Mr. G. Rigden of Canterbury, who, out of 4132 consecutive cases in midwifery, yields, as the result of his obs., 9 deaths -3 from convulsions and coma, 4 from puerperal fever, I from heart disease, and I from a cause not stated. Finally:
Excluding such cases as death by smallpox, phthisis, and other fatal diseases not connected with childbearing, and correcting for defective specification, I am disposed to set down the mort. at present prevailing in England at not more than 5 deaths of the mothers to every 1000 deliveries, or of 1 in every 200 deliveries. Stillborn children may occasion death in childbirth, so that a correction should be made for their exclusion, and a correction of another kind is required for the births of twins and triplets to get the exact mort. of women in childbirth. Our tables, in their crude form, show the proportion of mothers dying to children born alive; the necessary corrections I have discussed in former reports. [BIRTHS.] [METRIA.] [PREGNANCY.] [PUERPERAL FEVER.]
CHILDREN.-In the divisions of life adopted by the Reg.-Gen. and the Census Commissioners, Children (as distinguished from "infants" below them, and "boys" and "girls" above them), are all who range from 5 to 10 years of age. The census of 1851 [England] gave the number of "Children" on this classification as 2,098,808; in 1861 the number was 2,350,261; in 1871-not yet ascertained. CHILDREN, DISEASES OF.-The congenital malformations and developmental diseases of children rank as Order 1 in the Class of DEVELOPMENTAL DISEASES, and embrace premature birth, cyanosis, spina bifida, other malformations, and teething. The deaths in England from these causes show very little variation. In 1858 they were 12,412; in 1862, 12,787; in 1867, 14,666. Over a period of 15 years ending 1864, they averaged 995 per million of the pop. living.
The deaths in 1867 were thus divided: males, 8203; females, 6463. Of the males 7049 died under 1 year, and 8190 under 5; 9 between 5 and 10; I between 15 and 20; 2 between 20 and 25; and I between 25 and 30. Of the females, 5340 died under I year, and 6440 under 5; 12 between 5 and 10; 2 between 10 and 15; 3 between 15 and 20; I between 20 and 25; 3 between 25 and 35; and I between 35 and 40. The deaths at these more advanced ages owe their origin to diseases of childhood.
We propose to treat of the mort. of children more at large under INFAnt Mort. CHILDREN'S FORTUNES, INS. OF.-The English Co. for Ins. Children's Fortunes was projected in 1720. We have no details of the plan intended to be pursued; but it was prob. a system of endowment ins.
CHILDREN, INS. OF, AND INSURANCES FOR.-Between the years 1699 and 1712 various projects were put forward, having for their avowed object the Ins. of Children. These will be spoken of at large under LIFE INS., HIST. OF. We propose here to deal only with the modern phase of this branch of bus.
By the Common Law, an infant (that is a person under 21) cannot enter into a binding contract for anything not deemed a necessary, in relation to his station or condition. By the Act against Wagering Ins., 1774 (14 Geo. III c. 48), all ins. are prohibited in which the person effecting the pol. has not an interest in the life of the person ins. By the Friendly Societies Acts an infant may, however, enjoy all the benefits provided by asso. enrolled under them.
It was held in the case of Holmes v. Blogg, in 1818, that a pol. of ins. may be effected for the benefit of, and in the name of an infant upon his own life, or the life of another; but only upon the well-understood condition that upon attaining 21, any liability thereunder on the part of the former minor might be repudiated.
It was held in the case of Halford v. Kymer, before the Courts in 1830, that a parent has no insurable interest in the life of his child, for the word "interest" in the statute means pecuniary interest.
In a subsequent case Mr. Justice Bayley held that a father might ins. a son's life for the son's benefit.
The Anglo-Australian Ins. Asso., founded 1853, orig. a most comprehensive system of Ins. and Annu. for Children under the title of INFANT INS., of which the following were the main features:
Infant Assurances.-I. Deferred assu. on infant lives for £25 to £5000 on death at any time after 14 years of age. But should death occur before the age of 14, all the prems. would be returned. II. Provisional assu. from 1 year of age for £100 and upwards on death at any time after 14 years of age; with the payment of £25 p.c. of the sum assured, for funeral purposes, in the case of death before 14.
