Formula; and it is doubtful if any one but a first-class mathematician could do so. Certainly the House of Commons gladly accepted Mr Fisher's jest in lieu of an explanation. It is essential that the whole business should be simplified; that there should be one grant to each authority for all grades of education; that the authority should, within the limits of its approved scheme, be authorised to spend and distribute it; that that grant should consist of half the gross expenditure of the Council on education, plus such a further percentage of the total expenditure as should be sanctioned by the Board of Education in considering the scheme submitted by the Council and taking into account the value of a penny rate in the area involved. This system is simple; it is equitable; it would give every inducement to a local authority so to develop its educational work as to add to the rateable value of the area; it would at once place secondary education on a sound financial and a sound educational footing. Direct grants from the Board to the endowed schools should cease. The Board, in retaining the power and duty of inspection and of revising from year to year the local schemes of education, would retain the power requisite for the maintenance of an organic national system, and at the same time would secure that freedom of local development which is equally necessary.

If Mr Fisher's Bill fails, it will be because of the financial muddle that mars it. To secure success for his great scheme he needs the enthusiastic support of the local education authorities. As things stand, it is not at all certain that he will have this support in the measure and degree that is essential. London is frankly discontented; and that discontent will rightly spread. It would be a sad thing if a great scheme of educational reconstruction, which at last brings to the doors of the people the larger hope that is essential to a great democracy, were to fail because, in a comparatively small matter of money, the Government lacked that courage which is as needful for the conduct of peace as it is for the prosecution of war.

J. E. G. DE MONTMORENCY.

Art. 11.-THE STATE AND THE MOTHER.

1. Carnegie United Kingdom Trust: Report on the Physical Welfare of Mothers and Children. Two vols. By E. W. Hope, M.D., D.Sc., Medical Officer of Health, Liverpool, and Janet M. Campbell, M.D., M.S., one of the Senior Medical Officers of the Board of Education. 1917. 2. Report to the Local Government Board on the Provision of Midwifery Service in the County of London. By Janet E. Lane Claypon, M.D., D.Sc., formerly a Medical Inspector of the Local Government Board. 1917. 3. Report of Medical Officer of Local Government Board on Maternal Mortality in connection with Child-bearing. 1915. [Cd. 8085.]

4. Memorandum on the National Care of Maternity. Women's Cooperative Guild; May, 1917.

5. Maternity: Letters from Working Women. Bell, 1915. 6. The Health of the People: A New National Policy. By Waldorf Astor, M.P., and others.

6

SOME months ago there was published a remarkable little book consisting of 160 letters from working women, describing their experience of child-birth. These letters,' wrote Mr Herbert Samuel in a prefatory note, 'give an intimate picture of the difficulties, the troubles, often the miseries, sometimes the agonies, that afflict many millions of our people, as a consequence of normal functions of their lives.' The women correspondents were the wives of men earning a weekly wage varying from eleven shillings to five pounds in upwards of a hundred different occupations. On the whole, they represented a group of working-class families above rather than below the social level of their class. The letters reveal the manifold problems of the working-man's home life, the centre and vitals of a nation. Politicians, reformers and administrators are apt to forget that their schemes are not seldom misconceived and misapplied, for the simple reason that they ignore the real, living issues of human society. Their plans are concerned with people in the mass; and frequently the problem itself is viewed too exclusively from the outside, from the administrative standpoint. The real issue, however, is often individualistic and possessing characters hidden and inherent in

the social and industrial system, coloured, and sometimes inspired, by deeply rooted aspirations of considerable. potential value.

For instance, the problem of child-birth in the home of the well-to-do is an entirely different proposition, in theory and in practice, from that which presents itself in the poverty-stricken, over-crowded home of the workman. Yet, of the 850,000 births occurring in England and Wales every year, probably eighty per cent. take place under grave limiting conditions. These letters tell their own tragic story of how grave and limiting and all-but universal are such conditions. It is a story of perpetual over-work, of ever-recurring illness, of almost incredible suffering of the slow and chronic order. There are, it is true, many bright patches, many happy domestic episodes, a persistence of hopefulness, and a splendid loyalty, but the grey and the shadow predominate. The evidence cannot be doubted or impugned. It points unhesitatingly and with certainty to the broad fact that to bear children under such conditions is to bear a deterrent and intolerable burden of suffering. 'There is no joy in the prospect of a child,' says one. 'What with worry and feeling bad, I am never surprised at hearing of an expectant mother committing suicide,' writes another. 'Oh, the horrors,' exclaims a third, we suffer when men and women are ignorant'; and a fourth says, 'I am a ruined woman through having children.' The Women's Cooperative Guild, which has rendered noble service in behalf of these women, writes as follows:

'It is vital to the welfare of the country that an enlightened and generous care of Maternity should replace the present indifference and neglect. The vast majority of women have to bear children under conditions which are most unfavourable to the mother and child. Out of the ordinary workman's wage there is no margin to provide for the expenses which would be necessary to secure healthy conditions of child-birth; while, if the husband is ill or out of work, the wage disappears partially or entirely, and the fate of the mother is tragic.

