“No other disease illustrates so completely the effects of inadequate nutrition. An infant nursed by its mother and receiving from her a sufficient supply of adequate food, never contracts the disease, however disadvantageous its environment may be in other respects.
“Defect in the diet is the prime and essential cause of rachitis; while, as might be expected, the most advanced forms of the disease are to be seen when the effects of inadequate food are intensified by unhygienic environment....
“The effects of rachitis on the general constitution are extremely severe. The relationship between the nutrition of the infant and the condition of the child and adult has received but little attention. But there can be no doubt that the defects of nutrition occurring in infancy are of paramount importance in regard to the development of the adult. The cases of retarded physical and mental development in the child and the adult are numerous at the present time, and it is probable that their chief cause lies in defective nutrition during the period of infancy.
“Rachitis is a disease attended with a high mortality with which it is never credited, for the disease itself is seldom, if ever, fatal. In consequence of the cachectic condition and the extreme debility associated with advanced rachitis, the specific infectious diseases, such as measles, pertussis, and others, are associated with a much higher mortality in these cases than in others. Associated more or less closely with rachitis is a large class of disorders, such as bronchitis, diarrhœa, laryngismus stridulous, convulsions; these are attended with many fatal issues.”—The Nutrition of the Infant, by Ralph M. Vincent, M.D., pp. 226 et seq.
III
MIDWIFERY AND DEATH
Dr. Thomas Darlington, President of the New York Board of Health, says: Any movement for a proper regulation of midwives has my earnest support. Under the laws of New York as they now exist there is no adequate regulation. It is very easy for a woman to become a midwife in this city. She is required, it is true, to come to the department of health with a certificate from some school of midwifery, here or abroad, or to present statements from two physicians as to her fitness and character, but the status of the school does not enter into the consideration, and that it is not difficult to obtain the indorsement from the two doctors is indicated by the great degree of incompetency and carelessness to be found in the ranks of the 800 midwives of New York City. Under the laws now existing we have no right to demand further proof of qualification. If the applicant meets the slight requirements, we must put her down as a “registered midwife.” She brings this phrase prominently into use in her solicitations for business in her neighborhood, and it inspires confidence—a good deal more confidence than it should. Thus are the people deceived by the laxity of the law. A measure was introduced in the legislature, providing for a much stricter supervision of midwives than is now the case. The bill had the support of this department and of the medical societies of standing, and yet, because of ignorance and indifference concerning the evils of the practice, it failed to reach a place on the statute books. My own opinion is that the midwife should, before being allowed to practise, undergo a schooling at least as long and as careful as that of the trained nurse.
Dr. Henry C. Coe, Professor of Gynecology at Bellevue Hospital, New York, and Chief Surgeon of Gynecology and Obstetrics at the General Memorial Hospital, New York, says: Midwives are responsible for the majority of cases sent to public hospitals. It is a sad commentary on the mediæval customs of obstetrics that such facts, known to all doctors, should be ignored by coroners. The remedy is plain,—to have educated midwives, as in Germany.
Dr. J. Clarence Webster, of the Rush Medical College, Chicago, says: The midwives are, as a class, uneducated and untrained. They are responsible for the great majority of maternal deaths. Every gynecologist who works in a large charity hospital can give evidence of the morbidity among poor women resulting from infection where the attendant was a midwife. The splendid results obtained by the lying-in hospitals and dispensaries, where women are attended by skilled physicians and trained nurses, are chiefly due to a rigid technique, the essential feature of which is cleanliness. It is a disgrace to every city that the benefits of such institutions cannot be extended to all poor women. Any surgeon who would dare to operate under the conditions observed by midwives would be denounced not only by the medical profession, but also by the enlightened laity. Yet the latter are apparently indifferent to the work of the midwife, and allow her to carry on her dangerous career uncensured. The extension of the benefits of scientific obstetrics is chiefly due to the persistence and self-sacrifice of the medical profession, but the doctors are unable, unaided, to do what remains to be done.
Dr. Francis Quinlin, President of the New York County Medical Association, says: All reputable physicians who have given the matter the slightest consideration are of one mind in regard to the menace to life in the ignorant work of the great majority of midwives. The New York County Medical Association has let slip no opportunity to throw the weight of its influence on the side of remedial measures. That little has been accomplished so far is due to the fact that the midwife, as she exists to-day, is a time-honored institution, difficult to uproot. Most midwives have apparently no conception of the scientific cleanliness which is rightly regarded by physicians as being of prime importance. The most ordinary antiseptic precautions are ignored, with the result that, every day, women who have been attended by midwives are brought to hospitals suffering from blood-poisoning. In their habits of carelessness the midwives also carry from one house to another the germs of infectious diseases. In the interest of a host of poor mothers and of children whose lives are valuable to the nation, I say that the practice of midwifery should come under a much closer scrutiny of the law than is now the case.
Dr. Eleanor B. Kilham, Head of the Maternity Department of the Women’s Infirmary, New York City, says: That much injury results to mothers and children from the unrestrained practice of midwives there can be no doubt in the mind of any physician who has been brought in contact with the conditions. There is an opportunity here for an important reform, and I am very glad to know that something is being done in this direction.