IRLF 
 
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 M7 173 
 
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DEFT. 
 
INFANT WELFARE 
 
 IN 
 
 GERMANY 
 DURING THE WAR. 
 
 REPORT 
 
 Prepared in the Intelligence Department of the 
 Local Government Board. 
 1918. 
 
 LONDON: 
 PUBLISHED BY HIS MAJESTY'S STATIONERY OFFICE. 
 
 To be purchased through any Bookseller or directly from 
 
 H.M. STATIONERY OFFICE at the following addresses : 
 
 [PERIAL HOUSE, KINGSWAY, LONDON, W.C. 2, and 28, ABINGDON STREET, LONDON, S.W. 1 
 
 37, PETER STREET, MANCHESTER; 1, ST. ANDREW'S CRESCENT, CARDIFF; 
 
 23, FORTH STREET, EDINBURGH ; 
 or from E. PONSONBY, LTD., 116, GRAFTON STREET, DUBLIN. 
 
 1918. 
 
 Price Qd. Net. 
 
Infant Welfare in Germany during the War. 
 
 PAGE 
 
 I. INTRODUCTION 1 
 
 II. THE BIRTH-RATE : 
 
 (a) Before the War 2 
 
 (b) During the War 2 
 
 III. INFANT MORTALITY : 
 
 (a) Before the War ... 3 
 
 (b) During the War 3 
 
 IV. GENERAL CONDITIONS AFFECTING INFANT WELFARE : - 
 
 (a) In Large Towns 6 
 
 (b) In Country Districts : 6 
 
 (c) Effect of the War on Infant Health 7 
 
 V. THE IMPERIAL MATERNITY GRANTS 9 
 
 VI. INFANT WELFARE WORK : 
 
 (a) Before the War " 12 
 
 (b) During the War ... 14 
 
 (c) Welfare Centrea and the Imperial Maternity Grants ... 17 
 
 (d) Care of Children in Institutions 19 
 
 (e) Care of Illegitimate Children 21 
 
 (/) The War Sponsorship Movement 24 
 
 VII. OTHER MEASURES. ON BEHALF OF MOTHERS AND INFANTS: 
 
 (a) Supply and Distribution of Milk 24 
 
 (b) Special Arrangements for Distribution of Food 26 
 
 (c) Additional Rations of Food 26 
 
 VIII. SUMMARY AND CONCLUSIONS ... 28 
 
 Appendix I 
 
 Appendix II 
 
THE PRESIDENT. 
 
 1. The present report deals with conditions in Germany as to infant welfare 
 since the outbreak of war. Information is given as to the birth-rate and the 
 death-rate, the special maternity grants which have been provided, and the 
 other measures for saving the lives and improving the health of infants, 
 including special measures as regards milk and other foods. A summary of 
 the principal facts and some conclusions drawn from the evidence are given 
 in the last chapter ; the conclusions are necessarily tentative, having regard 
 to the restricted sources of information. 
 
 The most striking fact is the heavy fall in the number of births. The first 
 three years alone of the war reduced by over 2,000,000 the number of babies 
 who would have been born had peace prevailed. Some 40 per cent, fewer 
 babies were born in 1916 than in 1913. 
 
 2. The infantile death-rate has been kept well down. In the months 
 immediately following the outbreak of war there was a sudden rise, which 
 has been attributed mainly to the economic disturbance, but probably was 
 due at least as much to the general mental unrest combined with the hot and 
 dry summer. 
 
 For the years 1915 and 1916 the infantile death-rate was markedly reduced, 
 at least in the towns, partly by the special measures which were taken, largely 
 also no doubt because of the cool summers. It is noteworthy that the death- 
 rate was low, despite the undoubtedly difficult conditions of the food supply. 
 
 High though the death-rate was in the months immediately after the 
 outbreak of war, it was not so high as in the very hot months of 1911, when 
 the heat and dryness proved more fatal even than the cataclysm of war. 
 
 3. The most noteworthy measure taken for infant welfare is the special 
 grants to women who give birth to children. One of these grants is given only 
 to women who breast-feed their babies. 
 
 From one point of view the grants may be regarded as eking out the low 
 rate of separation allowances to the dependants of soldiers. From another 
 point of view they may be regarded as payments for specific services rendered 
 to the State. 
 
 The grants are in the main an extension of benefits paid, or which were 
 permissible (but which were in fact rarely paid), under the Sickness Insurance 
 Law, and are administered largely through the Insurance Societies. This 
 method, however, has not given general satisfaction, and there is a strong 
 consensus of opinion among those best qualified to judge that grants of this 
 kind should be administered through infant welfare centres. 
 
 4. At the beginning of the war, under the pressure of military needs, infant 
 welfare work suffered. The high death-rate and the claims of the nation's 
 future soon led, however, to a large extension of the work. Voluntary societies 
 have played an active part in this extension ; but the general tendency is for 
 the movement to become more and more municipal. 
 
 The progress has largely taken the form of an increase in the number of 
 infant welfare centres, with functions similar to those in this country. 
 
 It had been the practice at many of the centres, before the war, to pay 
 premiums to mothers who breast-fed their babies. It is stated that, when 
 these premiums ceased to be paid because of the grants made under the 
 imperial scheme, in many cases mothers no longer availed themselves of the 
 welfare centres, and infants suffered in consequence. Many of the centres 
 now give premiums for breast-feeding only after the initial three months to 
 which the imperial grants are limited. Where special grants of this kind are 
 not made, a large proportion of mothers cease to breast-feed their babies when 
 the imperial grants are no longer paid. 
 
 (B2338) Wt. 19738 697. 3000. 5/18. SirJ.C. & S. Gp. 32. 
 
IV. 
 
 5. The proper provision of food for expectant and nursing mothers, and 
 for infants and children, became difficult at an early stage of the war ; and the 
 local authorities have been active in measures for overcoming the trouble. 
 Many municipalities have themselves undertaken the supply of food, in some 
 cases through the infant welfare centres. 
 
 The diversity of conditions in different parts of Germany must always be 
 borne in mind. While imperial regulations may be made, the administration 
 of them rests generally with the local authorities, and what is really done depends 
 on their activities. The municipalities have also wide scope for initiative ; 
 and imperial measures generally follow on action already taken by enterprising 
 local authorities. 
 
 The improvements in infant welfare in Germany during the war have been 
 effected principally in the towns, although efforts are being increasingly made 
 to extend the work to rural districts. In a large number of these districts^ 
 however, conditions are lamentably backward and the death-rate very high. 
 In contrast to this country, the infantile death-rate in Germany in the country 
 districts is higher than in the towns. 
 
 6. The Germans excel in publicity, and much is written by them, often 
 admirably, about their schemes and plans. It is always a useful corrective 
 to look at the actual results. When this is done, it is found that this cqunTry 
 is far ahead of Germany ; that its infantile death-rate is some 50 per cent. 
 lower ; and that, while undoubtedly we may, and if wise, will, learn from 
 the measures adopted there, this should not blind us to the more favourable 
 results already obtained from the general conditions prevailing in this country. 
 
 I. G. GIBBON. 
 
 INTELLIGENCE DEPT., 
 
 LOCAL GOVERNMENT BOARD, 
 March, 1918. 
 
INFANT WELFARE IN GERMANY 
 DURING THE WAR. 
 
 I. INTRODUCTION. 
 
 (1) The twofold loss of human life which all the warring countries are 
 sustaining through the destruction of men on the battlefield and the rapid 
 decline in the number of births at home has brought into prominence the 
 question how far and in what way this loss may be made good. The most 
 obvious measure is to preserve the lives and to ensure the well-being of the 
 children. This report shows what action has been taken in Germany during 
 the war to these ends. 
 
 (2) Up to the end of last century very little had been done in Germany 
 to combat the high infant mortality which then prevailed. Notwithstanding 
 the efforts made to care for orphan, deserted and illegitimate children, the 
 complaint of social reformers that Germany was behind other countries in 
 caring for infant life generally was well founded. 
 
 This indifference to the loss of infant life was supported by the thought, 
 seldom expressed but nevertheless a potent influence in the minds of the people 
 generally, that the growth of the population had been so rapid during the 
 second half of the nineteenth century that Germany could afford to lose many 
 thousands of young lives every year without menace to the future. 
 
 Towards the beginning of the present century the danger to the nation 
 of the great loss of infant life, together with the declining birth-rate, began 
 to arouse attention. 
 
 (3) Comparison of the infant death-rates at that time in European countries 
 placed Germany in a very unfavourable position. Out of every 1,000 children 
 born alive in that country 200 died before attaining one year of age, a rate 
 nearly 50 per cent, higher than that in England and Wales, and more than 
 twice as high as that for Norway and Sweden (Table A*). 
 
 The following chapters deal with the birth-rate, infant mortality, and 
 measures taken to promote infant welfare chiefly during the war ; for com- 
 parison, information of the principal facts before the war is also given. 
 
 The chief sources of information are journals published in Germany 
 devoted to infant welfare, local government, medicine and social reform. 
 
 * The tables referred to in the text will be found in Appendix I at the end. 
 
II. THE BIRTH-RATE. 
 
 (a) BEFORE THE WAR. 
 
 (4) It will be seen from the following figures that the birth-rate in Germany 
 remained high up to the end of last century, the rate for the decade 1891-1900, 
 over 36 per thousand, being the same as that for the years 1841-1850 : 
 
 1841-1850. 36-1 per 1,000 estimated inhabitants. 
 
 1851-1860 35-3 
 
 1861-1870 37-2 
 
 1871-1880 39-1 
 
 1881-1890 36-8 
 
 1891-1900 36-1 
 
 1901-1910 31-9 
 
 In the ten years, 19011910, there was a rapid decline, the mean rate for 
 those years being under 32 per thousand. The rate for the last year of this 
 period, 1910, was below 30 per thousand, and the steady fall has continued 
 since that year, the rate for 1912 being 28-3. 
 
 This decline in the birth-rate during recent years is not, of course, peculiar 
 to Germany. 
 
 (b) DURING THE WAR. 
 
 (5) The following figures of the number of live births in the German Empire 
 during the war years were quoted some time ago in an article in Die Hilfe 
 by Karl Doormann, a member of the Reichstag. The general accuracy of the 
 figures is confirmed from other sources. They show a slight reduction in 
 1914 as compared with 1913, but a very large one in 1915 and again in 1916. 
 Comparing 1913 and 1916 there is a difference of 40 per cent. 
 
 
 Total No. of 
 Live Births. 
 
 Decrease as compared with 
 
 1913. 
 
 1914. 
 
 1915. 
 
 1913 
 1914 
 1915 ... 
 1916 
 
 1,839,000 
 1,820,000 
 1,416,000 
 1,103,000 
 
 Per cent. 
 
 1-03 
 23-0 
 40-0 
 
 Per cent. 
 
 22-2 
 39-4 
 
 Per cent. 
 22-1 
 
 Doormann estimated that a war of three years' duration would mean a 
 loss to Germany of over two and a half million new lives. 
 
 The figures given above may be compared with those worked out from the 
 official returns for places with 15,000 inhabitants and over, which are published 
 monthly by the Imperial Health Office (Table B). It will be observed that 
 the percentage reduction in the towns is slightly higher than that for the 
 empire as a whole. 
 
 Corresponding figures for England and Wales are given for comparison. 
 
 ENGLAND AND WALES. 
 
 
 Total No. of 
 
 Decrease as compared with 
 
 
 Live Births. 
 
 1913. 
 
 1914. 
 
 1915. 
 
 1913 
 
 881,890 
 
 Per cent. 
 
 Per cent. Per cent. 
 
 1914 
 
 879,096 
 
 0-31 
 
 
 
 
 
 1915 
 
 814,614 
 
 7-6 
 
 7-3 
 
 
 
 1916 ... 
 
 785,520 
 
 10-9 
 
 10-6 
 
 3-6 
 
 The crucial importance for Germany, especially with her ambitions, of so 
 great a reduction in the birth-rate is manifest. It is possible there may be an 
 increase in the birth-rate after the war, as in the decade immediately following 
 the Franco-Prussian War of 1870-71 ; but the increase will have to be great 
 to compensate for the loss occasioned by the war. 
 
III. INFANT MORTALITY. 
 
 (a] BEFORE THE WAR. 
 
 (6) The rate of infant mortality (that is, the number of deaths of infants 
 under one year of age per thousand live births) for the German Empire declined 
 slowly but steadily from the year 1906 to the year 1911, when the unusually hot 
 summer sent it up again. The year 1912 showed an improvement on all previous 
 records, but in 1913 there was once more a slight rise. 
 
 The rates per thousand for the years 1901-1913 in the whole empire, and 
 in Prussia and Bavaria, are given below. It will be noted that the figures 
 for Prussia are lower than those for the whole empire, while those for Bavaria 
 are much higher. The corresponding rates for England and Wales are given 
 for comparison ; they are much lower than those for Germany. 
 INFANT MORTALITY RATES, 1901 TO 1913. 
 
 
 1901. 
 
 1902. 
 
 1903. 
 
 1904. 
 
 1905. 
 
 1906. 
 
 1907. 
 
 1908. 
 
 1909. 
 
 1910. 
 
 1911. 
 
 1912. 
 
 1913. 
 
 German Empire 
 Prussia 
 Bavaria 
 
 207 
 200 
 
 183 
 172 
 
 204 
 194 
 
 196 
 185 
 239 
 
 205 
 198 
 241 
 
 185 
 177 
 227 
 
 176 
 168 
 220 
 
 178 
 172 
 217 
 
 170 
 164 
 217 
 
 162 
 157 
 202 
 
 192 
 188 
 223 
 
 147 
 146 
 177 
 
 151 
 
 150 
 182- 
 
 England &Wales 
 
 151 
 
 133 
 
 132 
 
 145 
 
 128 
 
 132 
 
 118 
 
 120 
 
 109 
 
 105 
 
 130 
 
 95 
 
 108' 
 
 The improvement in the infant death-rate for the whole empire, shown 
 by the above figures, appears to have been largely due to a reduction in the 
 infant mortality of the large towns. 
 
 The infant mortality rates for a number of large towns are given in Table O 
 They show that, with the exception of the hot year 1911, the rates become 
 gradually lower in the ten years preceding the war. 
 
 (7) Prussia. Figures for Prussia, published by the Prussian Statistical" 
 Office, show that in the last quarter of the last century and for the first few 
 years of the present century the rate of infant mortality was higher in the 
 urban districts taken as a whole than in the rural districts. There was a gradual 
 reduction in the rate in both urban and rural areas, but it was more rapid in 
 the towns than in the country. In the year 1906 the rates for urban and rural 
 districts were about the same, but from 1907 down to 1914 the rate was lower 
 in the urban than in the rural districts (Table D). 
 
 (8) Bavaria. The infant mortality rate has long been high in Bavaria, 
 and the rate in the country has been, and still is, higher than that in the towns 
 (Table E). 
 
 In recent years, the Bavarian Statistical Office has prepared returns as to 
 infant mortality in districts grouped according to the number of inhabitants. 
 The figures for the years 1911, 1912 and 1913 are shown in Table F. The 
 higher figures in the least populated areas are significant ; whereas in the large 
 towns the rate in 1913 was under 160, in the rural districts it exceeded 190. 
 
 (b) DURING THE WAR. 
 
 (9) Statistics for the year 1914. The infant mortality rates for the year 
 1914 in Prussia, Saxony and Bavaria, as given in official returns, were 164, 173 
 and 193 per thousand respectively. Official figures for the whole empire are 
 not available, but these three states together comprise nearly 80 per cent, of 
 the total population of the German Empire. 
 
 Table G gives the infant mortality rates for the separate quarters of the 
 year 1914 in all three of the states named, and corresponding figures for the 
 years 1911 and 1913. The outstanding feature of the returns for 1914 is an 
 abnormal rise in the third quarter. 
 
 The infant mortality rates of nearly all large towns show the same tendency 
 (an exceptional rise) in the two months immediately following the outbreak. 
 
of war. Some examples are given in Table H, the corresponding figures for 
 1911 and 1913 being included for comparison. In many towns the rate was 
 over 200 and, in a few, over 300 per thousand in the two months in question. 
 
 The rural districts, in Prussia at least, shared in the sudden increase in the 
 rate of infant mortality after the outbreak of war (Table I). 
 
 It is significant, however, that grave as was the effect of the outbreak 
 of war on the mortality of infants, it was less disastrous than the excessive 
 summer heat of 1911. 
 
 (10) Causes of increased mortality. The increase in the rate of infant 
 mortality in the first months of war was observed with much concern by 
 health authorities. Enquiries were made by a number of leaders in infant 
 welfare work in order to determine the causes to which the increase might be 
 attributed. The general consensus of opinion, arrived at independently by 
 investigators in different towns and states, was that, although some influence 
 must be attributed to the heat and drought of the two months in question, 
 the rise was not in the main to be attributed to this cause. 
 