'For the upper or middle-class woman it would be thought an outrage if she were deprived of the possibility of sufficient nourishment, rest, exercise, medical advice, skilled attendance, relief through nurses and others from ordinary

cares, and the provision of an adequate outfit and other necessaries for the infant and herself. Among the workers, during the months of pregnancy, the woman must learn by "experience and ignorance," usually being told that all her troubles are "natural." In order to scrape together a few shillings she often goes out to char or sits at her sewing machine or takes in washing; she puts by pence in money boxes; she saves little stores of tea, soap, oatmeal, and other dry goods; when times are bad she goes without, providing for her husband and children before herself. If not working long hours in a factory, her home work may be more injurious, when, ill or well, she washes, mangles, lifts heavy weights, and may still be carrying an infant in arms. She may, at the same time, have to nurse a sick husband or child. Up to the last minute before child-birth she has to wash and dress the children, cook the meals she is sometimes too tired to eat, and do all her own housework.

'At her confinement often only an untrained midwife is available, who sometimes has to make use of a child's help. In the poorest cases there is no preparation of any kind; and in some parts, as regards the baby's clothes, the custom is to get 18. bundles from the pawnbroker. In the areas where bad housing causes the family in hundreds of thousands of cases to live in two or three rooms (not to speak of those living in one), privacy and quiet are impossible. Husband or children may be sleeping in the same room, while often lack of help in the house leads her to lie in the living room, with her purse under her pillow, superintending her house and children as best she may. When dependent on neighbours, she may lie neglected for hours; she may get out of bed the third day to make her own gruel, fainting in doing so; she will be doing her washing and cooking within the week, or she will be found mixing a pudding or sewing while in bed, or with a bowl of washing at the bedside. All these circumstances lead to mental worry and depression, of which the women feel the greatest desire to be relieved, so that the birth of their children may be welcomed and not dreaded. It is obvious that such conditions must react on the child, and constantly leave both mother and child a legacy of illhealth in one form or another.'

When we come to consider the details lying at the back of these 160 letters we find, as we should expect, a complex medley of influences and conditions incriminating the social and economic system—inadequate

wages, bad housing, domestic labour, the practice of artificial prevention of child-birth, a defective food and milk supply, lack of hospital accommodation, and so forth. But over and above all else there emerge two predominant evils-ignorance of, and under-equipment for, maternity, and an absence of proper and available attention at child-birth. The mother seems to come to her supreme function almost entirely unready and uninformed; and she fulfils it, somehow or other, without sufficient skilled assistance. It is, indeed, an amazing story of improvisation and incompetence. Yet this is the source of the nation. The domestic problem here unfolded must be solved, first, in order to avoid this great mass of preventible suffering, and secondly, to remove the discouragement of and deterrence from childbirth. We have, and it must be added we deserve to have, a declining birth-rate. But the Empire needs an increasing birth-rate, a growing and virile population.

'The conclusion,' adds Mr Samuel, ' is clear, that it is the duty of the community, so far as it can, to relieve motherhood of its burdens, to spread the knowledge of mother-craft that is so often lacking, to make medical aid available when it is needed, to watch over the health of the infant. And since this is the duty of the community, it is also the duty of the State. The infant cannot indeed be saved by the State. It can only be saved by the mother. But the mother can be helped and can be taught by the State.'

Such is the social side of the problem. But there is a scientific side also. The progress of Preventive Medicine has now for a generation drawn attention to the vital importance of racial health. Nature breeds true, and on the whole she appears to breed soundly. It is estimated that 80 per cent. of children are born healthy.' The balance of diseased births are due to unhealthy, overworked or injured mothers, to alcoholism and various toxæmias, to syphilis and other constitutional hereditary diseases and predispositions, and to unwholesome antenatal conditions, all of which play havoc with healthy maternity and are the active cause of a certain amount of the distress revealed in the letters to which reference has been made. The Royal Commission on Venereal Disease (1916) recorded