An epidemic of measles spreads over the great city. Silently and mysteriously it enters and, unseen, touches a single child in the street or the school, and the result is as the touch of the blazing torch to dry stubble and straw; only it is not stubble but the nation’s heart, its future citizenry, that is attacked. From child to child, home to home, street to street, the epidemic spreads; mansion and tenement are alike stricken, and the city is engaged in a fierce battle against the foe which assails its children. In the tenement districts doctors and nurses hurry through the sun-scorched streets and wearily climb the long flights of stairs hour after hour, day after day; in the districts where the rich live, doctors drive in their carriages to the mansions, and nurses tread noiselessly in and out of the sick rooms. Rich and poor alike struggle against the foe, but it is only in the homes of the poor that there is no hope in the struggle; only there that the doctors can say no comforting words of assurance. When the battle is over and the victims are numbered, there is rejoicing in the mansion and bitter, poignant sorrow in the tenement. For poor children are practically the only ones ever to die from measles. Nature starts all her children equally, rich and poor, but the evil conditions of poverty create and foster vast inequalities of opportunity to live and flourish.
Dr. Henry Ashby, an eminent authority upon children’s diseases, says: “In healthy children among the well-to-do class the mortality (from measles) is practically nil, in the tubercular and wasted children to be found in workhouses, hospitals, and among the lower classes, the mortality is enormous, no disease more certainly being attended with a fatal result. William Squires places it in crowded wards at 20 to 30 per cent of those attacked. Among dispensary patients the mortality generally amounts to 9 or 10 per cent. In our own dispensary, during the six years, 1880–1885, 1395 cases were treated with 128 deaths, making a mortality of 9 per cent. Of the fatal cases 73 per cent were under two years of age and 9 per cent under six months of age.”[[16]]
These are terrible words coming as they do from a great physician and teacher of physicians. Upon any less authority one would scarcely dare quote them, so terrible are they. They mean that practically the whole 8645 infant deaths recorded from measles in the United States in the year 1900 were due to poverty—to the measureless inequality of opportunity to live and grow which human ignorance and greed have made. Moreover, the full significance of this impressive statement will not be realized if we think only of its relation to one disease. The same might be said of many other diseases of childhood which blight and destroy the lives of babies as mercilessly as the sharp frosts blight and kill the first tender blossoms of spring. The same writer says: “It may be taken for granted that no healthy infants suffer from convulsions; those who do are either rickety or the children of neurotic parents.”[[17]] And there were no less than 14,288 infant deaths from convulsions in the United States in the census year. It would probably be a considerable underestimate to regard 10,000 of these deaths, or 70 per cent of the whole, as due to poverty.
It is not my intention to attempt the impossible task of sifting the death returns so as to measure the sum of infantile mortality due to poverty. These figures and the table which follows are not introduced for that purpose; I have taken only a few of the diseases more conspicuously associated with defective nutrition and other conditions comprehended by the term poverty, and, supported by a strong body of medical testimony, made certain more or less arbitrary allowances for poverty’s influence upon the sum of mortality from each cause. Some of the estimates may perhaps be criticised as being too high,—no man knows,—but I am convinced that upon the whole the table is a conservative one. No competent judge will dispute the statement that some of the estimates are very low, and when it is remembered that only a few of the many causes of infantile mortality are included and that there are many others not enumerated in which poverty plays an important part, I think it can safely be said that in this country, the richest and greatest country in the world’s history, poverty is responsible for at least 80,000 infant lives every year—more than two hundred every day in the year, more than eight lives each hour, day by day, night by night throughout the year. It is impossible for us to realize fully the immensity of this annual sacrifice of baby lives. Think what it means in five years—in a decade—in a quarter of a century.
| Table showing Infantile Mortality from Eleven Given Causes and the Estimated Influence of Poverty thereon | |||
|---|---|---|---|
| Disease | No. of Deaths under Five Years | Est. Per Cent Due to Bad Conditions | Est. No. of Deaths Due to Bad Conditions—Poverty |
| Measles | 8,465 | 85 | 7,195 |
| Inanition | 10,687 | 90 | 9,618 |
| Convulsions | 14,288 | 70 | 10,000 |
| Consumption | 4,454 | 60 | 2,648 |
| Pneumonia | 37,206 | 45 | 14,340 |
| Bronchitis | 10,900 | 50 | 5,450 |
| Croup | 10,897 | 45 | 4,900 |
| Debility and Atrophy | 12,130 | 75 | 9,397 |
| Cholera Infantum | 25,563 | 45 | 11,502 |
| Diarrhœa | 3,962 | 45 | 1,782 |
| Cholera Morbus | 3,180 | 45 | 1,431 |
| 151,732 | 51.57 | 78,263 | |
IV
There are doubtless many persons, lay and medical, who will think that the foregoing figures exaggerate the evil. But I would remind them that I have only ascribed 30 per cent of the infantile death-rate to “socially preventable causes,” and only 85 per cent of that number to poverty in the broadest sense of that word.[[C]] I have purposely set my estimate much lower than I am convinced it should be. All the facts point irresistibly to the conclusion that even 50 per cent would be a conservative estimate.
In connection with the New York Foundling Asylum on Randall’s Island, it was decided some few years ago to introduce the Straus system of Pasteurizing the milk given to the babies. The year before the system was introduced there were 1181 babies in the asylum, of which number 524, or 44.36 per cent, died. In the year following, during which the system was in operation, the number of children was 1284 and the number of deaths only 255, or 19.80 per cent. In other words, there were 8.03 per cent more children and 48.66 per cent fewer deaths.[[18]]
Even more important is the testimony furnished by the Municipal “Clean Milk” depots of Rochester, New York. Some years ago the Health Officer, Dr. George W. Goler, called the attention of the city authorities to the high infantile mortality occurring over a period of several years during the months of July and August. After thorough investigation it was fairly established that impure milk was one very important reason for this high death-rate among children under five years of age. Accordingly the Pasteurization system was introduced. Depots were opened in the poorest parts of the city and placed in charge of trained nurses. After three years it was decided that instead of Pasteurizing the milk obtained from all sorts of places, with all its contained bacteria and dirt, a central depot on a farm should be established and all energies should be devoted to the insuring of a pure, clean, and wholesome supply by keeping dirt and germs out of the milk and sterilizing all bottles and utensils. Strict control is also exercised in this way over the farmer with whom the contract for supplying the milk is made.
CITY OF ROCHESTER, N.Y. Deaths in Children Under 5 Years of Age 1892 Began Efficient Milk Inspection. 1897 Municipal Milk Stations Established. 1900 Established A Municipal Standard of 100000 Bacteria per c.c.