 Reference may be made in this connection to the experience of this 
 country during the same period. The records for England and Wales do not 
 show any higher mortality in the third quarter of 1914 than of 1913, so that, 
 although the summer of 1914 was hotter and drier than the average, the 
 conditions in this country were not specially unfavourable to infant life. 
 
 The main cause of the rise in the rate of infant mortality in Germany at 
 this period was to be looked for, according to observers in that country, in the 
 economic distress which followed on mobilisation. The calling up of the 
 fathers of so many young families left the mothers with very meagre resources, 
 while among the men not taken for military service there was for a time 
 widespread unemployment. The excitement and general mental disturbance 
 caused by war conditions seems also to have had a serious effect on the welfare 
 of infants and young children ; and, judging from some accounts, may have 
 been the predominant factor in the high mortality rates. 
 
 (11) Statistics for the years 1915 and 1916. The official statistics available 
 for these years are those published weekly and monthly by the Imperial Health 
 Office relating to places with a population of over 15,000. The total population 
 living in these areas forms a little more than 40 per cent, of the total population 
 of the German Empire, and includes communities under urban and semi-urban 
 conditions. In these communities, taken as a whole, infant mortality was 
 lower before the war than in the rural districts. 
 
 The figures officially given as the mean rates for the twenty-six largest 
 towns (towns of more than 200,000 inhabitants), and for all places with 
 15,000 or more inhabitants, are shown below. The rates for England and Wales 
 for the same years are given for comparison. 
 
 INFANT MORTALITY.* 
 GERMAN EMPIRE. 
 
 
 1914. 
 
 1915. 
 
 1916. 
 
 Mean rate for twenty-six towns with 200,000 or 
 more inhabitants. (Total population in 1914, 
 11 700 000.) 
 
 153 
 
 140 
 
 130 
 
 Mean rate for all places with 15,000 inhabitants or 
 more. (Total population in 1914, 26,400,000.) 
 
 155 
 
 144 
 
 133 
 
 ENGLAND AND WALES. 
 
 1914. 1915. 1916. 
 
 London and County 
 All Urban Areas 
 
 Boroughs 
 
 116 
 109 
 
 120 
 115 
 
 101 
 95 
 
 * When the total number of births is falling, the infant death-rate calculated in the 
 ordinary way tends to overstate the true rate of mortality ; but the overstatement is not 
 so great as might at first appear, because of the large proportion of deaths in the first weeks 
 and months of life. 
 
It will be seen from the above figures that the mortality among children 
 under one year in German towns was lower in 1915 than in 1914, and that 
 1916 showed an improvement on 1915. In 1916 the towns of 15,000 inhabitants 
 and over reached the low figure (for Germany) of 133 per thousand. 
 
 In England and Wales, on the contrary, the infant mortality rate was higher 
 in 1915 than in 1914, but was much lower again in 1916. In all cases the rates 
 for England and Wales are much lower than those for Germany. 
 
 Table K shows the mortality in the twenty-six largest German towns in 
 the years 1913 to 1916. This table is compiled from the returns published 
 periodically by the Imperial Health Office. 
 
 From this table it will be seen that in some towns (Frankfort, Hanover, 
 Bremen, Hamburg, Dresden) the infant mortality rates have remained 
 comparatively low during the first three years of the war. Even in 1914 
 there was no serious rise in these cases. 
 
 In other towns (for instance, Berlin, Leipzig, Charlottenburg and Breslau) 
 although the rate throughout is comparatively high and there was an 
 appreciable rise in 1914, the position in 1916 is either somewhat better or no 
 worse than in 1913. In a few cases (for instance, Schoneberg, Danzig, Dort- 
 mund, Konigsberg, Neukolln) the year 1916 showed a marked improvement 
 on 1913. 
 
 The mean rate for all the towns indicates that on the whole the position 
 in 1915 was practically the same as in 1913, while in 1916 there was a further 
 improvement. 
 
 The decrease of infant mortality in the large towns is attributed by German 
 writers to the imperial maternity grants and the greater activity in infant 
 welfare work ; but official journals and more cautious writers point out that 
 the absence of excessive summer heat in both years must be regarded as the 
 main factor. In support of this conclusion it may be mentioned that in the 
 cases of five towns, Schoneberg, Charlottenburg, Hanover, Dresden and 
 Hamburg, the rate for the third quarter was lower in both years, 1915 and 
 1916, than the rate for the whole year, while in five other towns the same 
 observation applies to either one year or the other. 
 
 It appears that there has been a considerable migration of families from 
 the large towns to the country districts during the war. It is stated in the 
 reports of a number of welfare centres that mothers of young families went 
 away to relatives in the country when their husbands were called up, in order 
 to escape the food troubles and scarcity in the towns. These movements 
 may have tended to increase infant mortality in the rural districts and to 
 reduce it in the towns. 
 
 (12) Statistics for the year 1917. The only figures available for 1917 are 
 the returns issued monthly by the Imperial Statistical Office. These returns 
 are in many cases incomplete. Those relating to the largest towns for the 
 first half of the year do not show any great divergence from those for the same 
 period of the four previous years, except that in a few towns, Cologne, 
 Magdeburg, Duisburg and Hanover, the rates are higher than in the first half 
 of any of the four previous years. 
 
 The rates for the third quarter of 1917, on the other hand, are higher in all 
 the large towns, except four, than the rates for the third quarter of 1916 ; 
 the difference varies from 22 per thousand in the case of Essen to 106 per 
 thousand in the case of Konigsberg. The rates also compare unfavourably 
 with those for the third quarter of 1915 in all cases except six. 
 
 In three instances, Charlottenburg, Dresden and Frankfort, the rates for 
 the third quarter of 1917 are above those for the third quarter of 1914, which, 
 as previously stated, were exceptionally high in nearly all cases. This increased 
 rate in the third quarter of 1917 can scarcely be attributed to climatic conditions, 
 in view of the cold and wet weather which prevailed generally. It is possible 
 
6 
 
 that the epidemic of dysentery which occurred in Germany during that year 
 was not without influence on mortality among infants. The proportion of 
 infant deaths due to intestinal troubles was considerably higher in July and 
 August of that year than in the corresponding months of the two previous 
 years or of the year 1913.* 
 
 (13) Mortality in rural districts. The foregoing particulars relate only to 
 urban districts. As previously indicated, in pre-war times the infant death- 
 rate was generally speaking higher in the rural districts than in the towns, 
 and there is no reason to suppose that this relation has been changed during 
 the war. The returns for Prussia in 1914 show a rate of 160 in the urban 
 districts and 167 in the rural districts. In Bavaria also, as may be seen by 
 the figures in Table L, in the years 1914 and 1915 the infant mortality rates 
 were much higher in the rural districts than in the towns, the smallest parishes, 
 taken as a whole, having rates of 205 and 231 in the two years respectively. 
 Figures for the rural districts in Bavaria in 1916 are not available, but the 
 rates for the groups of towns of different sizes show the same relation as the 
 figures given in the table for 1914 and 1915, being 145 for the towns with 
 over 20,000 inhabitants and 176 for those with between 15,000 and 20,000 
 inhabitants. 
 
 IV. GENERAL CONDITIONS AFFECTING INFANT WELFARE. 
 
 (a) CONDITIONS IN LARGE TOWNS. 
 
 (14) Apart from the direct administrative measures for ensuring the well- 
 "being of infants and young children referred to in later chapters, much activity 
 had been displayed in some large towns before the war in improving the social 
 conditions of the whole community. Attention had been given to the 
 housing of the working classes, the provision of open spaces, the securing 
 of milk for children, and the care of illegitimate children. In these matters 
 there were, as might be expected, great differences between one town and 
 another, towns in western and north-western Germany reaching a higher 
 level, generally speaking, than those in the east and south-east. 
 
 It seems clear that the towns which had been most active before the war 
 in furthering the general welfare of the people have shown the greatest improve- 
 ment in their infant mortality rates both before and during the war. It is 
 in the large towns that infant welfare work has progressed most rapidly. 
 During the war these towns as a rule have taken the most active measures 
 to grapple with food" difficulties in the interests of their poorer inhabitants ; 
 and in distributing food they have, in many instances, given preference to 
 expectant and nursing mothers and young children. 
 
 The statistics published by the Imperial Health Office with regard to the 
 reduction of infant mortality in the towns as a whole have frequently been 
 referred to in the German Press in a tone of self -congratulation, and surprise 
 has been expressed that such results should have been achieved during the 
 stress of a great war. The figures for the war years only are quoted, so that 
 an impression of continuous progress is given. By omitting any reference 
 to the statistics for rural districts, the reader is left to assume that the reduced 
 infant mortality in the large towns is general throughout the empire. 
 
 (b) CONDITIONS IN COUNTRY DISTRICTS. 
 
 (15) While the infant death-rate has been reduced in many large towns, 
 both before and during the war, reports from country districts show that little 
 or no progress has been made in rural areas as a whole. 
 
 "* * Later figures, for October and November, 1917, for large towns continue to show, in 
 most cases, a higher infant mortality in 1917 than in 1915 or 1916. The figures for 
 December, 1917 (just received), indicate generally better conditions, compared with 1915 
 and 1916, than those for October and November, 1917. 
 
As in the case of the towns there are considerable differences in this respect 
 between different provinces and districts. In Prussia there are some provinces, 
 for example, Schleswig-Holstein, Hanover and Hesse-Nassau, where the 
 infant death-rate has always been and still is relatively low, but there are 
 others, such as East Prussia, Silesia and Pomerania, where it has always been 
 and still is very high. 
 
 Some light was thrown upon these high rates by a speaker at a recent 
 congress of the Rural Welfare Association in Konigsberg, who urged the great 
 need for infant welfare work in the country districts in East Prussia. He 
 pointed out that the general idea that infant welfare work was less important 
 in the country because of the abundance ofc resh air and good milk, and the 
 fostering care of the land-owning classes, was altogether wrong. He stated 
 that infant mortality in the country districts of East Prussia was much greater 
 than in other provinces, in spite of the fact that the majority of mothers 
 breast-fed their infants, the good influence of breast-feeding being counter- 
 acted by the low level of general culture. Facilities for travel are so scanty 
 that many confinements must take place without the help of a midwife. 
 Doctors are few and far between. Mid wives, even if available, are ignorant, 
 inefficient and superstitious. Plenty of fresh air there may be in the open 
 country and in the fine houses of the landowners, but not in the huts of the 
 peasants, where a single room, with small windows which can seldom be opened, 
 serves as a living and sleeping place for the whole family, and often for animals 
 as well. Above all things there is a lack of cleanliness. The patriarchal 
 relationship, of which so much is said, has really disappeared ; as a matter 
 of fact, advice offered by women of the property-owning classes would be 
 received with mistrust. The effect of breast-feeding is spoilt by the irregular 
 way in which the children are often fed. Women working all day in the fields 
 are apt to feed their children only at night, leaving them during the day with 
 " something to suck." 
 
 The high infant death-rate in the country districts of Bavaria also is largely 
 to be attributed to backward social and sanitary conditions. 
 
 In the first report (for the year 1915) of the Upper Franconian (Bavaria) 
 District Association for Infant Welfare, the district doctor pointed out that 
 the principal factors in producing the high infant mortality in the district 
 were lack of cleanliness, the want of proper care for infants, and imperfect 
 knowledge of the proper methods of feeding. There were not nearly enough 
 midwives in the country districts. There had been some increase in the 
 number of mothers who breast-fed their infants, but other harmful conditions 
 must be removed before any good results could be seen. 
 
 Dr. Eidam, whose work in a Bavarian rural district is referred to later, 
 observes that country people generally do not rightly understand the value 
 of child life. They look upon it as a matter of course that a large number of 
 children should die in their first year. He mentions the prevailing dirty and 
 insanitary conditions, especially in the eastern parts of Bavaria, as being most 
 harmful to infant life. 
 
 (c) EFFECT OF THE WAR ON INFANT HEALTH. 
 
 (16) Information as to the effect of the war on the health (as distinct from 
 the mortality) of infants is scanty, and is derived mainly from a few reports 
 made by doctors in charge of welfare centres and children's clinics or hospitals. 
 From towns or districts where no special facilities exist -for the treatment of 
 infants and young children little information is forthcoming. 
 
 There appears to have been an increase in the number of cases of sickness 
 among infants due to certain diseases, especially rickets and syphilis. 
 
 Rickets is said to have been increasingly prevalent in 1915. Not only 
 were there more children suffering from this disease but the cases were of a 
 more severe type. 
 
8 
 
 It is stated that 23 per cent, of the infants brought to the infant welfare 
 centres in Charlottenburg during 1915 were suffering from rickets in some 
 degree, and in the case of a new centre opened at Treves in March 1916, 
 43 per cent, of the children who attended during the first year were found to 
 be suffering from more or less severe rickets. 
 
 The increased number of cases of this disease is attributed by some doctors 
 lo the harder conditions under which the working classes were living, and to 
 the dearness and scarcity of nourishing food, especially fat ; by others to the 
 damp, dark winter of 1915-16. 
 
 Some writers, while admitting that rickets has increased somewhat in 
 -prevalency, maintain that the variation is no more than normal, and might 
 liave occurred had there been no war. 
 
 A Mannheim report states that in view of the intensive infant welfare 
 work undertaken in that town in the year 1915, and of the great increase in 
 the number of breast-fed infants, it was hoped that there would be a diminution 
 in the number of cases of summer diarrhoea. But this expectation was not 
 fulfilled. Although the number of cases was not so high as in 1914, it was 
 ^considerably higher than in 1913. Judging from the official returns as to 
 -causes of death, this experience was shared by a number of other large towns. 
 
 Reference is made in reports both for 1915 and 1916 to a considerable 
 Increase in the number of infants and young children suffering from skin 
 disease. In some cases this increase is attributed to the worse household 
 conditions and less cleanliness. The scarcity of soap is mentioned as affecting 
 children. 
 
 Very little mention is made of tuberculosis in the reports for 1915 and 1916, 
 but in a number of cases special arrangements have been made for the care 
 of tuberculous children. 
 
 It is reported from some of the smaller towns that the lack of flour food, 
 vegetables and, towards the end of the year 1916, of full cream milk, had a 
 bad effect on the health of weaned and older children. 
 
 Reports from several centres refer to an increase in the number of syphilitic 
 ^children. The Berlin centres in particular are making arrangements to provide 
 special treatment for all such cases at an early stage. 
 
 Dr. Eidam states in a report of July, 1916, relating to a country district 
 in Bavaria, that on the whole children were better nourished and in better 
 health during 1915 and the first half of 1916 than in previous years. He 
 attributes the improvement to the fact that mothers had more money to 
 spend on food than usual. With separation allowances, the maternity grants, 
 and the milk distributed by the Red Cross they were in many instances better 
 off than before the war. 
 
 (17) War infants. A controversy has been waged for some time in Germany 
 as to whether the war had produced a new kind of infant. A Charlottenburg 
 doctor first claimed to have observed so-called " war infants " (Kriegsneuge- 
 borene) both at infant welfare centres and in private practice. He described 
 them as not actually ill, but small, backward in growth, delicate and thin, 
 with wrinkled skin suggestive rather of old age than of infancy. They were 
 not prematurely born infants, but under-developed at the time of birth. A 
 constant restlessness, accompanied by automatic grasping movements, was a 
 marked characteristic of this type of infant. The condition of these children 
 was attributed to the anxiety and nervous strain endured by the mothers, 
 as well as to insufficient and unsuitable food. 
 
 A number of medical men discussed this subject in various journals. The 
 majority of them held that the war had not produced a special type, but many 
 admitted that the general increase of excitement among mothers had led to 
 an increase in the number of excitable infants, that a larger proportion were 
 below the normal weight, developed slowly and were reared with difficulty. 
 On the other hand, some writers maintained that on the whole the infants born 
 during 1915 and 1916 were in better condition than those born in 1914. 
 
9 
 V. THE IMPERIAL MATERNITY GRANTS. 
 
 (18) Origin of the grants. The principal measure adopted in Germany to 
 promote infant welfare during the war has been the distribution of the imperial 
 maternity grants. As previously stated, it was generally believed that the 
 rise in the infant death-rate in the first months of the war was due mainly 
 to economic distress. The cost of food and of the necessaries of life rose 
 rapidly in Germany in the earliest days of the war, and the separation allowances 
 given to the wives and families of soldiers out of imperial funds were very small. 
 The imperial maternity grants were intended as a remedy. 
 
