VII
The efficient work done by the school nurses in New York City, and elsewhere, though sadly restricted in its scope, suggests far wider possibilities. If nurses were appointed in far greater numbers, at least one to each large school, their functions might be enlarged. If, as has been suggested, they were to receive special social training, possibly at the expense of part of their present medical training, they might attend to the needs of those below school age as well as of those enrolled at school. Above all, they might be made a potent means of educating the mothers. It has been found that visiting nurses attached to the schools receive cordial welcome as a rule, are not viewed with suspicion as other officials or philanthropic visitors are, and have a correspondingly greater influence. The weak point in such a proposal lies in the fact that the school nurse would not, if her work was based upon the school registration, reach those families not represented in the schools. Thus the most important cases of all, educationally, young mothers with their first babies, would not be reached.
Elsewhere I have referred to the efforts made in some cities to educate mothers by the distribution of leaflets and pamphlets upon the subject of infant feeding and general care. Some of these leaflets and pamphlets which I have seen are models of concise lucidity, and their wide distribution among mothers intelligent enough to profit by them would be of great value. One of the first difficulties presented when this plan is attempted upon a large scale is the efficient distribution of the literature. To accomplish anything at all, the literature must be printed in the various languages represented in the city’s industrial population, and it is no easy matter to see that each mother gets literature in her own language. Quite recently, I heard of a tenement in which there were families representing no less than fourteen nationalities, and in which lived Mrs. O’Hara, a German, speaking little English! Added to this difficulty is the expense of distribution. If sent by mail,—and in large cities no other method seems possible,—the cost is enormous. To send a single circular to the registered voters of New York City, for instance, requires an expenditure of upwards of $60,000 for postage alone.[[168]] There would seem to be no good reason why the Federal Government should not authorize the Health Boards to send all such educational matter through the mails free of cost. Why should the Health Department of a city not have the privilege of a local frank? Nothing could well be more foolish than the system under which the city, while performing a national service, must pay the national post-office for doing its share of the work.
Many of the mothers, especially of our immigrant population, are quite unable to read, and literature is wasted upon them. It will be seen, therefore, that the propaganda of health by literature is subject to several important restrictions. While admirably adapted to simple, homogeneous communities in which there is a small percentage of illiteracy, it fails to meet the needs of our great cosmopolitan cities. If it were possible to have all births reported at once to the Health Department by telephone, in order that each case might be visited by special maternity nurses, it would be comparatively easy to give special, personal attention to those cases in which literature would be worthless. This plan has been adopted in Australia with conspicuous success. The State Children’s Department appoints women inspectors to visit the children of the poor. These nurse inspectors have to report, not only upon the condition of the homes, but of the children. The mothers are furnished with printed instructions as to the kind of food to be given, the proper quantities, methods of preparation, and times of feeding. If the child does not thrive satisfactorily, the nurse inspector calls in one of the physicians of the department. If milk cannot be properly assimilated, something else is tried. In short, all that skill and care can do to protect the lives of the infants is done, with the result that the infantile death-rate has been reduced from 15 per cent to 8 per cent.[[169]]
A MAKESHIFT: HAMMOCKS SWUNG BETWEEN THE COTS IN AN OVERCROWDED DAY NURSERY
VIII
I would not leave this subject without insisting upon the urgent need of State or Federal supervision of the manufacture and sale of patent infant foods. The mortality from this one cause alone is enormous. There has been no satisfactory or comprehensive inquiry into this important matter in this country, and it is therefore impossible to get reliable figures. In Germany, where the law requires that the death certificate of an infant under one year of age must state what the mode of feeding has been as well as the cause of death,—a wise provision which might with advantage be adopted in this country,—it is possible to ascertain approximately the extent of the evil. The records show that of children fed on artificial food 51 per cent die during the first year, while only 8 per cent of the children exclusively nursed by their mothers die during the same period.[[170]] No one familiar with the work of our infants’ hospitals can fail to be impressed by the large number of cases of illness and death in which artificial feeding appears as a primary or contributing cause. I have gone over the record books of many such hospitals in different parts of the country, with the almost invariable result that artificial foods appeared to be the source of trouble in many cases. Most of the patent foods, one might almost go farther and say all of them,[[171]] are unhealthful because of the starch they contain, which the little infant stomachs cannot digest. Many of the cheaper kinds of patent infant foods upon the market are, as previously stated, little better than poisons. The testimony of the greatest authorities upon the subject of infant feeding, backed by the grim eloquence of hospital records and the death-rates, points irresistibly to the need of some strict supervision of the production and sale of artificial foods for children. Whether this should be done by the establishment of certain standard formulæ, or by compelling the makers to submit certified samples for official analysis, is a question which only a body of experts should decide.
The question of reducing the rate of infant mortality is, it will be seen from the foregoing, most complicated. It is not without reluctance and misgiving that I have ventured upon this detailed discussion of measures to that end, and in doing so I have kept from speculation and theory, confining myself almost entirely to those measures which have been tested by experience and found beneficial. If Berlin has been able to reduce its infantile death-rate from 200 per thousand to 80 per thousand, Australia to reduce its rate from 15 per cent to 8 per cent; if Rochester can reduce its summer death-rate of infants by 50 per cent, it is surely evident that, given the determination to do so, we can at least hope to save one-half of the babies who, under present conditions, are perishing each year. In other words, it is possible to save almost 100,000 babies annually from perishing in the first year of life. No greater, worthier task than this ever challenged the attention of a great nation.