The more well-to-do and the wealthy families had a somewhat different answer. Here initial cost and upkeep played no part in the size of families. Motor cars were an accepted and little considered part of daily life. But the arguments for small families were even more emphatic. Doctors whose practice was confined almost entirely to the wealthy but who had no point of contact with each other, invariably wrote me that potential fathers and mothers were refusing to bring children into a world which held such an insecure future. It was not for them to bring up their boys to take part in future wars nor their girls to be plunged into the vicissitudes of an uncertain working world.
There are enough exceptions all around us to prove that this is far from a universal state of mind. We still see and meet families that are fairly large. But we also have enough knowledge of childless “families” to give us pause for thought. Certainly the state of the world during the past few years is enough to give us a sympathetic insight into the minds of those who would limit all offspring for purely unselfish reasons. We must have something better than this to offer our future children, or possibly it may be better that they should not be born. In wondering about this tendency toward a lower birth rate, we should not forget that even Germany and Italy, with their desire for larger populations and the incentives they offer toward increased childbearing, have not been successful in inducing their peoples to respond. Russia is more successful. Since free abortion has been discontinued and the dissemination of birth control information limited or altogether stopped, its birth rate is soaring to almost unbelievable heights. Which brings us to a consideration of the probable outcome of these changes.
A few years ago I submitted to one of our leading monthly magazines an idea for an article on “A Moratorium for Babies.” My theory was that women could force the world to abandon war as a national policy if they would simply refuse to bear children until governments came to their senses, or realized that there would be no future soldiers. I thought it would be an interesting and fairly easy topic. The editor was interested, and I started to work it out. The thesis was sound and workable for all the civilized nations, but it led me into some startling conjectures. The inevitable consequence of any such procedure became apparent. Assuming that Europe and America might well respond to the purpose of this crusade, what of India? What of China? And what of all the other so-called backward—but populous—countries of the world? I began to see our birth rate as a matter of world-percentage. Cutting it down, even if by so doing we might make our civilization still more civilized, could easily mean the end of innumerable gains that we have already made, and the dominance of the Orient or some unthought-of race to whom such ideals would mean nothing!
That is as near as I have come to a logical reason for having babies. Certainly it is worth while for us to keep alive and well those children who are already born or who may be born. Our falling birth rate can be met only in this way. That it has been met, in part at least, is to me a cheering sign. That the progress we have made has been through saving the babies we have from sickness and death, rather than through keeping the birth rate high to cover a high mortality, is even more gratifying. It is evidence that we have the means within our power to solve the problem, at least in part, from the humanitarian, sentimental and world progress points of view.
Granted that this work is worth doing and worth doing well, the enormous impetus that is pushing it forward at the present time is a heartening inspiration. Throughout the world today, the importance of child hygiene is accepted. Within the space of thirty years it has, from an isolated instance, grown to almost unbelievable proportions. In the United States there is hardly a township or a village that at the present time has not established some work for the reduction of infant mortality and for preventing ill health during childhood. I know of no other cause that has grown so rapidly. From its beginning in New York City in 1908, it has advanced so that now each one of our forty-eight states has a Bureau of Child Hygiene, and Hawaii, Alaska and Porto Rico have joined with us in the good work. Preventive medicine as a public service has been established from this humble beginning. Public Health Nurses are found everywhere today whereas, thirty years ago, they were employed only in the New York City Department of Health. The basic principles of keeping babies well that began in our limited efforts in New York City are now so well known that few workers in the field have any idea that they have not always existed. It is difficult for me to comprehend that this acceptance has developed from such recent beginnings and that it is now so great. A great honor and opportunity happened to alight on my doorstep years ago, and a greater honor and deeper satisfaction has come to me in its success. Not that it was altogether easy. The idea was good and did not need much pushing but there were long days of political interference, rank discouragement and constant struggle to keep from being submerged. There were too many days when I could have echoed the words of Abraham Lincoln:
“If I were to try and read, much less answer, all the attacks made on me, this shop might as well be closed for any other business. I do the best I can; and I mean to keep on doing so until the end. If the end brings me out all right, what is said against me won’t amount to anything. If the end brings me out wrong, ten angels swearing I was right would make no difference.”
Sometimes I could have wished it otherwise. In the earliest years it was practically all struggle. There were, no doubt, many mistakes. That seemingly could not be helped. No one liked a woman in an executive job in a city department. Few tried to help. Later, when results began to come, my friends were many and of the right sort. First among them were the pediatricians of the city, although in the very beginning they too had held themselves very much aloof. I owe a large debt of gratitude to Dr. L. Emmett Holt, Dr. Henry Dwight Chapin, Dr. Herbert B. Wilcox, Dr. Ira S. Wile, and many others. Later the obstetricians came to my aid and all cooperated with the Bureau in many helpful ways. I am proud and honored to count them among my friends. No one could have asked for better support than I had among the professional groups. Though we had our differences of opinion, they were loyal and stalwart champions of our common cause.