 The law of 4th August, 1914, fixed the imperial allowances at 9s. a month 
 for a soldier's wife and 6s. a month for each child during the six summer 
 months, and 12s. and 6s. a month respectively in the winter months. The 
 winter rate came into force on 1st November, 1914, and was continued in force, 
 after the winter, by a special decree. In the autumn of 1915 the allowances 
 were increased to 15s. and 7s. Qd., and these rates were continued during the 
 summer of 1916. In November of that year the allowances were increased 
 to 20s. and 10s., and again in October, 1917, to 30s. and 15s. 
 
 Additions to these allowances are made from communal and other public 
 and charitable funds in the case of nearly all towns ; each communal authority 
 fixes its own scale, and the amounts given vary considerably. Many large 
 towns gave an amount equal to the imperial allowance in the early days. 
 A good deal of assistance is given in kind in a number of towns. 
 
 Separation allowances are not given to all soldiers' wives as a matter of 
 course. " Necessity " must first be proved, but instructions have been given 
 that the term " necessity " is to be liberally interpreted. 
 
 Cases occurred in the early days of the distribution of grants in which the 
 separation allowance was refused to wives of soldiers on the ground that, as 
 they were receiving maternity benefit, they were not in need. The imperial 
 authorities, however, decided that the receipt of maternity benefit was not 
 to be a reason for refusing the separation allowance. 
 
 It was clearly difficult for a woman to meet the extra expenses connected 
 with the birth of a child out of the small allowance given at the beginning 
 of the war, and there was a general demand for some further provision to be 
 made for soldiers' wives in these circumstances. The Government, in response 
 to this demand, decided to provide for the payment of maternity grants, 
 partly out of imperial funds and partly out of sickness insurance funds, to 
 the wives of men on active service. Part of the 10,000,000 voted by the 
 Reichstag for war relief purposes was to be used to meet the imperial payments. 
 
 Provision for maternity benefit had previously been made to a certain 
 extent through the imperial scheme of sickness insurance ; and it was provided 
 that the new grants should be linked up with this scheme and administered 
 largely through the sickness insurance societies not always, as experience 
 showed, with the best results. 
 
 (19) Maternity benefit under the Imperial Insurance Law. The Imperial 
 Insurance Law of 1910 provided for the compulsory payment of money benefit 
 (equal to sickness benefit) in respect of confinement to all insured women for 
 eight weeks, at least six of which were to be after the confinement. In 
 addition, the discretionary powers conferred upon societies enabled them : 
 
 (a) With the consent of the insured woman : 
 
 (i) to provide nursing and attendance in a maternity home 
 
 instead of giving money payments ; 
 (ii) to provide domestic help in the home, and for this purpose 
 
 to retain one-half the money payment. 
 
 (b) To provide free medical or midwifery attendance for all insured 
 women. 
 
10 
 
 (c) To pay sickness benefit during pregnancy for a period of six weeks, 
 and to provide medical or midwifery attendance, where necessary, 
 during the same period. 
 
 (d) To pay an allowance equal to half sickness benefit for breast-feeding 
 for twelve weeks. 
 
 (e) To extend maternity benefits to the uninsured wives of insured men. 
 
 The number of insured women was added to in 1910 by the inclusion of 
 domestic servants, farm hands, casual workers, and workers in all industries 
 carried on at home. These persons were, however, insured in separate societies, 
 and in their case the sickness societies were required to pay maternity benefit 
 for four weeks only, although they had power to pay for eight weeks if they 
 wished. The number of women brought into insurance was further extended 
 by an Order of the 1st of January, 1914. 
 
 Societies generally were reluctant to make use of their discretionary 
 power to give additional benefits (which, of course, were generally possible 
 only with additional premiums), although constantly urged to do so by social 
 reformers and philanthropic organisations. Statistics for the Grand Duchy 
 of Hesse, quoted in March 1914, as being exceptionally satisfactory owing 
 to the efforts of the Infant Welfare Association, showed that, .at that date, 
 of the 133 sickness societies in the Grand Duchy, 85 had introduced additional 
 benefits for their insured women members. Of this number, 58 gave medical 
 and midwifery attention at confinement ; 44 medical treatment during 
 pregnancy ; while 17 gave an allowance for breast-feeding. Thirty-six societies 
 had extended some or all of these benefits to the uninsured wives of insured 
 men. 
 
 (20) Position of the sickness insurance societies on the outbreak of war. 
 It was feared that the economic changes brought about by the war would 
 have so adverse an effect upon the funds of sickness insurance societies that 
 it would be necessary to limit their payments as far as possible in order to 
 insure their stability. An imperial Emergency Law was therefore passed on 
 the 4th August, 1914, which restricted payments out of the funds of sickness 
 societies to the compulsory benefits provided for under the Insurance Law, 
 and suspended all additional benefits for the duration of the war. The result 
 of this Law was that the only benefit received by insured women at maternity 
 was the money benefit, equal to sickness benefit, for eight weeks or four weeks, 
 as the case might be. Medical attendance during pregnancy and at confinement 
 ceased to be provided, and all breast-feeding allowances were stopped. 
 
 It soon became evident, however, that the funds of sickness insurance 
 societies had not suffered to nearly the extent feared, and that it would be 
 safe to allow them to resume some part at least of their burden. 
 
 Since the number of insured women was small relatively to the total number 
 of those needing help during the war, and the number of those entitled to 
 more than minimum benefits much smaller still, a provision which benefited 
 insured women only would have been wholly inadequate. It was agreed that 
 all wives of soldiers, whether insured or not, must receive assistance. 
 
 (21) Institution of imperial grants. The Federal Order authorising the 
 imperial grants appeared on the 3rd December, 1914. It provided for the 
 payment of the following allowances : 
 
 (a) A single payment of 25s. towards the expenses of confinement. 
 (6) An allowance of Is. daily, including Sundays and holidays, for 
 eight weeks, at least six of which must be after the confinement. 
 
 (c) A grant up to 10s. for medical attendance during pregnancy, if 
 needed. 
 
 (d) An allowance for breast-feeding at the rate of 6rf. a day, including 
 Sundays and holidays, for twelve weeks after confinement. 
 
11 
 
 The sickness insurance societies had power to substitute medical or 
 midwifery attendance for (a) and (c), with the consent of the insured woman. 
 Under the Order three groups of women were entitled to benefit : 
 
 Group I. Women who were given a claim to maternity benefit 
 under the Federal Order, but did not come within the sickness insurance 
 law ; that is, non-insured wives of insured soldiers. 
 
 Group II. Women who were given a claim to maternity benefit 
 under the Federal Order and also came within the sickness insurance 
 law ; that is, insured wives of insured soldiers. 
 
 Group III. Women who came within the sickness insurance law, but 
 were not given a claim under the Federal Order (except that their 
 insurance rights were extended) ; that is, insured wives of non-insured 
 soldiers, or of men not serving in the war. 
 
 W^omen in Group I received the payments exactly as set out above. The 
 highest sum which could be received by any woman in Group I was 6 13s. Od. 
 
 Women in Group II might receive a higher maternity allowance than 
 Is. a day, if insured for more, but were not to receive less ; the other payments 
 were the same as in Group I. 
 
 Women in Group III might receive a lower maternity benefit than Is. a 
 day if insured for less ; the other payments were the same as in Group I. 
 
 All three groups were to receive their allowances through the sickness 
 insurance societies of which either they or their husbands were members. 
 
 The following table shows how the cost of grants is met in the case of each 
 group : 
 
 
 Imperial Funds. 
 
 Funds of Sickness 
 Insurance Societies. 
 
 - 
 
 Group I 
 Group II 
 
 Group III 
 
 All payments. 
 All payments except the 
 maternity allowance (b) . 
 
 
 The maternity allowance (b). 
 All payments. 
 
 
 In order to help societies to bear the extra burden thrown upon them by 
 the Imperial Order, it was arranged that they should be able to obtain loans 
 from the State Insurance Institutions for invalidity insurance at a low rate 
 of interest, the loans to be repayable within ten years. 
 
 (22) New classes included. In deference to the widely expressed opinion 
 that the imperial maternity grants ought to be extended to the wives of men 
 not eligible for insurance, e.g., small craftsmen and tradesmen, a further Order, 
 issued in April, 1915, extended the grants to : 
 
 (i) All soldiers' wives who were receiving separation allowances,* and 
 (ii) Soldiers' wives of small means, whose husbands were not insured. 
 " Small means " were interpreted as a combined income of not more than 
 125 or, after the husband had gone, an income of not more than 75 for the 
 wife and 12 10s. Qd. for each child under 15 years of age. 
 
 A woman coming within class (ii) receives only the money allowance for 
 eight weeks, unless there is evidence that she needs further help. 
 
 The allowances to these additional classes of women could not be paid 
 through the sickness societies, as neither the women themselves nor their 
 husbands were insured persons. The investigation and payment of their 
 claims was therefore entrusted to the local bodies who are responsible for 
 paying the imperial allowances to soldiers' families. 
 
 * As previously s.tated, soldiers' wives do not receive separation allowances as a matter 
 of course. 
 
12 
 
 The cost of the allowances to these additional classes of women is borne 
 entirely by imperial funds. 
 
 The increased separation allowance and the maternity grant were not 
 considered enough to enable women to meet the cost of living. By a Federal 
 Order of the 6th June 1917 the maternity grant of Is. a day for eight weeks 
 was raised to Is. 6d. 
 
 A Federal Order of 6th July, 1917, extended the imperial maternity grants 
 to women whose husbands were employed on patriotic auxiliary service, and 
 who were not entitled to the grants under earlier Orders. In these cases, 
 applicants for the grant were required to prove that the economic position 
 of the husband had been impaired by his employment on patriotic service, 
 and that they were in need of the assistance. This last condition was to be 
 determined with reference to an income limit. 
 
 Women who were themselves employed on patriotic auxiliary service were 
 entitled to grants, provided the joint income of husband and wife was below 
 a certain amount. 
 
 The cost of the grants in these cases is divided between the sickness insurance 
 societies and imperial funds in the same way as the allowances to the wives 
 of soldiers: 
 
 The results of the imperial maternity grants and some comments on their 
 administration are stated in the next chapter. 
 
 VI. INFANT WELFARE WORK. 
 
 (a) BEFORE THE WAR. 
 
 (23) The beginning of the infant welfare movement. Until the close of the 
 last century, most of the work done for the welfare of infants was institutional 
 in character ; for example, orphanages, children's hospitals, convalescent 
 homes, etc., were set up in which children deprived of parental care, or needing 
 medical attention and nursing, were received. A number of creches were 
 also in existence. 
 
 In the early years of the present century a new movement was begun. 
 Previous efforts had been directed to remedying defects rather than removing 
 causes, and did not by any means cover the whole ground of infant protection. 
 Those who led the new movement realised that in future a new aim must be 
 given to infant welfare work. The infants cared for in institutions were after 
 all only a small proportion of those whose lives were endangered by improper 
 feeding or other harmful conditions. If all these were to be reached, the aim 
 must be to set the mothers themselves on the right road by giving them advice 
 and help in rearing their infants ; the new developments must be non- 
 institutional in character, and must not involve the separation of the children 
 from their mothers. 
 
 Efforts to promote the well-being of infants and young children in the 
 past had been almost entirely dependent upon charity; but, as the new move- 
 ment developed, it became clear that the care of mothers and infants was too 
 large a question to be left entirely to private benevolence, and that the State 
 and the municipality must take their due share of the burden. 
 
 An impetus was given to the development of infant welfare work by the 
 International Congress on the " Gouttes de Lait " in Paris in 1905. The few 
 German delegates who attended this congress were impressed by the accounts 
 given of the organised infant welfare work which was being done in France. 
 Much interest was aroused in the movement, and by the time the second 
 International Congress met in Brussels in 1907 the " Imperial Association for 
 
13 
 
 the Care of Infants " had been formed in Germany with the object of encourag- 
 ing, organising and directing the development of infant waif are jwork in all 
 parts of the empire. 
 
 (24) Infant welfare associations. The most important feature of the new 
 movement was the formation of local societies, chiefly in the large towns, 
 for promoting infant welfare, and the establishment by the societies of infant 
 welfare centres. In 1915 there were nearly 800 such centres, distributed 
 among the areas of 550 local authorities. 
 
 Central associations for directing infant welfare work have been set up 
 in all the larger States and in many of the smaller divisions of the empire. 
 Prussia and Saxony were the first to take this step in 1907, and Bavaria 
 followed in 1908. The Grand Duchy of Mecklenburg-Schwerin set up a central 
 association as recently as March, 1917. 
 
 The Imperial Association for the Care of Infants keeps in touch with all 
 these State associations. 
 
 (25) Breast-feeding allowances. The encouragement of breast-feeding by 
 means of allowances in money and kind has been regarded in Germany as one 
 of the most powerful means of furthering infant welfare. In the reports of 
 many centres reference is made to the increasing amounts disbursed year by 
 year before the war in the form of such allowances. Some leaders in infant 
 welfare work go so far as to say that the giving of breast-feeding allowances 
 is the sole secret of the successful working of a welfare centre. 
 
 Objections have been raised to the policy, especially to the giving of money, 
 on social grounds, and some welfare associations, that of Hesse-Nassau for 
 instance, did not adopt the practice ; but it is defended by its advocates as 
 the only means of helping a poor mother to fulfil her natural duty, and as 
 the most powerful inducement to mothers to bring their infants regularly to 
 the centres. 
 
 (26) Municipal infant care work. Infant welfare work is now, in many 
 towns, a branch of municipal activity, the expense of the centres, visitors, etc., 
 being borne partly or wholly by municipal funds. In Berlin there are nine 
 centres controlled by the municipality, one of which is a children's clinic. 
 In Cologne there are thirteen centres, and in Leipzig six. Generally speaking, 
 the work was initiated by private societies and afterwards taken over by the 
 municipality. In some towns the centres are under the control of a welfare 
 association, on which various public bodies and societies are represented, and 
 financial help is given by the municipal authority. 
 
 Many large towns made special grants out of municipal funds towards the 
 allowances given by the centres for breast-feeding. Considerable sums have 
 been contributed in this way out of public money by municipal authorities. 
 For instance, Cologne's first payments for this purpose were made in 1908, ' 
 when a sum of 1,192 was allotted ; the contribution increased yearly, until 
 in 19H it amounted to 2,248. 
 
 (27) Co-operation of sickness societies. In many instances the local sickness 
 societies made grants to the welfare centres in return for the supervision of 
 maternity cases which have a claim upon the societies. For example, in 
 Chemnitz the District Sickness Society introduced breast-feeding allowances 
 as an additional benefit at the beginning of 1914, arid made an agreement 
 with the Infant Welfare Association to supervise, through its welfare centre, 
 all mothers who claimed the benefit, and to give certificates to those who 
 carried out the conditions. In return for these services the sickness society 
 was to make a grant of 150 a year to the Infant Welfare Association. 
 
 In Berlin, Frankfort and other large towns where good results of infant 
 welfare work are recorded, a considerable measure of co-operation between 
 the infant welfare workers and the sickness societies has been achieved. 
 
14 
 
 (28) Co-operation ofmidwives. The importance of securing the co-operation 
 of mid wives in infant welfare work has not been overlooked. The midwives 
 as a body were inclined to show hostility to the movement in its early stages, 
 and this spirit has by no means yet disappeared. In some towns the centres 
 have adopted the plan of paying a small fee to the midwives in respect of 
 every mother whom they persuade to attend the centre. 
 
 Plans are being discussed for including instruction in infant care in the 
 courses of training for midwives. 
 
 (29) Infant welfare work in the country. An interesting example of infant 
 welfare work in a country district is that carried out by Dr. Eidam, as medical 
 officer for the district of Gunzenhausen, about thirty-rive to forty miles south 
 of Nuremberg. Dr. Eidam observed that the visit for the purpose of vaccination 
 was often the only opportunity the doctor had of coming into contact with 
 the mother of a young infant. He therefore induced the doctors to use this 
 opportunity to impress upon mothers the importance of breast-feeding their 
 infants, and to give any other advice that seemed necessary. At the same 
 time the doctor filled up a form showing how each child was being fed, and 
 forwarded it to Dr. Eidam. It was also arranged for the midwives in the 
 district to visit mothers whom they had attended until the infant was nine 
 months old, and to report at intervals as to the manner of feeding. A small 
 fee was paid to the midwives by the district authorities for this service. 
 Dr. Eidam stated that, after seven years' work on these lines, the number 
 of breast-fed infants had increased from 60 to 80 per cent., and the infant 
 death-rate of the district had been reduced. 
 
 (b) DURING THE WAR. 
 
