V
However interesting and sociologically valuable such an analysis might be, the separation of the different features of poverty so as to determine their relative influence upon the sum of mortality and sickness is manifestly impossible. We cannot say that bad housing accounts for so many deaths, poor clothing for so many, and hunger for so many more. These and other evils are regularly associated in cases of poverty, the underfed being almost invariably poorly clad, and housed in the least healthy homes. We cannot regard them as distinct problems; they are only different phases of the same problem of poverty,—a problem which does not lend itself to dissection at the hands of the investigator. Still, notwithstanding that for many years all efforts to reduce the rate of mortality among infants have dealt only with questions of bad housing and of unhygienic conditions in general,—on the assumption that these are the most important factors making for a high rate of infant mortality,—it is now generally admitted that, important as they are in themselves, these are relatively unimportant factors in the infant death-rate. “Sanitary conditions do not make any real difference at all,” and “It is food and food alone,” was the testimony of Dr. Vincent before the British Interdepartmental Committee,[[20]] and he was supported by some of the most eminent of his colleagues in that position. That the evils of underfeeding are intensified when there is an unhygienic environment is true, but it is equally true that defect in the diet is the prime and essential cause of an excessive prevalence of infantile diseases and of a high death-rate.
Perhaps no part of the population of our great cities suffers so much upon the whole from overcrowding and bad housing as the poorest class of Jews, yet the mortality of infants among them is much less than among the poor of other nationalities, as, for instance, among the Irish and the Italians. Dr. S. A. Knopf, one of our foremost authorities upon the subject of tuberculosis, places underfeeding and improper feeding first, and bad housing and insanitary conditions in general second as factors in the causation of children’s diseases. In Birmingham, England, an elaborate study of the vital statistics of nineteen years showed that there had been a large decrease in the general death-rate, due, apparently, to no other cause than the extensive sanitary improvements made in that period, but the rate of infantile mortality remained absolutely unchanged. The average general death-rate for the nine years, 1873–1881, was 23.5 per thousand; in the ten years, 1882–1891, it was only 20.6. But the infantile death-rate was not affected, and remained at 169 per thousand during both periods. There had been a reduction of 12 per cent in the general death-rate, while that for infants showed no reduction. Had this been decreased in like degree, the infantile mortality would have fallen from 169 to 148 per thousand.[[21]]
Extensive inquiries in the various children’s hospitals and dispensaries in New York, and among physicians of large practice in the poorer quarters of several cities, point with striking unanimity to the same general conclusion. The Superintendents of six large dispensaries, at which more than 25,000 children are treated annually, were asked what proportion of the cases treated could be ascribed, on a conservative estimate, primarily to inadequate nutrition, and the average of their replies was 45 per cent.
In one case the Registrar in a cursory examination of the register for a single day pointed out eleven cases out of a total of seventeen, due almost beyond question entirely to undernutrition.
The Superintendent of the New York Babies’ Hospital, Miss Marianna Wheeler, kindly copied from the admission book particulars of sixteen consecutive cases. The list shows malnutrition as the most prominent feature of 75 per cent of the cases. Miss Wheeler says: “The large majority of our cases are similar to these given; in fact, if I kept on right down the admission book, would find the same facts in case after case.”