III. Deferred endowment assu. for £25 and up to £5000 to be received by the child on his attaining either of the following ages, or payable earlier in the event of death after 14: viz. 21, 30, 40, 50, or 60. Should death take place before 14 years of age, then the whole prems. would be returned.
IV. Legacy assu., securing to a child a certain legacy from £100 to £5000, payable on the death of an uncle, aunt, or other relative or friend, provided the child be then alive.
V. Endowments, from £25 to £5000, payable on attaining the ages of 14, 21, or 30, the whole of the prems, to be returned should the life fail before attaining the specified age.
Infant Annuities.-VI. Immediate annu. from £10 to £300 p.a. for life.
VII. Temporary annu. from £10 to £300 p.a., to continue from six months till 14 years of age, or from six months to 21 years of age.
VIII. Deferred annu. for £10 and upwards, payable for the remainder of life on the child attaining either of the following given ages: viz. 14, 21, 30, 40, 50, or 60. The whole prems. returned should death occur before attaining the given age.
IX. Assu. anuu., whereby £10 and upwards p.a. for the remainder of life is secured to the child on surviving either of the following specified ages: viz. 14, 21, 30, 40, 50, or 60. And also the sum of £25 and upwards payable at death at any time after 14 years of age, or the whole prems. returned if death occur before 14.
XII. Legacy annu., by which an income from £10 to £350 p.a. for life may be secured to a child after the death of an uncle, aunt, or other relative or friend.
All infant assu, effected under the age of ten carry universal pol., which will allow the assured to travel by sea or land, and reside in any part of the world, without extra prem., or consent of the directors, or forfeiture of pol.
Most ins. offices grant Endowment pol. These will be spoken of under ENDOWMENT
Nearly all the industrial ins. offices grant pol. on the lives of children. The terms and conditions on which they are granted will be spoken of in our hist. of INDUSTRIAL INS. Regarding the practice, it may find some defence in the manufacturing districts, where every parent has an interest in the prospective earnings of his child; but it too frequently leads to the commission of the most unnatural of crimes. We have already
referred to these under BURIAL CLUBS.
In 1867 a case was before the police courts wherein a nurse in charge of a child had ins. its life.
[ENDOWMENT INS.] [FRIENDLY SOS.] [INDUSTRIAL INS.] [INSURABLE INTEREST.] CHIMNEY-SWEEPER'S CANCER.- A popular name of the Cancer, Scroti, or Munditorum, or Soot-wart. CHIMNEY-TAX [Hearth-money] -A Tax levied by 13 & 14 Chas. II. c. 10-1662; abolished by I Wm. & Mary, c. 10-1689. The returns obtained from this Tax formed one of the bases upon which early estimates of the pop. of England were formed. [CENSUS.] [POPULATION.] CHIMNEYS.- Chimneys are said to have been first introduced into our architecture about A. D. 1200. They were then confined to the kitchen and the large hall. Chafing dishes were used previously. By about 1310 Chimneys had become general. In 1774 a new Building Act was passed-14 Geo. III. c. 78-which was not only designed to regulate the building of Chimneys, but went further. Sec. 78 recites :
And whereas many of the parishes within the limits of this Act have been frequently put to considerable expense, occasioned by the neglect of the inhabitants, as well lodgers and inmates as housekeepers, in not causing their chimneys to be duly swept, by means of which alarms of fire are frequently made, to the great terror and danger of His Majesty's subjects, which prob. would be prevented if such inhabitants were obliged to defray and bear the charges and expenses attending such their neglects, or some reasonable part thereof.
Any rewards paid by the churchwardens, or other expenses incurred, were to be paid by the person causing such fire.
This act was amended in 1834 by 4 & 5 Wm. IV. c. 35, which having expired, was