 (30) Effect of mobilisation on infant welfare work. The outbreak of war 
 and consequent mobilisation caused a sudden interruption of infant welfare 
 work in nearly all towns. In a large number of instances the doctor in charge 
 of the work was called up for military service, or the welfare workers were 
 taken for army nursing, and the centres had to be closed. Many of the 
 institutions for infants were turned into military hospitals. , In the Grand 
 Duchy of Hesse, for instance, one-fourth of all the centres were closed, 
 and an infants' home in Darmstadt was turned into a military hospital. 
 In Cologne five of the fourteen centres were closed ; one of the buildings has 
 been used as a military hospital ever since ; the others were re-opened after 
 intervals of from two to six months. In Kiel the medical superintendent was 
 mobilised, while the larger of the two infants' homes was closed and offered 
 to the military authorities on the 5th August ; towards the end of September 
 the authorities decided not to accept the building, and the home was re-opened 
 for the reception of infants. 
 
 Some centres which remained open were obliged to cut down the number 
 of consultations for want of doctors or nursing staff. 
 
 Many centres which continued their work as usual report that the attendance 
 of mothers fell off very considerably during August and September. This 
 was partly accounted for by the fact that many families moved to the country 
 when the father went into the army ; foster children were also in many cases 
 taken to grandparents in the country as soon as they were old enough. In 
 only one case, Charlottenburg, was a better attendance than usual noted in 
 August and September, 1914. 
 
 It is reported from some centres that their visitors rarely found the mothers 
 at home during the first few weeks of the war ; they were generally wandering 
 about, watching and waiting for military events. It would seem that the 
 excitement and general unrest which followed on mobilisation had a most 
 harmful effect upon the health and well-being of infants of all classes. Many 
 mothers, even among the well-to-do, are said to have neglected their infants 
 at this time, and in many instances mental distress deprived mothers of the 
 power to feed their infants at the breast. 
 
In Mannheim the municipal creche, which was usually closed during 
 August, was specially kept open after the outbreak of war, as it was believed 
 that an unusual number of children would need to be cared for while the 
 mothers went out to work ; but, contrary to expectation, very few children 
 were brought to the creche during August and September. 
 
 (31) Revival of infant welfare activity. For a time the mobilisation of the 
 fighting forces seems to have absorbed all the attention, and the. welfare of 
 the mothers and children left behind was almost forgotten. In a letter addressed 
 to the Imperial Association for the Care of Infants, on the 12th of August, 
 the Kaiserin pointed out that it would be a fatal mistake to allow infant 
 welfare work to lapse, or its institutions to be crippled, even for military 
 considerations. 
 
 The alarm occasioned by the sudden inc\^ase in infant mortality during 
 the first months of war led to efforts being mVdj in all directions to revive 
 and extend infant welfare work. 
 
 Leading infant welfare workers protested against the withdrawal for army 
 service of nurses skilled in infant care ; as a result of their representation 
 nurses were gradually released by the military authorities and allowed to 
 return to their former work. 
 
 After a time most infant welfare associations found themselves able to 
 carry on their primary functions, even though travelling courses for instruction, 
 exhibitions, the training of nurses, etc., could not at once be resumed. 
 
 Early in 1915 the Imperial Association for the Care of Infants issued an 
 appeal to all its affiliated associations urging them to continue and, if possible, 
 to extend their activities, in view of the increasing number of mothers who were 
 obliged to go out to work in order to support their families. 
 
 (32) Extension of infant welfare work. There has been a great extension 
 of infant welfare work generally during the last two years. New associations 
 have been formed and centres opened in a number of towns where none 
 previously existed. Here and there schemes have been inaugurated in rural 
 districts. Skilled welfare workers are now greatly in demand, and numerous 
 special training courses have been established to increase the supply. The 
 municipality of Charlottenburg, for instance, has lately arranged courses for 
 both paid and voluntary workers. The need is so urgent that many volunteers 
 are obliged to take up their new duties with very little preparation. 
 
 The Prussian Government have recently instituted a scheme for granting 
 diplomas, similar to those granted to nurses, to infant welfare workers who 
 have taken a regular course of training and passed a prescribed examination. 
 The examinations are to be conducted under the direction of the President 
 of each Government District on lines laid down by the Ministry of the Interior. 
 
 (33) Care of young children. The importance of caring for children above 
 the age of infancy, children from one to five years of age, had been recognised 
 by welfare workers before the war, especially in view of the fact that there had 
 been little or no reduction in the death-rate of children between these ages 
 in recent years. Under the difficult conditions as to food prevailing during 
 the war, young children are specially likely to suffer. The scarcity of milk, 
 flour, fat, etc., affects them adversely. For these reasons many welfare centres 
 have made arrangements to look after children up to a higher age than formerly. 
 The Imperial Association for the Care of Infants decided at the close of 
 1916 to bring young children within its scope, and it is now urging all its 
 affiliated associations to keep children under observation up to five years of 
 age. The Central State Office for Infant Care in Bavaria resolved at its last 
 general meeting to extend its care functions to young children. 
 
 (34) Ante-natal work. Ante-natal care is one of the most recent develop- 
 ments of infant welfare work. A beginning has been made by setting up, 
 in connection with the welfare centres, clinics where expectant mothers may 
 
16 
 
 receive advice and treatment, and the need for extending this branch of the 
 work is generally recognised. It is stated that very few women claim the 
 allowance provided for in the imperial maternity grants (any sum not exceeding 
 10s.) for medical or midwifery attendance during pregnancy. The sickness 
 insurance societies of several large towns report that their total payments 
 for this purpose during 1916 amounted only to a negligible sum (4 4s. in the 
 case of Nuremberg and 16s. in that of Weimar). 
 
 Considerable sums have been spent in some towns on special nourishment 
 for expectant mothers. In Magdeburg a scheme was organised in the early 
 days of the war under which private persons undertook to provide dinners 
 for expectant mothers in needy circumstances, the town being divided into 
 twenty districts for this purpose. 
 
 (35) An imperial fund. In the spring of 1916 a movement was set on foot 
 by the leaders of infant welfare work in Berlin to form an Imperial Fund 
 (" Deutsche Spende ") for the support of infant welfare work in all parts of 
 the empire. It was arranged that the money collected in each individual 
 State should be handed over to the Central Association for the Care of 
 Infants in that State. Where no central association existed the money was 
 to be used, first of all, in establishing one. In urging the claims of this fund 
 upon public attention, it has been repeatedly pointed out that the organisation 
 of infant welfare work is by no means evenly distributed in all parts of the 
 empire. In some places very little is done, and in many large areas no attention 
 at all is paid to the subject. 
 
 (36) Infant welfare work in the country. Many thoughtful persons are 
 well aware that an infant welfare campaign is needed in the country districts. 
 It is generally recognised that the methods adopted in the towns are impossible 
 in the country, owing to the long distances which mothers would have to 
 travel to reach the centres or the health visitor to go to them. The scheme 
 adopted in one country district of Bavaria has already been described. Various 
 other suggestions have been made, such as : 
 
 That infant welfare associations in the towns should endeavour to 
 extend their area of work to surrounding rural districts. This plan has 
 recently been adopted in a few cases, for example, Chemnitz ; 
 
 That instruction should be given to the elder girls in the elementary 
 and secondary schools, the' necessary courses being first of all provided 
 for the teachers in training schools and elsewhere ; 
 
 That the assistance of the Press should be enlisted, and paragraphs 
 and articles inserted in parish magazines, mission leaflets, etc. The 
 almanack which finds a place in every home in country districts might 
 also be utilised ; 
 
 That more thorough training should be provided for midwives, 
 and a better class of woman attracted to the work by raising the standard 
 of the profession and guaranteeing a minimum salary out of public 
 funds ; 
 
 That small but well-equipped maternity homes should be established 
 at convenient centres for country districts. (In the whole of the 
 provinces of East and West Prussia there were only seven such institu- 
 tions in 1909, with a total provision of just over 200 beds) ; 
 
 That teachers should be appointed to go from village to village to 
 give simple courses of instruction. 
 
 (37) Demand for imperial law. Towards the close of 1916 a conference 
 was called by the leaders of infant welfare work, at which representatives of 
 the Imperial and Prussian Governments were present, to consider proposals 
 for setting up infant welfare organisations in every local authority's district 
 throughout the empire, and to urge the need for an imperial law making the 
 adoption of infant welfare measures compulsory upon all local authorities. 
 
17 
 
 Stress was laid upon the harm done to the whole community by the neglect 
 of so many local authorities to take steps in this direction, the good effect 
 of the work done by progressive districts being counteracted by the indifference 
 of the others. 
 
 This demand for a general law has met with a considerable degree of 
 support, but the proposals made have not yet materialised. 
 
 (c) WELFARE CENTRES AND THE IMPERIAL MATERNITY GRANTS. 
 
 (38) Effect of the grants on infant welfare work. The appearance of the 
 Order relating to maternity grants was hailed by some leaders in infant welfare 
 work as " the greatest social event of the war," and as " the first sign of 
 imperial concern for the welfare of mothers and infants." It was confidently 
 hoped that the imperial allowances would strengthen the hands of welfare 
 workers in their efforts to revive and to extend the breast-feeding of infants 
 generally. 
 
 A little experience of the working of the Order, however, produced a change 
 of tone. The welfare centres, many of which had hitherto given allowances 
 in money or kind to mothers who breast-fed their infants, had been able to 
 impose a condition that the mother should bring the child regularly to the 
 centre and observe its rules. Under the new Order the sickness insurance 
 societies were required to distribute the imperial grants to all who had a legal 
 claim, and it was left to the societies to decide what evidence, if any, they 
 would require that a mother was really breast-feeding her infant. 
 
 When mothers became entitled to receive the allowances direct from the 
 sickness insurance societies the effectiveness of the welfare centres was seriously 
 undermined. Attendances fell off rapidly, and mothers and infants were thus 
 deprived of beneficent influence. 
 
 Many prominent persons urged that the allowances for breast-feeding 
 should be made through the welfare centres, and should be conditional upon 
 regular attendance. A petition in this sense was made to the Government, 
 but the Minister who replied stated that it would be contrary to all precedent 
 to impose such a condition. He suggested that the infant welfare centres 
 should offer a further allowance out of their own resources to be given after 
 the lapse of the v twelve weeks covered by the imperial grant, on condition 
 that the infant was brought regularly to the centre and the rules of the centre 
 observed during the whole period. The Government also suggested to the 
 sickness insurance societies that they should notify the infant welfare associa- 
 tions of every case in which an allowance was being paid, and direct the mothers 
 to go to welfare centres for help and advice. 
 
 (39) Administration of grants through centres. Some infant welfare associa- 
 tions had already realised that the only way to turn the imperial grants to 
 good account was to secure that the sickness insurance societies should work 
 in close touch with them. In the majority of cases where infant welfare 
 work was well organised, those who directed it approached the societies with 
 the proposal that the breast-feeding allowances should be paid by the societies 
 only to those mothers who produced a certificate from the welfare centre 
 stating that they were fulfilling the condition. It would seem that in course 
 of time the sickness societies in most towns where infant welfare associations 
 existed came to some agreement of this kind, and that in many cases they 
 were willing to make a suitable payment to the welfare centres for performing 
 this duty. In some instances negotiations occupied six or eight months ; 
 in others the smaller societies only refused to come into line ; this happened 
 in Berlin. 
 
 In a number of cases the centres themselves give allowances, out of their 
 own funds or out of municipal grants, to mothers who have no claim to the 
 imperial grants, and further premiums to those who have a claim, if they 
 continue to breast-feed their infants after the three months. These latter 
 
18 
 
 payments often take the form of a single payment at the end of one or more 
 fixed periods. Thus, in Cologne, 6s. is given at the end of the fifth month 
 and a further 10s. at the end of the ninth month. In Mannheim 3s. is given 
 at the end of the fourth month. In another instance 6s. is given at the end 
 of the sixth month, and an additional 5s. at the end of the eighth month. 
 
 It is definitely stated in a few cases that agreements with regard to the 
 supervision of nursing mothers were made between the local bodies who pay 
 the separation allowances and the infant welfare associations ; and it is probable 
 that such agreements are fairly general, especially where infant welfare work 
 is municipally controlled or assisted. 
 
 Where no welfare association existed, or where there was no co-operation 
 between the association and the societies, the latter appear frequently to have 
 contented themselves with a certificate from the midwife that the applicant 
 was breast-feeding her infant. 
 
 In some towns and districts where the sickness insurance societies do not co- 
 operate with the infant welfare societies it is reported that the imperial grants 
 are largely wasted or misspent by the mothers, instead of being expended on 
 nourishing food for themselves or their infants. The hope is still expressed 
 in many quarters that some way may be found of compelling the societies 
 in every district to work with the welfare centres in distributing the grants. 
 
 While there is complaint that the sickness insurance societies do not all 
 work in harmony with the infant welfare movement, it is clear that the district 
 societies in some of the large towns are doing good work on behalf of their 
 members who claim maternity benefit. Agreements have been made with 
 maternity homes so that mothers can if they wish go into them instead of 
 claiming the money grants. Other societies have arranged for " home 
 helps " to look after the mother in her own home for a certain number of days 
 after confinement. In several towns, including Hamburg, the societies 
 have appointed visitors (generally midwives) to visit and advise the 
 mothers at regular intervals, and to give a certificate as to breast-feeding. 
 Many societies make periodical enquiries through their officials as to the 
 number of breast-fed infants, the period during which breast-feeding is con- 
 tinued, and the effect on the health and mortality of infants. 
 
 (40) Effect of the grants on breast-feeding. The most striking effect of the 
 imperial allowances was the great increase in the number of breast-fed children 
 among those attending the centres. A Mannheim physician said : " The 
 revival of breast-feeding, for which we have striven so long in years of peace, 
 has suddenly come to pass in the midst of the world war." Of the mothers 
 of the 4,952 children born in Mannheim during 1915, 2,463 claimed the imperial 
 maternity grants, and 92 per cent, of these breast-fed their infants at least for 
 a time. In Cologne 80 per cent, of the infants brought to the centres during 
 1915 were breast-fed. 
 
 Reports from the majority of infant welfare centres speak of a great increase 
 in the number of infants breast-fed in the first three months of life. The 
 number of women found to be unable to breast-feed their infants is very small. 
 
 Many infant welfare workers hoped that the economic conditions produced 
 by the outbreak of war would have the effect of inducing mothers to breast- 
 feed their infants. One leading authority remarks regretfully that no such 
 effect was produced among the mothers of Germany, and that nothing but 
 the hope of an allowance secured the desired result. 
 
 It is recorded from a large number of centres that mothers discontinue 
 breast-feeding immediately the imperial allowance ceases, regardless of the 
 well-being of their infants. In some cases the further allowance which the 
 centre can afford is too small in comparison with the imperial allowance to 
 induce them to go on ; in other cases no further allowance can be offered. 
 
 The general opinion is that some way should be found for continuing the 
 allowance beyond the first three months, this period not being long enough 
 
19 
 
 to protect the infant from later suffering. A number of centres report that 
 infants who were breast-fed up to three months, and then suddenly weaned, 
 were peculiarly susceptible to digestive troubles, especially where the change 
 took place during the hot weather. The tendency everywhere is for mothers 
 to cease to attend the centres when the allowance can no longer be claimed. 
 The infants are thus deprived of care and supervision at the very time when 
 they are exposed to fresh danger from artificial feeding. It seems to have 
 happened in many cases that so long as the imperial allowance was forth- 
 coming the mothers remained at home, but as soon as these payments came to 
 an end they sought some paid employment outside the home and the infants 
 were weaned and left to the care of other persons. 
 
 In Danzig it was found that the imperial maternity grants made no difference- 
 in the number of breast-fed infants, and had no influence on the death-rate 
 among the children of soldiers' wives during the year 1915. An infant 
 welfare association was started in January, 1916. Fifteen months' work,, 
 with the administration of the allowances in co-operation with the centres,, 
 brought about an increase from 40 to 60 per cent, in the number of breast- 
 fed infants ; and the death-rate among legitimate infants, which had been: 
 177 per thousand in 1914 and 159 in 1915, fell to 109 in 1916. " It is clear/' 
 says the town doctor in his report, " that money grants alone, without the 
 advice and supervision afforded by infant welfare work, could not produce 
 the desired results." 
 
 (41) Demand for continuance of grants after the war. There is a demand 
 among leaders in infant welfare work for the continuance of the imperial 
 maternity grants after the war. All are not agreed as to how the necessary- 
 funds should be raised or by whom they should be administered. The 
 sickness insurance societies do not by any means cover all the ground. Most 
 persons consider it essential that imperial or state funds should give some 
 assistance. 
 
 (d) CARE OF CHILDREN IN INSTITUTIONS. 
 
