SAVING THE BABIES
BUT the really remarkable work in the reduction of the death-rate within the last few years has been done among the children. It is here that the war worth waging has been carried on most effectively. If, as Ellen Key says, this is the century of the child, New York proved it in its first decade by concentrating the health battalions on infant mortality.
“A baby that comes into the world has less chance to live one week than an old man of ninety, and less chance to live a year than a man of eighty,” Bergeron, the French authority on children’s diseases, said ten years ago. Within five years those chances have been increased by a third in New York. In 1911, throughout the United States one death in every five was that of a child under one year of age, while in New York only one death in every eight was that of a child under one year of age. Yet five years before that time New York’s average of infant mortality had been equal to that of the rest of the country. And in 1912 the infant mortality was further decreased by six per cent., a greater decrease than that of any other city.
Drawn by Jay Hambidge. Half-tone plate engraved by H. C. Merrill
WEIGHING THE BABIES AT AN INFANTS’ MILK STATION IN NEW YORK
What has accomplished this result? Primarily, two causes: first, the attention of the Board of Health, whose department of child hygiene now receives a larger annual appropriation than any other (in 1913 it will have more than $600,000, a fifth of the entire budget); and, second, the work of the New York Milk Committee, a semi-public organization composed of many of the chief physicians and philanthropists of the city.
Eight years ago there was not one infants’ milk station in New York. The babies of the poor were obliged to live on what milk could be found easily for them. Few could afford and still fewer could find what is known as “Grade A” milk, which sells in the commercial market for from fifteen to twenty-five cents a quart, and which is thoroughly inspected and certified. At the close of 1912 there were seventy-nine such stations in the city. At every one Grade A milk was sold at the nominal price of eight cents a quart, so as to be in easy competition with ordinary commercial milk. Every day thousands of mothers with their babies throng these stations. However, their chief purpose is not the mere selling of pure, rich milk. They serve principally as dispensaries. The milk is used by the city as a lure by means of which ignorant mothers are brought within the reach of the physicians of the Health Department. With the milk, thorough instruction and advice as to the care of infants is given gratis. The old idea that mothers know entirely how best to care for their own children has been proved erroneous. Not all mothers in a large city know how to care for their children. Many of them are virtually as helpless as the children themselves. They have to be taken in hand, trained, and taught in the care of their offspring as completely as the children themselves are taken in hand a few years later in the public schools.
In addition to the seventy-nine dispensaries of milk and medical knowledge, the city maintains a large corps of trained nurses who make visits, especially during the summer, to the homes to complete the instruction. In the poorer districts, every child under a year old is visited by a city nurse at least once in ten days. The average cost is fifty cents a month for each child. At the same time the inspection of the general milk-supply has become thorough. The city’s inspectors now cover all farms within two hundred miles from the city hall, and the sources of supply are thus kept in proper sanitary condition.
The city also gives ice in summer to those families (with children) that are unable to buy it. In the summer of 1912, 900,000 pounds were thus distributed. This is in addition to the accepted efforts to secure better playgrounds, better ventilated schools, etc.
A decade ago the summer death-rate among children in New York was from two to three times as high as the winter death-rate. For the last four years it has been steadily decreasing, and in 1912 it was almost as low as the winter death-rate. Deaths from diarrheal diseases among children have been reduced to a minimum through the concentrated efforts of a few years. The next work to be taken up will be the winter deaths from respiratory diseases. This is a more difficult problem.
Yet the greatest problem in infant mortality has still to be solved. This is the care of the “institution” baby. As in England and in France, the largest number of deaths among New York children occur among the illegitimate and those lacking a mother’s care during the early months of life. In 1911 more than forty per cent. of the deaths of infants under one year in Manhattan occurred in institutions.
The institutions that receive foundlings are too few and too poorly equipped. One day Mr. J. Pierpont Morgan saw in the street, within a block of his home, a poor woman hugging despairingly to her breast a new-born infant. In consequence, he caused to be built the million-dollar lying-in hospital on Stuyvesant Square, which has already been the means of saving many an innocent life. But that superb hospital, large as it is, has not the facilities for taking care of more than a small number of the infants that require such an institution.
The material agencies, efficient and marvelous as they have become, have not been the chief aid in the reduction of the death-rate, especially among children. Public education has really had more to do with it. Even those in direct charge of the work in infant mortality do not assert that the entire credit for the satisfactory progress should be given to the milk stations, the dispensaries, and the hospitals. Pamphlets, lectures, newspaper articles, and school-room instruction are at the base of the advance. Publicity has proved to be a greater force than milk inspection. Certain popular newspapers in New York have the power to achieve definite radical reforms in modes of living whenever they choose to prosecute a vigorous campaign. Just as the newspapers can expose corruption in any of the city’s departments, so almost as readily they can uproot or at least substantially lessen certain sanitary evils. A case in point is their campaign against the fly last summer. By means of wide-spread and vigorous news articles and editorials they succeeded in so rousing the mass of the people that the fly pest was visibly reduced. Health Department officials testify readily to this.
The work of the social settlements, of the mothers’ clubs, of the neighborhood nursing associations, of the diet-kitchens, all contribute to the general education that is bringing about a condition of excellent public sanitation. This work is necessarily of slow growth. Its effect is not nearly so evident as that of vaccination, of smallpox segregation, or of typhoid diagnosis. It is not so simple as establishing proper sewers or purifying the water-supply; but it is no less important.