Babies, on the other hand, are exceedingly sensitive to their environment. Surroundings that are even slightly unfavorable are likely to make babies sick. In order to remain healthy, they must have exactly the right kind of food, in the right quantities and at the right times; their sleep, exercise, and clothing must be carefully regulated; they must be protected from careless handling, from nervous strain, and above all, from the many kinds of infection to which they are peculiarly susceptible. The life of a baby fortunately can be controlled almost completely;
when properly regulated it offers, therefore, an unequalled opportunity to see how hygienic principles work out in actual practice.
The primitive mother's instinct to nourish and protect and succor her helpless child was the original form of nursing. Instinct alone, unfortunately, has never accomplished much in preserving health. The human race has now had an experience in the care of infants that extends over thousands of years. Yet today we are still, on the whole, less successful in keeping babies alive than we are in raising domestic animals; we still allow society to continue, like a modern Herod, in its ruthless career of slaughtering the innocents.
About 14 babies out of every 100 born in the registration area[1] of the United States die before reaching the age of one year, while in some of our industrial cities as many as 25 out of every 100 born die before they are a year old. Most of these deaths are preventable. Thus, in a few American cities, the death rates have been so reduced that fewer than 10 babies out of every 100 die before completing the first year; while in Dunedin, New Zealand, as a result of the work of the Society for the Health of Women and
Children, the infant death rate has been so reduced that in 1912 only about 4 out of every 100 babies died before they were a year old.
While ignorant mothers, who may or may not be uneducated women, and contaminated milk, are as a matter of fact, chiefly responsible for our high infant death rates, yet as we have already seen, every factor in the environment has its effect upon a baby. This fact has led Sir Arthur Newsholme, an eminent English authority, to say:
"Infant Mortality is the most sensitive index we possess of social welfare. If babies were well born and well cared for, their mortality would be negligible. The infant death rate measures the intelligence, health, and right living of fathers and mothers, the standards of morals and sanitation of communities and governments, the efficiency of physicians, nurses, health officers, and educators."
Care of the child should begin at the earliest possible moment: that is, nearly nine months before he is born. Care before birth, for want of a better name, is called prenatal care of the mother. Every woman who thinks that she is pregnant should put herself at once under the care of a competent physician, so that he can make the necessary examinations as early as possible. If she follows his advice in regard to hygiene and proper regulation of her life, she may be free from anxiety,
and may justly expect that her delivery will be a safe and normal process.
A demonstration of the value of prenatal care was recently made by the Boston District Nursing Association. During the year 1915 prenatal care was given to 751 expectant mothers in 5 wards of the city; each woman attended a pregnancy clinic, where she was under the care of an experienced obstetrician, and was visited at intervals by a nurse who kept careful watch of her general condition and gave necessary advice and encouragement. In consequence the death rate among the babies whose mothers had prenatal care was only half as great, through the whole first year of life, as the death rate of babies in the same wards whose mothers had not had prenatal care. Moreover, the rate of still-births was only half as great as the rate among the general population of Boston. If prenatal care can save so many lives, surely it ought to be available for every pregnant woman in the land, including even that generally neglected class of people who are neither very rich nor very poor.