 (42) Infant welfare work and institutional care. While the new movement 
 for promoting infant welfare through the instruction of mothers and the 
 encouragement of breast-feeding is much the more important, there are still 
 a certain number of children who must be cared for in institutions of various 
 kinds infants' homes, children's hospitals or creches. The greater concern 
 for infant welfare generally has stimulated interest in these institutions, and 
 kindled a desire to bring their work into harmony with the new movement. 
 The tendency now is to connect their work as far as possible with that of the 
 welfare centres. 
 
 (43) Infants' homes. There are in Germany, as in other countries, a number 
 of orphanages and homes for infants and young children carried on by religious 
 and philanthropic societies and by private benevolence. 
 
 In addition, a number of towns have established, within the last ten to 
 fifteen years, municipal " Infants' Homes," in which infants chargeable to 
 public funds are cared for until they are old enough to be boarded out ; in 
 some instances other infants needing special care are received for a time. 
 Training schools for children's nurses are often attached to these institutions. 
 The work of the infants' homes and of the welfare centres, especially where 
 both are under municipal control, is often closely associated. 
 
 A considerable number of new infants' homes have been opened during the 
 last two years. In many cases it has been decided to keep the children in 
 the home until a later age than has hitherto been the custom, because of the 
 difficulty of boarding them out under the present food conditions. Many 
 homes now shelter the infants of mothers who are employed on war work. 
 
 (44) Children's hospitals. Some German towns have special hospitals for 
 infants and young children, generally with a children's clinic attached. Some 
 
20 
 
 of these hospitals have been in existence long enough to have accumulated 
 considerable experience and valuable records. In some cases, e.g., at Charlot- 
 tenburg and Mannheim, the municipality carries on an infants' home and a 
 children's hospital under the same medical supervision. 
 
 It may be mentioned in this connection that a large number of the general 
 hospitals in Germany are municipal. 
 
 (45) Creches and Children's Shelters. The creche is a familiar institution 
 in most German towns, especially in those where large numbers of women 
 work outside their homes. Creches are generally managed by philanthropic 
 societies, and supported by voluntary subscriptions, grants from public funds, 
 and the payments made by the mothers. Children between the ages of six 
 weeks and two to three years are admitted. 
 
 The Berlin Creche Association, for instance, has been in existence for 
 nearly forty years ; it had six creches before the war, in which provision was 
 made for more than 1,000 children. A large proportion of these children were 
 infants under one year of age. 
 
 Some municipal authorities have now their own creches, which form part 
 of the scheme of infant welfare work. 
 
 (46) Extension of creches during the war. When war first broke out a 
 number of new creches were opened in Berlin and other large towns by well- 
 meaning persons who thought that mothers of families would be compelled 
 to seek work outside their homes in large numbers. Many of these institutions 
 were located in parts of the town where they were least wanted, often in 
 unsuitable premises, and staffed by untrained and inexperienced persons ; 
 few of them were under medical supervision. The creche movement was some- 
 what discredited by these ill-advised efforts ; and much harm might have 
 been done had not most of the creches remained almost empty, as few women 
 obtained work outside their homes at once, and those who did so showed 
 little disposition to place their children in creches. Most of these mushroom 
 institutions were closed after a few months. 
 
 Later, in view of the large and increasing number of women who have 
 entered munition and other factories, the creche associations in most large towns 
 have extended their work. New creches have been opened in localities where 
 they are needed. Several were started in Berlin during 1916, and the number 
 of children looked after was increased by more than 400. Arrangements 
 have been made for some of the creches to be kept open at night to take charge 
 of the children of women working on night shifts. 
 
 In Barmen a room has been set aside in the municipal creche for the use 
 of mothers who come in the intervals of work to nurse their children, and 
 a cup of hot soup is provided for them at each visit. 
 
 The employment of increasing numbers of women in industry gives rise 
 to much anxiety among infant welfare workers. It is urged in some quarters 
 that mothers should not be allowed to work for three months after the birth 
 of a child, and in others that the mothers of young infants should at least 
 be prohibited from working on night shifts. Not much heed is paid to these 
 suggestions ; on the contrary, more and more women are drawn into factory 
 work. The leaders in infant welfare work press for the establishment, either 
 by the military or the civil authorities, of creches in or near every place where 
 fifty or more women are employed, and for regulations which will allow the 
 women time to suckle their infants at suitable intervals without loss of pay. 
 
 In response to these demands the Women's Division of the Patriotic 
 Auxiliary Service Office has made a special effort to induce creche associations 
 to establish creches in the vicinity of every factory where a number 
 of women are employed. Employers are being urged to afford the use of 
 suitable premises for creches, and to contribute towards the expense of 
 maintaining them. In many cases they have given material help. The 
 War Bureau has set aside certain sums of money towards paying the salaries 
 
21 
 
 of superintendents of creches and children's shelters in connection with war 
 industries. It has been arranged that a contribution shall be made to creches 
 established for women employed in State workshops ; the mothers themselves 
 will make some payment. 
 
 It is hoped that the provision of creches will act as an inducement to women 
 to volunteer for " work of national importance " ; but the mothers as a rule 
 seem very unwilling to commit their children to the care of these institutions, 
 preferring wherever possible to leave them in the charge of relatives or neigh- 
 bours. Various plans have been put forward for overcoming the prejudice 
 of the mothers. It is suggested that each member of the creche committee 
 should make herself responsible for a particular child or children, and that 
 the advantages of the creche from a sanitary and educational point of view 
 should be carefully and sympathetically explained to the mothers. It is 
 feared that the children may suffer through being left to the care of neighbours, 
 especially in view of the food difficulties. Some writers insist that a licence 
 should be required by persons who undertake to look after children during 
 the day in return for payment, and that their dwellings should be under 
 inspection. A measure of this kind has been for some time in operation 
 throughout the Government District of Diisseldorf . 
 
 (e) CARE OF ILLEGITIMATE CHILDREN. 
 
 (47) Percentage of illegitimate births. The general rate of infant mortality 
 in Germany is greatly influenced by the high percentage of illegitimacy. 
 
 In the whole of the German Empire the proportion of illegitimate births 
 is between 9 and 10 per cent. In certain districts the rate is much higher. 
 The proportion of illegitimate births fell significantly in the decade immediately 
 following the Franco-Prussian War, and rose again in the next decade. The 
 average for each of the following two decades has shown some decrease. 
 
 If, however, the figures for each year since 1900 be taken, it will be seen 
 that the lowest figure was reached in 1903 (when it was 8-3 per cent.), and that 
 from that date up to 1912 (when it was 9-5 per cent.) there has been a gradual 
 but steady increase in the percentage of illegitimacy (Table M). This increased 
 proportion of illegitimate births is due to a more rapid decline in the legitimate 
 than in the illegitimate birth-rate, and not to an actual increase in the number 
 of illegitimate births. 
 
 (48) Mortality among illegitimate infants. The death-rate among 
 illegitimate infants is much higher than among the legitimate. As will be 
 seen in Table N, the effect of this high mortality among the illegitimate is 
 to bring the general infant death-rate up to about 10 per thousand above the 
 rate for legitimate infants. The increasing proportion of illegitimate births 
 acquires additional importance in view of the higher mortality among them. 
 
 (49) Measures for the protection of illegitimate children. The problem of 
 caring for illegitimate children had received attention in Germany long before 
 the beginning of the infant welfare movement, but it is only in recent years 
 that the need for comprehensive measures on their behalf has been fully 
 realised. Organisations whose special object was to care for illegitimate 
 children claim to have shown the way to modern infant welfare work ; on 
 the other hand, infant welfare workers could not fail to be impressed by 
 the striking differences in the death-rates of legitimate and illegitimate 
 infants, and they have urged that every possible means should be taken to 
 prevent the high mortality among the latter. The two movements appear 
 to have reacted upon each other to the advantage of both. 
 
 In the course of the present century most of the States have introduced 
 laws providing for some measure of guardianship for illegitimate children. 
 The first step generally was to give to the directors of public educational and 
 poor law institutions legal guardianship over the children therein maintained, 
 the guardianship continuing until the children were of full age, even though 
 they might have left the institution. 
 
In some States, e.g., Prussia, Baden and Hesse, later legislation provided 
 that all children maintained out of public funds should be placed under 
 guardianship, whether boarded out with relatives or foster-mothers, or supported 
 in institutions. In Bavaria and Saxony the law provides for the supervision 
 of all illegitimate children, whether maintained out of public funds or not. 
 Hamburg has adopted the same measure. 
 
 The application and extension of these measures was left to individual 
 towns and local authorities. Leipzig, for instance, was the first town to 
 institute a scheme under which paid doctors and nurses were appointed to 
 watch over all illegitimate children. In Dresden, Chemnitz and Strassburg 
 similar arrangements were afterwards made. There are still, however, a 
 large number of places where nothing is done in this direction ; for this reason 
 social reformers put forward a plea that the law as to caring for illegitimate 
 children should be made uniform and compulsory throughout the empire. 
 
 In most of the towns mentioned above, and in a number of others, the 
 guardianship of illegitimate children is now exercised by a body composed 
 partly of officials and partly of persons representing educational and philan- 
 thropic organisations interested in the welfare of children. Many of these 
 local bodies have united to form a central union, known as the " Registry of 
 Guardianship," which serves as an exchange for the experiences and opinions 
 of the local bodies. A number of guardianship committees in Austria-Hungary 
 and Switzerland are affiliated to this central body. 
 
 In some towns where infant welfare work is carried on, the official guardians 
 now arrange with the infant welfare centres to supervise infants coming under 
 their care. There is a scheme of this kind in Berlin. 
 
 One of the functions of the official guardians is to recover payments towards 
 maintenance from the fathers of illegitimate children. As an illustration 
 it may be mentioned that the Berlin official guardianship, which was established 
 in 1912, had under its care at the end of its second year nearly 5,000 children, 
 and had received on their behalf upwards of 50,000. 
 
 The steps by which official guardianship is gradually extended to all 
 illegitimate children may be illustrated by the example of Mannheim. It 
 will be seen that in Mannheim, as in other places, the period of this gradual 
 extension coincided with the growth of the wider movement for promoting 
 the welfare of all children. 
 
 In 1903 the municipal authority of Mannheim appointed a doctor to examine, 
 and treat if need be, all foster children free of charge. Foster mothers were 
 required to bring the children regularly to the doctor ; children under one year 
 not less often than once a month. It was also arranged that the women 
 poor law visitors should visit all foster children under one year of age once a 
 fortnight in the home of the foster parents. 
 
 In the following year all children maintained at the public expense were 
 placed under legal official guardianship, whether maintained in institutions 
 or boarded out. 
 
 In the course of time it became clear that the supervision of these particular 
 classes of illegitimate children was not sufficient, since a large proportion 
 escaped supervision because they remained either in the mother's family 
 or in the charge of other relations without special payment. The municipal 
 authority determined in January, 1913, to set up complete supervision over 
 all illegitimate children. The provisions of the Order relating to medical 
 and nursing care were at the same time extended to all such children. 
 
 Mannheim supports, in addition, an infants' home in which infants reared 
 at the cost of the town are kept until they are old enough to be boarded out 
 in private families. 
 
 (50) Influence of the war on illegitimate children. On the outbreak of war 
 the care of foster children was interfered with in many instances by the 
 mobilisation of the doctors appointed to look after them. 
 
23 
 
 Provision for illegitimate children generally became more difficult, because 
 during the war no action could be taken against soldiers for the recovery of 
 sums towards the maintenance of their children, and it was impossible to take 
 legal action to establish paternity. 
 
 As the war went on, however, the various forms of guardianship over 
 illegitimate children which had been instituted before the war appear to have 
 been exercised with greater closeness and care than formerly, although there is 
 still great variation in this matter between one town and another. A Chariot - 
 tenburg writer notes with satisfaction that since the war a larger number of 
 illegitimate children have remained under the care of their own mothers than 
 previously, and that this is a great advantage to them, especially in the early 
 months. He thinks that this is partly because unmarried mothers show 
 more affection for their children in time of war than in time of peace ; but 
 economic influences may also have been at work, since the same writer attributes 
 the decrease in the number of boarded-out children to the fact that the high 
 cost of food leaves little or no profit for the foster parents out of the payments 
 made by the State or by the mothers, while the mothers find it more economical 
 to keep their children with them than to increase the payments. 
 
 Another reason for the improvement in the lot of illegitimate children 
 is that many well-to-do persons have adopted children in war time who would 
 not have done so in time of peace. 
 
 Reports from several towns state that the number of illegitimate children 
 has been reduced by numerous " war marriages," the children then becoming 
 legitimate. 
 
 In Breslau it was decided, early in 1917, to give assistance from 
 municipal funds to unmarried mothers who wish to bring up their children 
 themselves. Allowances will be given to the mother while learning a trade, 
 and tools and implements supplied where needed. The assistance thus given 
 will not be counted as poor relief. 
 
 (51) Separation allowances for illegitimate children. Immediately after 
 the passing of the law of 4th August, 1914, as to separation allowances, the 
 Registry of Guardianship and several other philanthropic societies petitioned 
 the Government to extend the allowances to the illegitimate children of 
 soldiers, and on the 3rd September following it was announced that the 
 Government had decided that the allowances should be extended to such 
 children, provided the responsibility of the father for their maintenance had 
 been legally established. 
 
 As, in consequence of the war, no legal cases could be dealt with or 
 documentary evidence obtained, a large number of illegitimate children 
 were at first deprived of the advantage of these provisions. The need for some 
 more elastic arrangement was urged upon the Government, and in March, 1915, 
 uniform regulations were made by all the Federal States according to which 
 the claims of illegitimate children to allowances were to be granted on condition 
 that the obligation of the father to maintain the child had been established, 
 but without requiring strict legal formalities. It was sufficient for the father 
 to have acknowledged paternity or to have contributed towards the child's 
 maintenance. 
 
 (52) Imperial maternity grants for the mothers of illegitimate children. 
 The imperial maternity grants were not at first (in December, 1914) given to 
 the mothers of the illegitimate children of soldiers, but by the amending order 
 of April, 1915, the benefit of the grant was extended to unmarried mothers, 
 provided proof was forthcoming that the father was serving in the army. 
 A letter to the mother was to be considered sufficient evidence. 
 
 (53) Mortality among illegitimate children during the war. The special 
 measures taken on behalf of illegitimate children have had the effect, in some 
 cases, of bringing about a greater relative improvement in the death-rate 
 among illegitimate infants than among the legitimate. Leipzig, Chemnitz 
 
24 
 
 and Strassburg may be mentioned as examples of this. Thus, in Leipzig, 
 while the rate of infant mortality for legitimate children improved a little 
 in 1915 as compared with 1914 the rate for illegitimate children was reduced 
 by about one-third. 
 
 In the Diisseldorf Government District the mortality rate among illegitimate 
 infants in 1915 was the lowest on record, viz., 217 per thousand, as compared 
 with 255 in 1914 and 238 in 1913. It will be noticed that the rates are still 
 high. 
 
 Some towns, on the other hand, report an increase in the death-rate among 
 illegitimate children in 1915 as compared with 1914. In Cologne, for instance, 
 the death-rate among illegitimate children was 222 per thousand in 1915 as 
 compared with 202 in 1914. Cologne also reports a higher percentage of 
 illegitimate births in 1915 than in 1914. In Aix-la-Chapelle the death-rate 
 among illegitimate children increased from 202 in 1914 to 229 in 1915. 
 
 (/) THE WAR SPONSORSHIP MOVEMENT. 
 
 (54) Institution and extension of scheme. In the early days of the war 
 (October, 1914) a committee of the Red Cross instituted a new scheme for 
 helping needy mothers and infants during the war. They called the scheme 
 " War Sponsorship." A war sponsor became responsible for the support 
 of a child, and, if necessary, of the child's mother. In some cases both mother 
 and child were received into the sponsor's home, in others they were paid for, 
 according to a prescribed scale of charges, in a suitable institution. 
 
 The scheme was started in Berlin and its suburbs, but it has since spread 
 to many other towns. The movement has been taken up very generally in 
 Saxony. In Dresden three hundred sponsors came forward almost at once. 
 In Silesia more than 1,000 children were under the care of war sponsors at 
 the close of the year 1915. A report on the working of the scheme in Mannheim 
 for the year 1915 stated that sixty persons had become war sponsors, and 
 that 119 families with about 300 children, 50 of whom were infants, were under 
 their care. Both mothers and children had benefited as a result of the personal 
 bonds thus established. 
 
 Jn some quarters the movement seems to have developed into a scheme 
 for looking after the children throughout their school life, and. funds have been 
 collected and invested which will afterwards be used to apprentice them to 
 various trades. Schemes of insurance with this object have also been started. 
 
