Boston Medical and Surgical Journal
It is impossible in the few minutes at my disposal to give more than the briefest summary of the main points regarding the importance, causation and prevention of infant mortality. The importance of the subject is shown by the fact that, according to the census of 1910, approximately 265,000 babies in the first and 53,000 in the second year of life died in the United States in 1910, making a total of 318,000. It is hardly necessary to advance other figures. The seriousness of the subject is
... the subject is emphasized, however, when it is realized that a baby comes into the world with less chance to live a week than an old man of ninety, and less chance to live a year than a man of eighty. The causes of death are shown approximately in the accompanying table : Causes of Death. 85% Prematurity, congenital debility, congenital defects nnd accidents of birth.25% Acute gastrointestinal diseases 25% "1 4fti/ Diseases of nutrition. 15% J-/c Acute respiratory diseases.20% Acute infectious diseases.'. 3% Tuberculosis. 2% Syphilis. 1% Unclassified. 9% It is evident from this table where the work must be done to diminish the present terrible rate of infant mortality. It seems a self-evident fact that the etiology of a condition must be understood before measures can be taken intelligently for its prevention. This fact often seems to be forgotten, however, in the campaign against infant mortality. Prematurity and congenital debility are, for example, due chiefly to alcoholism or disease in the parents and to overwork and undernutrition of the mother. The measures to be taken to remedy these conditions are obvious, but far-reaching. Amoiig them are the abolition of alcoholism, the prevention and notification of venereal diseases, the regulation of the employment of pixegnant women, the provision of proper food for pregnant women, prenatal care by public nurses and by prenatal clinics, and the provision of suitable hospitals for the care of premature infants. Most of the injuries at birth are avoidable, and ai'e the result of the neglect or incompetency of physicians and midwives. The remedies are the better education of physicians, the abolition or proper regulation of midwives and the establishment of free municipal clinics for the cai"e of poor women in labor. The diseases of nutrition and the acute gastrointestinal diseases are due primarily to bad feeding. In general, 85%' of all infantile deaths are in the bottle-fed and 90% of the deaths from the diarrheal diseases are in the bottle-fed. The remedy is again obvious. Women must be taught to nurse their babies and measures taken to enable them to do so. Public aid must provide for the mothers so that they do not have to wean their babies to go to work. They must be fed and helped. This can only be done when there is compulsory birth notification, which is enforced. The bottle-fed babies die because they are badly fed. They are badly fed because of the ignorance of mothers and doctors, the inability of the poor to get good milk and their inability to take care of it, if they get it. The remedies are again obvious. They are the better education of physicians in the matter of infant feeding, the education of the poor and ignorant classes by distinct nurses, milk stations and "consultations," the improvement of the milk supply in general, the px-ovision of clean milk for babies by public and private charities and the provision of free ice in the summer. Other causes of the acute diarrheal diseases are excessive heat, overcrowding, unhygienic surroundings and flies. The remedies are again obvious. Among them ai'e the improvement of the living conditions of the poor, the provision of parks, piers and playgrounds and the suppression of flies.