The house on Henry Street

by Lillian D. Wald

Children under two years who show the greatest need are given the preference in admission to our clinic. Excellent physicians practicing in the neighborhood have contributed their services as consultants, and conferences are held regularly. In 1914 the number of infants cared for was 518 and the mortality 1.8 per cent. The previous year, with 400 infants, the mortality was one-half of one per cent.

The Health Commissioner of Rochester, N. Y., a pioneer in his specialty, founded municipal milk stations for that city in 1897. He states that the reduction of infant mortality that followed the establishment of the stations was due, not so much to the milk, but to the education that went out with the milk through the nurse and in the press.

In 1911 New York City authorized the municipalization of fifteen milk stations, and so satisfactory was the result that the next year the appropriation permitted more than the trebling of this number. A nurse is attached to each station to follow into the homes and there lay the foundation, through education, for hygienic living. A marked reduction in infant mortality has been brought about and, moreover, a realization, on the part of the city, of the immeasurable social and economic value of keeping the babies alive.

The Federal Children’s Bureau in its first report on the study of infant mortality in the United States showed that, in the city selected for investigation, the infant death rate, in those sections where conditions were worst, was more than five times that in the choice residential sections.

This report constitutes a serious indictment of society, and should goad civic and social conscience to aggressive action. But there are evidences (and, indeed, the existence of the Bureau is one) that the public is beginning to realize the profound importance in our national life of saving the children that are born.

Perhaps nothing indicates more impressively our contempt for alien customs than the general attitude taken toward the midwife. In other lands she holds a place of respect, but in this country there seems to be a general determination on the part of physicians and departments of health to ignore her existence and leave her free to practice without fit preparation, despite the fact that her services are extensively used in humble homes. In New York City the midwife brings into the world over forty per cent. of all the babies born there, and ninety-eight per cent. of those among the Italians.

We had many experiences with them, beginning with poor Ida, the carpenter’s wife, and some that had the salt of humor. Before our first year had passed I wrote to the superintendent of a large relief society operating in our neighborhood, advising that the society discontinue its employment of midwives as a branch of relief, because of their entire lack of standards and their exemption from restraining influence.

To force attention to the harmful effect of leaving the midwife without training in midwifery and asepsis free to attend women in childbirth, the Union Settlement in 1905 financed an investigation under the auspices of a committee of which I was chairman.

A trained nurse was selected to inquire into and report upon the practice of the midwives. The inquiry disclosed the extent to which habit, tradition, and economic necessity made the midwife practically indispensable, and gave ample proof of the neglect, ignorance, and criminality that prevailed; logical consequences of the policy that had been pursued. The Commissioner of Health and eminent obstetricians now co-operated to improve matters, and legislation was secured making it mandatory for the Department of Health to regulate the practice of midwifery. Five years later the first school for midwives in America was established in connection with Bellevue Hospital.