 VII. OTHER MEASURES ON BEHALF OF MOTHERS AND 
 
 INFANTS. 
 
 (a) SUPPLY AND DISTRIBUTION OF MILK. 
 
 (55) Scarcity of milk at beginning of the war. Difficulties with regard to 
 the milk supply were encountered at an early stage of the war. Complaints 
 as to scarcity became general, and many large towns adopted special measures 
 for ensuring a supply of milk. The high price and scarcity naturally affected 
 most seriously the infants and young children, nursing mothers, and the sick. 
 
 (56) Imperial legislation. For a long time the Imperial Government were 
 unwilling to intervene, but the inadequacy of local measures led to agitation 
 in favour of some general regulation of the milk supplies. It was not until 
 the autumn of 1915 that the Government took the matter in hand. 
 
 By a decree of the Federal Council of 4th November, 1915, the l.irger towns 
 were required, and the smaller ones enabled, to control prices and to secure, 
 by preferential measures, a proper supply of milk to nursing mothers, to 
 
25 
 
 infants and young children, and to the sick. The actual quantities to be 
 allowed to each of these classes were laid down in a further decree of llth 
 November, 1915 (Appendix II (1)). 
 
 No further direct measures for controlling the milk supply were taken by 
 the Imperial Government until the 3rd October, 1916, when another decree 
 was issued restricting to children, expectant mothers (during the last three 
 months before confinement), nursing mothers, and the sick, the supply of full 
 cream milk ; all other persons were to receive skimmed milk only. The 
 Imperial Office for Fats was empowered to fix the quantities to which these 
 classes were to be entitled (Appendix II (2)). 
 
 It was provided that the milk was to be distributed by means of a card system 
 or other similar municipal arrangement, and that the claim to the prescribed 
 quantity of milk depended on the supply at disposal. 
 
 A new Milk Order, intended to secure more comprehensive seizure of 
 supplies at the source, was issued by the Imperial Office for Fats on the 3rd 
 November, 1917. Compulsory rationing of producers was provided for. 
 The regulations as to preferential supplies for mothers and young children 
 were not changed. 
 
 (57) Local Measures : Supply of milk. A number of municipalities adopted 
 active measures for the supply of milk before any imperial steps were taken. 
 In many instances, however, little was done. More activity followed after 
 the Imperial Government had been moved to deal with the matter. While 
 the Federal Council could make the regulations, the task of carrying them out 
 fell upon the local authorities, and the actual measures adopted depended 
 on their resources and initiative. 
 
 The great difficulty with which municipal authorities had to contend as 
 regards the milk supply was the scarcity caused by the dislocation of economic 
 conditions. Added to this, producers prices were, it is alleged, increased to an 
 unjustifiable extent. The fixing of maximum 'prices to prevent exorbitant 
 charges was generally found to be futile, and only resulted in further scarcity. 
 
 In these circumstances, many towns found it advisable to provide other 
 means of ensuring supplies. Several plans were adopted. Cows were bought 
 or hired and kept in the town in municipal premises adapted for the purpose, 
 or put out to pasture on meadows in the vicinity of the town, or " boarded 
 out " with neighbouring farmers. In some towns grants towards the 
 purchase of cows were made to private cowkeepers on condition that they 
 delivered a certain quantity of milk to the town ; and in others premiums 
 were paid according to the quantity of milk supplied daily. Contracts for the 
 supply of milk on various conditions were entered into by some towns. It 
 is claimed that satisfactory results were obtained where municipal milk depots, 
 in which dealers co-operated, were established. 
 
 The industrial towns were the most progressive in making arrangements 
 for the supply of milk, their greater difficulties no doubt calling forth greater 
 effort. Some examples of the action taken are given in Appendix II (4). 
 
 (58) Local Measures : Distribution of milk. It was generally recognised, 
 even before any regulations were laid down by the Imperial Government, 
 that infants and nursing mothers should have a prior claim on available 
 supplies, and this was taken into account by most municipalities in devising 
 plans for the distribution of milk. 
 
 The measures adopted differed in different towns, both before and after 
 the imperial regulations. In two towns at least the distribution of milk has 
 been taken over entirely by the municipality. 
 
 (59) Distribution of milk through welfare centres. The provision of " milk 
 kitchens " in connection with welfare centres appears to be common. A 
 number existed even before the war ; now few centres are without some 
 arrangement by which milk can be supplied for artificially fed infants. In 
 
26 
 
 some cases where the centre itself does not prepare the milk agreements are 
 made with neighbouring dealers. 
 
 ^ The milk is generally given out on medical authority. A charge is made 
 to^those who can pay, but a good deal of milk is distributed free. The cost 
 of^the milk distributed by the welfare centres without charge or below cost 
 is^generally defrayed out of municipal funds. 
 
 (60) Control of special milk foods. By a Federal Order issued in June, 
 1917, the manufacture of all milk preparations was prohibited, except with 
 the express permission of the Imperial Office for Fats. An exception was made 
 as regards albumenised milk, butter milk, Plasmon, Larosan and Ramogen. 
 These may be sold, however, only to officially licensed places hospitals, 
 clinics, welfare centres, etc. Local authorities may buy direct from the 
 factories and themselves undertake the distribution to the above-mentioned 
 institutions, or may allow them to arrange for a direct supply. These special 
 foods can be obtained only in exchange for full cream milk tickets. 
 
 (b) SPECIAL ARRANGEMENTS FOR THE DISTRIBUTION OF FOOD. 
 
 (61) Special methods of distribution. The shortage of food, often entailing 
 as it did long periods of waiting in queues, threw great strain on expectant 
 and nursing mothers. The injurious effect of this was realised by many 
 municipal authorities at an early stage, and appears to have been largely 
 avoided where the distribution was made on the basis of customers' lists (each 
 customer nominating a retailer and obtaining supplies only through him). 
 Elsewhere special measures had to be adopted. 
 
 The most general plan of making special provision for these women is by 
 a system of " preference cards " which usually entitle the holder to be served 
 before ordinary customers, so that she does not have to stand and wait among 
 these for her turn. These preference cards are given out on application to 
 the Polizei authorities in some towns or to the municipal food office in 
 others. The Polizei officials are instructed to see that the holders, on production 
 of such cards, are given the special treatment to which they are entitled. 
 
 (c) ADDITIONAL RATIONS OF FOOD. * 
 
 (62) Action of sickness societies. The central committee of the German 
 District Sickness Societies presented a memorial to the War Food Bureau 
 in the summer of 1916 stating that district sickness societies had observed 
 that women who came to claim the imperial maternity grants were insufficiently 
 nourished. The Committee asked that expectant and nursing mothers should 
 receive an increased bread ration, equal in amount to that granted to heavy 
 workers, and also a larger ration of fat. 
 
 Branch committees were at the same time advised by the central committee 
 to approach the authorities of their respective districts with a view to obtaining 
 additional rations of bread and fat for this class of members. 
 
 Local reports also drew attention to the needs of mothers. The district 
 sickness insurance society of Remscheid, which has a welfare centre of its 
 own, reported that breast-fed children, although not unhealthy, did not gain 
 the normal weight, and in many cases even lost weight, because their mothers 
 were insufficiently nourished. The society asked the municipal authorities 
 to allow nursing mothers \ Ib. of butter", at least 3 eggs and a generous 
 amount of fat weekly, as well as If pints of milk a day, and for each artificially 
 fed infant If pints of milk a day and \ Ib. of rolled oats weekly. 
 
 (63) Distribution of additional rations of food. As the difficulty of obtaining 
 food increased, many local authorities adopted measures for giving to expectant 
 and nursing mothers additional rations of certain kinds of food. As will be 
 seen from the instances quoted in Appendix II (5), different arrangements 
 were made in the various towns with regard to the kinds of food, the duration 
 
27 
 
 of the allowances, and the manner of distribution. The rations provided for 
 were generally of flour, semolina, groats, rice, rolled oats, macaroni, etc., and 
 in some cases butter, fat, eggs and meat. 
 
 The length of time during which the additional allowances were made 
 to expectant mothers corresponded in most, cases to the period, three months, 
 during which they were entitled to full cream milk under the Federal Order. It 
 was longer in some towns, for example, four months in Breslau, Dortmund 
 and Offenbach, five months in Berlin, Gottingen and Stettin, and seven months 
 in Glauchau. 
 
 The additional allowances to nursing mothers were generally granted for 
 two or three months after confinement, although in a few towns not so long. 
 In Leipzig, Stettin and Glauchau they were continued during the whole period 
 of breast-feeding ; in Bautzen up to nine months ; in Bonn and Brandenburg 
 up to twelve months ; and in Breslau up to two years. 
 
 It appears to be a common practice for the cards entitling mothers to buy 
 special rations to be given out by the welfare centres. 
 
 During the latter half of 1916 complaint became general that mothers 
 could not procure many articles of food suitable for infants and young children, 
 even though they had cards entitling them to buy specified amounts. To 
 meet this difficulty many municipal authorities arranged for certain kinds 
 of food, necessary for young children, to be sold through some other agency 
 than the ordinary dealer ; in some cases special municipal depots were opened, 
 often in connection with the infant welfare centre, in others the help of a 
 philanthropic society was enlisted. An account is given in Appendix II (6) 
 of the arrangements made in Munich in 1917 for distributing a large 
 part of the rations for young children through the infant welfare centres. 
 
 (64) Imperial action. Municipal measures for rationing infants and young 
 children and securing suitable food for them were followed in due course by 
 Government action. Mention has already been made of the Order issued by 
 the Federal Council on the 3rd of October, 1916, which limited the use of 
 full cream milk to mothers and infants and the sick. This Order was followed, 
 on the next day, by an Order of the Imperial Office for Fats prescribing minimum 
 food rations for infants (Appendix II (3)). 
 
 The Imperial Government decided in the spring of 1917 that it was desirable 
 to bring about some degree of uniformity in the measures already adopted 
 by local authorities for distributing food to expectant and nursing mothers, 
 infants and young children. With this object, the War Food Bureau on the 
 25th of May, 1917, issued instructions, under the title of " Rules as to the 
 Nourishment of Expectant Mothers, Infants and Children," to the various 
 State Governments, with a request that the local authorities should be directed 
 to see that they were properly carried out. The rules were drawn up by the 
 Imperial Health Office, with the co-operation of experts and children's doctors. 
 
 It was recommended in these rules that women in the last three months 
 of pregnancy should be allowed on request supplementary rations of milk 
 and bread, if possible, or if not, of macaroni, patent foods and sugar. 
 
 The local authorities were requested to see that the rations of milk for 
 mothers and infants were obtainable without difficulty or loss of time, and 
 to give preference to the requirements of infants and young children in the 
 distribution of rolled oats and wheaten whole meal. A certain quantity of finely 
 milled wheat was allowed to local authorities in place of the so-called " children's 
 flour," the preparation of which was discontinued. It was urged that the 
 supplies of food specially allocated to infants should be readily available ii? 
 .appointed places (welfare centres, hospitals, dispensaries, etc.), 
 
 As it was not possible to provide additional supplies for mothers and 
 infants, their special allowances were, if necessary, to be arranged for by a 
 slight reduction in the ration for the other classes of the population. 
 
28 
 
 The extent to which these provisions can be carried out depends, however, 
 on the local conditions as to supplies ; and the imperial instructions are no 
 guarantee that means will be available for their observance. 
 
 Reports from a number of large towns (Berlin, Nuremberg, Breslau, etc.) 
 towards the end of 1917 stated that in consequence of the dearth of milk the 
 daily quantities hitherto allowed to young children must be reduced ; rations 
 of prepared foods were to be given instead, wherever possible. 
 
 VIII. SUMMARY AND CONCLUSIONS. 
 
 (65) The war has brought about a great reduction in the number of births 
 in Germany, the total number in 1916 being about 40 per cent, less than in 1913. 
 
 The infant death-rate rose to an abnormal height for a time after the out- 
 break of war, but there appears to have been a gradual return to the pre-war rate. 
 
 The maternity grants are stated to have had some influence in reducing the 
 infant death-rate, but it is doubtful whether this has taken place except where 
 they are administered as part of an organised scheme of infant welfare work. 
 In towns and districts where the money is given out without any attempt 
 to see that the mothers and infants are properly cared for, the grants appear 
 to have had little or no effect on the infant death-rate. 
 
 The breast-feeding allowance is stated to have increased the number of 
 breast-fed infants during the first three months of life ; but here again, the 
 effect produced must be dependent upon the method of administration. 
 Where the sickness insurance societies take steps, either through the infant 
 welfare association or the midwives, to see that the mother does in fact breast- 
 feed her infant, much good has been done. Where, on the other hand, no such 
 action is taken, little or no improvement in this respect is seen. 
 
 It seems probable that the number of infants breast-fed beyond the first 
 three months of life has also increased since the allowances were given, especially 
 as some municipalities and voluntary infant welfare associations give further 
 grants to mothers who continue breast-feeding beyond this period. The wish 
 is generally expressed that the imperial allowances could he given for a longer 
 time. 
 
 (66) Infant welfare work received a set-back when war broke out, but the 
 importance of continuing it was soon realised and it has since received a great 
 impetus. 
 
 A number of new infant welfare centres have been opened during the 
 last two or three years, both in towns where a certain number already existed 
 and in those where no such work had hitherto been attempted. Suitable 
 schemes of infant welfare work for semi -rural and rural districts are being 
 organised here and there. The demand for trained workers is so great that it 
 is impossible for them all to receive the usual training. 
 
 While the number of infants to be cared for has been steadily diminishing, 
 the activities of the centres have been added to in a variety of ways. The 
 giving of certificates which entitle the mothers to claim the imperial breast- 
 feeding allowance has thrown much additional work on many centres. 
 
 Ante-natal work has been arranged for in a number of cases, but it is 
 admitted that much remains to be done in this direction. 
 
 The effect of war conditions on the well-being of children just above the 
 age of infancy has induced a large number of centres to extend their care and. 
 supervision to children from 1 to 5 years of age. 
 
 The distribution of milk, generally in prepared portions, for artificially 
 fed infants is undertaken by a very large number of centres. In many instances 
 the milk is prepared at the centre. 
 
 It appears to be a growing practice for the cards entitling mothers to buy 
 extra quantities of certain kinds of food for themselves and their young 
 
29 
 
 children to be distributed by the welfare centres. In at least one town, Munich, 
 a large part of the rations for children up to two years of age is actually sold 
 at the centres (Appendix II (6) ).* 
 
 All these additional functions have tended to add to the number of mothers 
 coming to the centres, and to make them more regular in attendance. 
 
 Under the conditions of war the tendency has been for the expense of 
 carrying on infant welfare to be thrown more and more upon public funds, 
 with the control of the work passing largely into the hands of the local 
 authorities. 
 
 There is a demand for an imperial law to make it the duty of all local 
 authorities to undertake infant welfare work. The backward conditions in 
 small towns and country districts are largely responsible for this demand. 
 
 In some towns the sickness insurance societies have themselves started 
 various schemes of infant welfare work on somewhat different lines from 
 those of the infant welfare associations ; for example, by arranging for mid wives 
 to visit for an extended period, and by supplying home helps during confine- 
 ment. In a few cases the societies have made extensive enquiries as to 
 breast-feeding and its effect upon the health of infants. 
 
 Illegitimate children have received increased care and attention during the 
 war, with beneficial results in many towns. 
 
 (67) While there has been development of infant welfare work on the 
 modern lines of caring for the child in the home, the older method of caring 
 for children in institutions has at the same time been extended. The demand 
 for women's labour is so great that an ever-increasing number of women are 
 being drawn into industrial work. While the mother toils by day or night 
 her child must be cared for by others. Those who are concerned for the 
 welfare of infants and young children believe that they will be better cared for 
 by trained and supervised workers in creches or infants' homes than in the 
 homes of foster mothers, especially in view of the difficult food conditions. 
 Endeavours are therefore being made to provide suitable institutions wherever 
 they are needed, and to link them up with the general movement for infant 
 welfare. But whether the measures taken will be adequate to counteract 
 the effect of the industrial employment of women under the present conditions 
 of night shifts, long hours and unusual strain, is a question which causes grave 
 anxiety. 
 
 (68) The food conditions in Germany, difficult as they have been, have 
 not been associated with excessive infant mortality, at least up to the end of 
 1916. In the towns, where the shortage of food has gradually become 
 more pronounced and the difficulties of distribution have increased, the 
 infant death-rate has tended to diminish. In the country the scarcity of 
 food has been less keenly felt than in the towns, yet all the evidence goes to 
 show that the infant death-rate has remained higher in the rural districts 
 taken as a whole than in the towns ; in some parts of the empire it has actually 
 risen. It must be remembered, however, that the infant death-rate depends 
 on a number of factors which may vary independently of each other. 
 
 (69) Special measures have been taken in a large number of towns to 
 secure supplies of food for the poorer inhabitants, and especially for soldiers' 
 wives. Although there is evidence that in some places expectant and nursing 
 mothers have suffered from the lack of sufficient and suitable food, the measures 
 taken by municipal authorities generally and the action taken by the Govern- 
 ment have helped towards a fairer distribution of available supplies. Defects, 
 however, are many and complaints bitter. The arrangements for giving 
 preference to mothers and infants in distributing certain kinds of food have, 
 nevertheless, prevented a good deal of hardship. The initiative in these 
 matters is taken as a rule by a few progressive towns ; when the measures 
 thus introduced have proved useful in local application the Imperial Government 
 follows with an Order requiring or permitting all towns to adopt them. 
 
 * The system has since been modified ; see footnote to the Appendix. 
 
30 
 APPENDIX I. 
 
 TABLE A. 
 
 Mean infant death-rates in the years 1901-05 in some European countries were as 
 follows : 
 
 (See the Seventy-fourth Annual Report of the Registrar-General, pp. 105-115.) 
 
 German Empire 
 
 Italy 
 
 Serbia... 
 
 Belgium 
 
 France 
 
 England and Wales . . . 
 
 Switzerland ... 
 
 Denmark 
 
 Sweden 
 
 Norway 
 
 199 per thousand live births. 
 
 168 
 
 -49 
 
 148 
 
 139 
 
 138 
 
 134 
 
 119 
 
 91 
 
 81 
 
 TABLE B. 
 
 Total number of Live Births in all German towns having a population of 15,000 and over, 
 
 during the years 1913 to 1916. 
 
 (Compiled from the official figures published monthly by the Imperial Health Office 
 in the " Veroffentlichungen des Kaiserlichen Gesundheitsamts.") 
 
 Year. 
 
 Total mid-year 
 population. 
 
 Total No. of 
 Live Births. 
 
 Decrease as compared with 
 
 1913. 
 
 1914. 
 
 1915. 
 
 
 
 
 Per cent. 
 
 Per cent. 
 
 Per cent. 
 
 1913 
 
 25.812,000 
 
 633,235 
 
 
 
 
 
 
 
 1914 
 
 26,424,000 
 
 621,453 
 
 1-8 
 
 
 
 
 
 1915 
 
 28,726,000 
 
 490,385 
 
 22-5 
 
 21-1 
 
 
 
 1916 
 
 27,015,000 
 
 -- 375,825 
 
 40-6 
 
 39-5 
 
 23-3 
 
 TABLE C. 
 
 Infant Mortality Rates in large towns in Germany in the years 1904-1913. 
 (From " Bewegung der Bevolkerung " published by the Imperial Statistical Office.. 
 
 
 1904. 
 
 1905. 
 
 1906. 
 
 1907. 
 
 1908. 
 
 1909. 
 
 1910. 
 
 1911. 
 
 1912. 
 
 1913. 
 
 Berlin 
 
 200 
 
 206 
 
 177 
 
 163 
 
 169 
 
 156 
 
 157 
 
 173 
 
 142 
 
 138 
 
 Hamburg 
 
 167 
 
 174 
 
 166 
 
 139 
 
 160 
 
 142 
 
 149 
 
 158 
 
 130 
 
 114 
 
 Leipzig 
 
 243 
 
 227 
 
 190 
 
 175 
 
 178 
 
 172 
 
 150 
 
 242 
 
 133 
 
 143 
 
 Cologne 
 
 227 
 
 215 
 
 222 
 
 191 
 
 193 
 
 173 
 
 154 
 
 234 
 
 152 
 
 156 
 
 Munich 
 
 229 
 
 228 
 
 196 
 
 204 
 
 192 
 
 192 
 
 166 
 
 176 
 
 134 
 
 139 
 
 Dresden 
 
 192 
 
 209 
 
 167 
 
 152 
 
 152 
 
 139 
 
 129 
 
 166 
 
 116 
 
 116 
 
 Essen 
 
 164 
 
 149 
 
 176 
 
 139 
 
 148 
 
 132 
 
 127 
 
 169 
 
 116 
 
 125 
 
 Frankfort 
 
 159 
 
 173 
 
 145 
 
 134 
 
 139 
 
 124 
 
 117 
 
 124 
 
 102 
 
 102 
 
 Diisseldorf 
 
 204 
 
 191 
 
 195 
 
 146 
 
 157 
 
 148 
 
 129 
 
 180 
 
 125 
 
 124 
 
 Stuttgart 
 
 185 
 
 204 
 
 194 
 
 157 
 
 175 
 
 148 
 
 144 
 
 150 
 
 133 
 
 128 
 
 Hanover 
 
 168 
 
 164 
 
 160 
 
 154 
 
 128 
 
 130 
 
 109 
 
 145 
 
 111 
 
 113 
 
 Duisburg 
 
 193 
 
 187 
 
 170 
 
 163 
 
 167 
 
 153 
 
 170 
 
 233 
 
 126 
 
 136 
 
 Bremen 
 
 170 
 
 178 
 
 160 
 
 146 
 
 113 
 
 120 
 
 126 
 
 135 
 
 120 
 
 107 
 
 Mannheim 
 
 231 
 
 217 
 
 196 
 
 189 
 
 177 
 
 189 
 
 166 
 
 185 
 
 151 
 
 139 
 
31 
 
 TABLE D. 
 Infant Mortality in Prussia. 
 
 From the " Medizinalstatistische Nachrichten " issued by the Prussian Statistical 
 Office, Second Series, 1910, p. 383. 
 
 
 Legitimate Infants. 
 
 Illegitimate Infants. 
 
 Years. 
 
 
 
 
 Urban Districts. 
 
 Rural Districts. 
 
 Urban Districts. 
 
 Rural Districts. 
 
 1876-1880 
 
 211 
 
 183 
 
 403 
 
 312 
 
 1881-1885 
 
 211 
 
 186 
 
 398 
 
 319 
 
 1886-1890 
 
 210 
 
 187 
 
 395 
 
 332 
 
 1891-1895 
 
 203 
 
 187 
 
 385 
 
 336 
 
 1896-1900 
 
 195 
 
 185 
 
 374 
 
 336 
 
 1901-1905 
 
 181 
 
 178 
 
 339 
 
 322 
 
 1906 
 
 168 
 
 167 
 
 303 
 
 303 
 
 The table below is compiled from later series of the same publication. The figures 
 are not given separately for legitimate and illegitimate children in the later years. 
 
 Year. 
 
 Whole State. 
 
 Urban Districts. 
 
 Rural Districts. 
 
 1907 
 
 168 
 
 166 
 
 170 
 
 1909 
 
 164 
 
 159 
 
 167 
 
 1911 
 
 188 
 
 187 
 
 188 
 
 1913 
 
 149 
 
 145 
 
 154 
 
 1914 
 
 164 
 
 160 
 
 167 
 
 TABLE E. 
 Infant Mortality in Bavaria. 
 
 From the " Handbuch der Medizinischen Statistik," by Dr. Friedrich Prinzing, 1906. 
 The author states that his figures are derived from official sources. 
 
 Years. 
 
 Legitimate Infants. 
 
 Illegitimate Infants. 
 
 Urban Districts. 
 
 Rural Districts. 
 
 Urban Districts. 
 
 Rural Districts. 
 
 1876-1878 
 
 294 
 
 286 
 
 376 
 
 392 
 
 1889-1892 
 
 254 
 
 264 
 
 325 
 
 359 
 
 1893-1897 
 
 247 
 
 251 
 
 317 
 
 356 
 
 1898-1902 
 
 224 
 
 246 
 
 306 
 
 356 
 
 TABLE F. 
 
 Infant Mortality in Bavaria. 
 (From the " Zeitschrift des Statistischen Landesamts, Bayern.") 
 
 
 
 
 
 Total 
 
 Towns or Parishes with a population of 
 
 1911. 
 
 1912. 
 
 1913. 
 
 population 
 
 
 
 
 
 about 
 
 Over 100,000 inhabitants 
 
 197 
 
 149 
 
 159 
 
 1,210,000 
 
 Between 20,000 and 100,000 inhabitants 
 
 199 
 
 163 
 
 153 
 
 840,000 
 
 5,000 20,000 
 
 217 
 
 171 
 
 170 "1 
 
 
 2,000 5,000 
 Under 2,000 inhabitants 
 
 232 
 231 
 
 170 
 186 
 
 186 y 
 
 193 J 
 
 5,010,000 
 
32 
 
 TABLE G. 
 Infant Mortality in Prussia, Saxony and Bavaria.* 
 
 
 1911. 
 
 1913. 
 
 1914. 
 
 Population 
 in 1910. 
 
 PRUSSIA. 
 1st quarter 
 2nd quarter 
 3rd quarter ... .... 
 4th quarter 
 
 Year 
 
 SAXONY. 
 1st quarter 
 2nd quarter 
 3rd quarter 
 4th quarter 
 
 Year 
 
 BAVARIA. 
 1st quarter 
 2nd quarter 
 3rd quarter 
 4th quarter 
 
 Year 
 
 148 
 142 
 312 
 141 
 
 138 
 141 
 171 
 146 
 
 135 
 128 
 143 
 150 
 
 40,165,000; 
 4,807,000 
 6,887,000 
 
 188 
 
 166 
 160 
 424 
 158 
 
 150 
 
 163 
 162 
 146 
 147 
 
 164 
 
 152 
 140 
 242 
 157 
 
 228 
 
 185 
 192 
 325 
 180 
 
 157 
 
 179 
 190 
 182 
 177 
 
 173 
 
 184 
 170 
 239 
 179 
 
 223 
 
 182 
 
 193 
 
 The figures show the high mortality in the third quarter of 1911 (due to high tem- 
 perature and drought) and of 1914 (due largely to conditions arising from the outbreak 
 of war). 
 
 TABLE H. 
 Infant Mortality in various large towns in the months of August and September, for the years 
 
 1911, 1913 and 1914. 
 
 The figures show the abnormal mortality of August and September of 1911, and, less 
 so, of 1914. 
 
 Town. 
 
 Year. 
 
 August. 
 
 September. 
 
 Whole Year. 
 
 
 r 
 
 1911 
 
 363 
 
 234 
 
 174 
 
 Berlin 
 
 "\ 
 
 1913 
 
 146 
 
 13'4 
 
 138 
 
 
 \ 
 
 1914 
 
 223 
 
 204 
 
 157 
 
 Hamburg 
 
 -{ 
 
 1911 
 1913 
 1914 
 
 290 
 118 
 158 
 
 235 
 121 
 164 
 
 158 
 115 
 126 
 
 
 f 
 
 1911 
 
 849 
 
 362 
 
 242 
 
 Leipzig ... 
 
 ...{ 
 
 1913 
 1914 
 
 159 
 306 
 
 165 
 262 
 
 143 
 168 
 
 
 f 
 
 1911 
 
 688 
 
 351 
 
 234 
 
 Cologne 
 
 ...< 
 
 1913 
 
 171 
 
 231 
 
 156 
 
 
 \ 
 
 1914 
 
 339 
 
 364 
 
 160 
 
 
 f 
 
 1911 
 
 484 
 
 264 
 
 169 
 
 Essen 
 
 -{ 
 
 1913 
 1914 
 
 138 
 255 
 
 165 
 211 
 
 125 
 137 
 
 Nuremberg 
 
 { 
 
 1911 
 1913 
 1914 
 
 503 
 139 
 235 
 
 374 
 144 
 230 
 
 203 
 162 
 165 
 
 
 f 
 
 1911 
 
 463 
 
 250 
 
 150 
 
 Stuttgart 
 
 4 
 
 1913 
 1914 
 
 141 
 162 
 
 112 
 149 
 
 132 
 132 
 
 
 
 1911 
 
 676 
 
 312 
 
 232 
 
 Magdeburg 
 
 
 1913 
 
 164 
 
 178 
 
 162 
 
 
 
 1914 
 
 382 
 
 295 
 
 194 
 
 
 f 
 
 1911 
 
 430 
 
 304 
 
 185 
 
 Mannheim 
 
 -{ 
 
 1913 
 1914 
 
 158 
 355 
 
 176 
 214 
 
 139 
 159 
 
 From the 
 
 Medizinalstatistische Nachrichten " issued by the Prussian Statistical Office; the 
 " Zeitschrift des Sachsischen Statistischen Landesamts," ; and the 
 "Zeitschrift des Statistischen Landesamis, Bayern." 
 
33 
 
 TABLE I. 
 Infant Mortality in the Rural Districts of Prussia. 
 
 
 1911. 
 
 1913. 
 
 1914. 
 
 1st quarter 
 
 157 
 
 141 
 
 140 
 
 2nd quarter 
 
 145 
 
 144 
 
 131 
 
 3rd quarter 
 
 296 
 
 174 
 
 242 
 
 4th quarter 
 
 143 
 
 150 
 
 155 
 
 Year 
 
 188 
 
 154 
 
 167 
 
 TABLE K. 
 
 Infant Mortality in the twenty-six largest German towns in the years 1913 to 1916. 
 (Compiled from the returns published periodically by the Imperial Health Office.) 
 
 
 1913. 
 
 1914. 
 
 1915. 
 
 1916. 
 
 PRUSSIA : 
 
 
 
 
 
 Berlin 
 
 138 
 
 156 
 
 141 
 
 128 
 
 Schoneberg 
 
 128 
 
 127 
 
 123 
 
 91 
 
 Breslau ... 
 
 172 
 
 185 
 
 179 
 
 170 
 
 Charlottenburg ... 
 
 123 
 
 140 
 
 134 
 
 123 
 
 Cologne ... 
 
 156 
 
 158 
 
 148 
 
 153 
 
 Danzig ... 
 
 170 
 
 195 
 
 192 
 
 v 126 
 
 Dortmund 
 
 142 
 
 136 
 
 125 
 
 128 
 
 Duisburg 
 
 136 
 
 168 
 
 143 
 
 140* 
 
 Diisseldorf 
 
 124 
 
 139 
 
 116 
 
 113 
 
 Essen 
 
 125 
 
 143 
 
 132 
 
 135 
 
 Frankfort 
 
 102 
 
 104 
 
 104 
 
 104 
 
 Hanover 
 
 113 
 
 123 
 
 112 
 
 103 
 
 Kiel 
 
 128 
 
 136 
 
 128 
 
 129 
 
 Konigsberg 
 
 184 
 
 197 . 
 
 196 
 
 136 
 
 Magdeburg 
 
 162 
 
 198 
 
 195 
 
 169* 
 
 Neukolm 
 
 143 
 
 156 
 
 138 
 
 111 
 
 Stettin 
 
 193 
 
 203 
 
 179 
 
 151 
 
 BAVARIA : 
 
 
 
 
 
 Munich ... 
 
 139 
 
 147 
 
 149 
 
 133 
 
 Nuremberg 
 
 162 
 
 165 
 
 164 
 
 145 
 
 SAXONY : 
 
 
 
 
 
 Chemnitz 
 
 161 
 
 208 
 
 165 
 
 153* 
 
 Dresden ... 
 
 116 
 
 122 
 
 108 
 
 103 
 
 Leipzig . . . 
 
 143 
 
 168 
 
 132 
 
 119 
 
 WURTTEMBERG : 
 
 
 
 
 
 Stuttgart 
 
 128 
 
 122 
 
 103 
 
 113 
 
 BADEN : 
 
 
 
 
 
 Mannheim 
 
 139 
 
 155 
 
 146 
 
 t 
 
 TOWN STATES : 
 
 
 
 
 
 Bremen ... 
 
 107 
 
 117 
 
 108 
 
 119 
 
 Hamburg 
 
 114 
 
 126 
 
 111 
 
 117 
 
 Rate for 26 towns ... 
 
 139 
 
 153J 
 
 140J 
 
 130J 
 
 * Returns for one month missing. 
 
 f Returns for three months missing. 
 
 { Figures published by the Imperial Health Office as the mean rates for the 26 town* 
 
34 
 
 TABLE L. 
 
 Infant Mortality in Bavaria. 
 (From the " Zeitschrift des Statistischen Landesamts, Bayern.") 
 
 Towns or Parishes with a 
 population of 
 
 Total 
 population 
 about 
 
 Infant death- 
 rates in 
 
 Percentage of the total No. 
 of infant deaths occurring 
 in each group of towns or 
 parishes in 1915. 
 
 1914. 
 
 1915. 
 
 Over 100,000 inhabitants (3 
 
 
 
 
 . 
 
 towns) 
 
 1,210,000 
 
 163 
 
 165 
 
 9-8 
 
 Between 20,000 and 100,000 
 
 
 
 
 
 inhabitants (21 towns) ... 
 
 840,000 
 
 165 
 
 165 
 
 7-8 
 
 Between 5,000 and 20,000"] 
 
 
 r 
 
 
 
 inhabitants 
 
 
 1 176 
 
 180 
 
 6-0 
 
 Between 2,000 and 5,000 V- 
 
 5,010,000 
 
 4 
 
 1 
 
 inhabitants 
 
 j 196 
 
 213 
 
 10-9 
 
 Less than 2,000 inhabitants J 
 
 
 ^205 
 
 231 65-5 
 
 
 
 
 
 
 
 
 100-0 
 
 TABLE M. 
 GERMAN EMPIRE. 
 
 Percentage of Illegitimate Births in years 1851-1912. 
 (From the " Statistisches Jahrbuch fur das Deutsche Reich," issued in 1914.) 
 
 Period or Year. 
 
 Percentage of Illegitimate Births. 
 
 1851-1860 
 
 11*5 per cent. 
 
 1861-1870 
 
 11-5 
 
 1871-1880 
 
 8-9 
 
 1881-1890 
 
 9-3 
 
 18911900 
 
 9-1 
 
 1901-1910 
 
 8-6 
 
 
 
 1901 
 
 8-6 
 
 1902 
 
 8-5 
 
 1903 
 
 8-3 
 
 1904 
 
 8-4 ,, 
 
 1905 
 
 8-5 
 
 1906 
 
 8-5 
 
 1907 
 
 8-7 
 
 1908 
 
 8-9 
 
 1909 
 
 9-0 
 
 1010 
 
 9-1 
 
 1911 
 
 9-2 
 
 1912 
 
 9-5 
 
 TABLE N. 
 GERMAN EMPIRE. 
 
 Mortality of Legitimate and Illegitimate Infants in the yeats 1901-1913. 
 (From the " Statistisches Jahrbuch fur das Deutsche Reich," issued in 1914.) 
 
 Year. 
 
 Death-rate of 
 legitimate infants. 
 
 Death-rate of 
 illegitimate infants. 
 
 General infant 
 death-rate. 
 
 1901 ... 
 
 194 
 
 339 
 
 207 
 
 1902 
 
 173 
 
 293 
 
 183 
 
 1903 
 
 193 
 
 327 
 
 204 
 
 1904 
 
 186 
 
 314 
 
 196 
 
 1905 
 
 194 
 
 326 
 
 205 
 
 1906 
 
 175 
 
 294 
 
 185 
 
 1907 
 
 166 
 
 280 
 
 176 
 
 1908 
 
 168 
 
 285 
 
 178 
 
 1909 
 
 160 
 
 268 
 
 170 
 
 1910 
 
 152 
 
 257 
 
 162 
 
 1911 
 
 182 
 
 299 
 
 192 
 
 1912 
 
 139 
 
 232 
 
 147 
 
 1913 , 
 
 142 
 
 237 
 
 151 
 
35 
 
 APPENDIX II. 
 
 (1) QUANTITIES OF MILK TO WHICH CERTAIN CLASSES OF PERSONS WERE ENTITLED UNDER 
 
 THE FEDERAL ORDER OF THE HTH OF NOVEMBER, 1915. 
 For infants up to the end of the second year, if they 
 
 were not being breast fed ... ... ... ... 1 litre (about 1 f pints) a day. 
 
 For nursing mothers 1 ,, a day. 
 
 For children over two years of age ... ... ... ,, 
 
 For sick persons ... ... ... ... ... ... Up to 1 litre a day. 
 
 (2) QUANTITIES OF MILK PRESCRIBED BY THE IMPERIAL OFFICE FOR FATS UNDER THE 
 
 DECREE OF 3RD OCTOBER, 1916. 
 
 For infants in the first and second years, if not breast fed ... ... 1 litre a day. 
 
 For nursing mothers, for each infant fed ... ... ... ... ... 1 ,, 
 
 For expectant mothers in the last three months before confinement ... 
 
 For children in the third and fourth years 
 
 For children in the fifth and sixth years \ 
 
 (3) RATIONS OF FOOD PRESCRIBED BY THE IMPERIAL OFFICE FOR FATS IN AN ORDER 
 
 OF 4TH OCTOBER, 1916. 
 For healthy infants up to two years of age : 
 
 30-50 grammes (about 1-1 f oz.) of sugar daily ; 
 
 200 grammes (about 7 oz.) of wheaten flour, ordinary milling, weekly ; 
 
 500 grammes (about 17| oz.) of oatmeal monthly. 
 
 These allowances were primarily intended to be used mixed with milk for the preparation 
 of infants' food. They were to be given whether the infant was artificially fed or not ; 
 if the mother breast-fed her infant, she was to have the allowance of food for herself. 
 For delicate infants up to two years of age : 
 
 Finer wheaten flour or special foods (that is, Plasmon, albumenised milk, butter 
 milk, etc.) might be given on a medical certificate, which must be renewed 
 monthly. 
 
 Where full food tickets were not issued for an infant the mother was to receive, 
 wherever possible, a supplementary allowance of food. 
 
 Children above two years of age were provided for under the various Orders dealing 
 with the rationing of food for the general population. 
 
 (4) EXAMPLES OF MUNICIPAL MEASURES TO ENSURE THE MILK SUPPLY, ESPECIALLY FOR 
 
 MOTHERS AND CHILDREN. 
 
 Frankfort on the Main (popn. 470,000). In March, 1917, the municipal authority 
 voted a considerable sum of money for the purpose of setting up municipal dairy farms. 
 The milk produced was to be reserved for infants and young children. Four Jarge estates 
 in rural districts were shortly afterwards leased. Besides having a good stock of cows 
 in these municipal dairies, the town has a number " boarded- out " with farmers as a 
 reserve stock, the cost of setting up accommodation for them being thus avoided. The 
 municipal supply is said to be enough for all infants up to one year of age. In addition, 
 the municipal authority gives grants, in money or otherwise, towards the establishment 
 of depots for the collection of milk in rural districts. 
 
 Mannheim (236,000). -In order to improve the milk supply a limited company, 
 controlled and financed by the municipality, was formed in 1915. A number of cows 
 were purchased and a central depot established. By the end of 1916 the number of cows 
 had reached 500, and the supply of milk had increased. Having regard to the difficulties, 
 the position was claimed to be favourable on the whole, in spite of a deficit of about 
 ^2,000 in the accounts of the central depot for the year 1916. The deficit was attributed 
 to the narrow margin of profit, fluctuation of business, and to the special expenses incurred 
 in extending the delivery area. 
 
 Strassbuvg (193,000). Strassburg was the first German town to undertake municipal 
 control of the entire milk supply. The town had for several years before the war suffered 
 from an insufficient and irregular supply of milk. The municipal authority had made 
 several attempts to control the trade in the common interest, but it was only under 
 pressure of war conditions (the supply fell to one-seventh of the usual amount in the 
 autumn of 1914) that the urgent necessities of the town prevailed over the opposition to 
 a municipal scheme. Towards the close of 1915 a sum of ^50,000 was voted for the 
 establishment of a central depot ; it was arranged that the greater part of this capital 
 should always remain in the hands of the municipality, while the rest of the shares were 
 given to the dairy owners in whole or part payment for the goodwill of their businesses. 
 All milk brought into the town or produced within its limits is now delivered under 
 contract to the agents of the municipal authority. The manufacture of milk products 
 is also municipally controlled. To facilitate distribution the town is divided into 
 districts, corresponding to the districts for bread tickets, in each of which a milk depot 
 
36 
 
 is established ; milk is sold on production of milk tickets. The amount of milk to which 
 each family is entitled depends on the number and ages of the members. Children under 
 two years of age receive four times as much as persons over fourteen, and children between 
 two and fourteen twice as much. Expectant mothers receive during the last three months 
 before confinement the same amount as children under two. 
 
 Dortmund (293,000) has now followed the example of Strassburg and municipalised 
 the whole of its milk supply. Early in 1917 the municipal authority bought 400 cows 
 and put them out to graze on estates in the vicinity of the town, and a small dairy was 
 acquired, the milk thus produced being distributed to infants and sick persons. A 
 limited company, controlled and financed by the municipal authority, was formed, and 
 on the 1st September, 1917, a municipal order was issued requiring all milk (whether 
 full cream, skimmed, condensed, dried, or sterilised) and cream, produced in or brought 
 into the town, to be handed over to this company at its various depots. All cow-keepers 
 supplying the town are required to report monthly to the company the amount of milk 
 produced on their premises, and any increase or decrease in their herds. The immediate 
 result of this measure was to increase considerably the supply of full cream milk, as the 
 conversion of milk into expensive preparations was stopped. Full cream milk is sold 
 only to those persons who hold cards entitling them to buy it. Cards for skimmed milk 
 also have been introduced. No milk is now delivered to customers' houses ; each house- 
 holder must fetch his supply from one of the 138 depots which have been opened in various 
 parts of the town. This arrangement is said to prevent any tampering with the milk. 
 Specially prepared milk for infants is sold at 12 of the depots. 
 
 The quantity of full cream milk supplied to the town in pre-war times was about 
 70,000 to 80,000 litres a day. In the summer of 1917 it had fallen to about 17,000 litres ; 
 since the municipalisation of the supply about 30,000 litres has been secured. The 
 population of the town has increased during the war from 234,000 to 293,000. 
 
 Cologne (653,000). The municipal authority spent large sums of money, even before 
 the war, in the distribution of milk. The expenditure for this purpose amounted to more 
 than ^4,000 in 1914. 
 
 Milk was scarce in the town in the summer of 1915, and many families able to buy 
 milk in ordinary times were glad to avail themselves of the municipal supply. As the 
 number of women who went out to work increased a larger number of children were 
 sent to creches, etc., where the milk was supplied by the town, and those who had to 
 cease breast-feeding their infants found the municipal milk a convenient substitute. 
 In the summer of 1916 the municipal authority voted money for the payment of an 
 allowance of 6s. a month, during the hot months, to needy nursing mothers who were not 
 in receipt of the imperial maternity grant. The object of this money payment was to 
 encourage women to breast-feed their infants and so to reduce the demand on the 
 available supply of milk. Children of two and three years of age were entitled to | litre 
 (nearly 1 pint) of milk daily. In special cases an allowance of milk for an infant might 
 be made even if the mother received the nursing allowance. This milk was given free 
 to needy families, and the cost borne by the town. 
 
 (5) EXAMPLES OF DISTRIBUTION OF ADDITIONAL RATIONS OF FOOD TO MOTHERS AND 
 INFANTS. 
 
 Munich. The Medical Advisory Council of the Food Office in Munich decided to 
 grant a supplementary bread ration to expectant and nursing mothers on receipt of an 
 application accompanied by a medical certificate. The increased ration was not to exceed 
 2 Ibs. 3 oz. for 14 days. 
 
 Leipzig. By an Order of the municipal authority of Leipzig in April, 1917, expectant 
 mothers, during the last three months before confinement, and nursing mothers, during 
 the time the infant was breast-fed, were to receive an additional weekly allowance of Ib. 
 of flour. The flour is given on production of a ticket obtained from the card distribution 
 bureau on medical recommendation. For the first four weeks after confinement a 
 certificate from the midwife is sufficient. Needy persons can obtain a medical certificate 
 at the infant welfare centre. Those who are not entitled to the imperial maternity grant 
 receive a monthly packet of food materials up to the value of 3s. 
 
 Frankfort. The municipal authority of Frankfort made arrangements for nursing 
 mothers to purchase, on presentation of a registered birth certificate, packets of semolina, 
 rolled oats, barley and other foods. An additional monthly allowance of 1^ Ibs. of 
 semolina or rolled oats could be received for children up to two years of age, on production 
 of the milk ticket. In both cases the distribution of these special rations was made from 
 the Red Cross Provisions Department, and grants towards the cost were made by the 
 associations for infant welfare. 
 
 Plauen. Nursing allowances in money and in kind are given in Plauen (139,000) 
 to needy mothers, provided that they were resident in the town at the time of the infant's 
 birth. The allowances are given up to the twenty-fifth week after the confinement. 
 
37 
 
 Fiirlh.ln February, 1917, the town council of Fiirth (74,000) authorised the 
 grant of an additional allowance of Ib. bread a week to expectant mothers, in the later 
 months of pregnancy, and to mothers during the period of breast-feeding, provided they 
 are not already in receipt of a similar allowance under any other order. A certificate, 
 which is good for two months, is required, either from a doctor or from the infant welfare 
 centre, that the mother is breast-feeding her infant. 
 
 Glogau. In Glogau (26,000) soup cards and additional bread cards are given to 
 nursing mothers by the town council through the infant welfare centre. 
 
 (()) THE DISTRIBUTION OF RATIONS OF CERTAIN KINDS OF FOOD FOR YOUNG CHILDREN, 
 THROUGH THE DISTRICT ASSOCIATION FOR THE CARE OF INFANTS AND YOUNG 
 
 CHILDREN IN MUNICH. 
 
 In view of the difficulties encountered by mothers in obtaining food for young children, 
 the welfare workers of the Munich District Association had, since the spring of 1915, 
 been selling rolled oats, semolina, etc., to the mothers who came to their centres. 
 
 The regular and sufficient provision of food suitable for young children became gradually 
 more difficult in Munich, and the need of distributing it in proper quanitites according 
 to the age of the children more urgent. The municipal food bureau therefore requested 
 the district association to undertake the distribution, through its centres, of the principal 
 articles of food required by young children in the town, and early in 1917 the district 
 association agreed to do so.* Participation in the scheme was made compulsory for all 
 inhabitants. 
 
 The articles which it was agreed to distribute were milk products, rolled oats, semolina, 
 barley, sugar, flour, malted foods, eggs, rice, biscuits, groats, and fat. 
 
 The following scales of rations were laid down by the municipal authority : 
 
 1 . For children from birth up to three months : 
 
 Rolled oats.f 0-7 oz. daily or 1 Ib. 5 oz. a month. 
 Sugar, about 1-1 oz. daily or 2 Ibs. 3-2 oz. a month. 
 
 2. For children from the beginning of the fourth to the end of the twelfth month : 
 
 Rolled oats or semolina, 1-4 oz. daily or 2 Ibs. 12 oz. a month. 
 Sugar, about 1-1 oz. daily or 2 Ibs. 3-2 oz. a month. 
 Flour, 0-3 oz. daily or 8-8 oz. a month. 
 
 3. For children over one year and under two years of age : 
 
 Rolled oats or semolina, 0'7 oz. daily or 1 Ib. 1-5 oz. a month. 
 Sugar, about 1-1 oz. daily or 2 Ibs. 3-2 oz. a month. 
 
 Flour, eggs, barley, groats and fat, the quantities allowed by the bread 
 card for children of that age. 
 
 Additional premises were taken close to each of the fifteen welfare centres, and a 
 number of voluntary workers enrolled. The extra expenses incurred by the district 
 association in carrying out this work were defrayed by the food bureau. 
 
 There were great difficulties to overcome : irregular and not always prompt delivery 
 of goods from the food bureau ; lack of staff and of means of transport ; the complicated 
 book-keeping required ; the want of understanding and the suspicious attitude of many 
 circles of the people towards any new institution ; and, perhaps the greatest difficulty of 
 all, the actual shortage of food. 
 
 On the other hand, the arrangement had considerable advantages. The provision of 
 sufficient nourishing food for all children under two years of age was guaranteed if supplies, 
 were sufficient, and the distribution according to the age of the children tended to economy. 
 The keeping of a careful index of the children has almost entirely prevented overlapping. 
 The care work of the centres has been much extended and developed. By means of the 
 customers' lists all children under two years of age are registered in the card index of the 
 district association, and this register has proved valuable. The association now receives 
 notifications of births, deaths, arrivals in the town and removals from it much earlier 
 than they were previously received from official sources. 
 
 The number of children to be supplied varies from 11,000 to 12,000. 
 
 * After about eight months' trial of this plan, the actual distribution of the food was 
 handed over to certain retailers selected by the food bureau, and supervised by the district 
 association. No food can be purchased for a child under two years of age until the card 
 has been stamped at the welfare centre. 
 
 t Rolled oats are generally used in Munich for thickening milk for infants under three 
 months old, and for making broth for older children. 
 
 Printed under the authority of His Majesty's Stationery Office 
 By SIR JOSEPH CATJSTON & SONS LTD., 9, Eastcheap, London, B.C. 3. 
 
T)6Cb 
 
 IJ> !-*, U-SJi$S 3S " to 
 
 (B706W)47 A* 
 
Gaylord Bros. 
 
 Makers 
 
 Syracuse, N. Y. 
 PAT. JAN. 21, 1908 
 
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