I presume I have always had the spirit of the pioneer, and at first, had the gay and gorgeous buoyance of youth. Not that I have recognized it; life has been too busy for that. But as I look back over the years, there seem to have been a surprising number of “firsts” in my life. I suspect that was because women were then making an effort to get out of the shadow-land where they had dwelt for so long, and the enormous vitality and strength of youth made almost anything seem possible. I was young and active during the years when women began to be emancipated and to find their place. I remember a remark that Anna Howard Shaw once made to a reporter who came to see her when women had lost their first battle for the vote in New York State. He asked her how it felt to lose. And Dr. Shaw promptly replied: “We haven’t lost. How can one lose what one has never had?” We women had never had any position of importance in the world and, during those years at the turn of the century and soon afterward, we had everything to gain. The pioneer aspect of my work—that I could have been the first woman to earn the degree of Doctor of Public Health, the first woman to hold an executive governmental position, the first woman to be appointed in the professional rank in the League of Nations and above all, the first woman (or man for that matter) to act on the idea that preventive medicine in baby and child care was a function of government—seems very strange and unreal now. But it has left me with a special interest in the achievements of my sex. Today women are everywhere in public life. Not that they have made the strides that I had hoped for them thirty years ago. It seemed for a time—certainly after they received the right to vote—as though the way were clear and open before them. For several years, women went constantly forward. Today, there are many signs that they are content with a lower level of attainment. Possibly the economic condition of the world is responsible, but the fact remains.
I know that in the profession of medicine wome
n are still a long way from their goal and, moreover, that they have been losing their higher grade positions and failing to get anywhere near the “top.” Hospitals still do not open their doors to women in staff positions; clinics still relegate them to the lower ranks and, on the whole, they have not held their hardly won gains of twenty, or even fifteen years ago. There are always exceptions, of course. In the political field, several women have proved their calibre. There are a few, a very few, who have reached the highest rank in the business world. But, on the whole, women still hold a very minor place in the working and professional world. We are all aware of men who stand at the very top in finance and business who might have great difficulty staying there if it were not for their able and efficient private secretaries—all women. And yet these latter women, brilliant as they may be, will go no further.
I hold no brief for women as women. There are good and bad in their ranks. But I have a strong suspicion that the same holds true for men, and I do not think that many women have been the success that they might well be. It is still a man’s world. The vote did not bring us either full emancipation or full opportunity. We still have plenty of indirect influence but little that is direct. We have made some gains but we have also suffered many losses. During the suffrage days I had no great illusion about my sex; I wanted the vote as a matter of common justice. But I still believe that women have something to offer this sick world that men either do not have or have not offered.
It seems to me that women could make a real contribution in the field of medicine. In the course of my lifetime that profession has, I fear, become less human. The general practitioner is passing. Today, a patient has virtually to make his own diagnosis of his ailment before knowing what doctor to choose to treat him. Specialism is rampant among both men and women doctors, although women, still at a disadvantage in the profession, increase the hazard if they decide to specialize. It is true today, as always, that the general practitioner could care for, with adequate and good results, at least eighty percent of all the ailments of mankind. The need for highly specialized knowledge is not frequent. And yet, general practice is no longer a lucrative calling. Present methods of diagnosis, for all their elaborate technique, leave much to be desired. It is true that the laboratory and the X-ray have added much that is valuable to our knowledge of diagnosis, but in this change of tactics the average doctor has lost much of his basic skill. Thirty years ago, we had to depend upon our sense of touch, sight and hearing to make a diagnosis, and experience developed an alertness that is not completely replaced by routine laboratory reports. Today this simple efficiency is discarded. No one who is ill can escape the exhausting round of diagnostic methods. A friend of mine told me of her experience in this connection and I relate it here, not because it is unusual, but because it is all too common:
My friend had a sharp pain in her head which she suspected was some sort of sinus trouble, and went first to a nose and throat specialist, who told her that a tonsillectomy, an operation to open up the sinus and a series of hypodermic injections would ease her pain. Not satisfied, she went to a doctor who seemed to be the nearest possible approach to a general practitioner. He suspected a brain tumor and advised her to have her teeth X-rayed and, probably, most of them extracted. To confirm his diagnosis, he referred her to a neurologist. The latter sent her to one laboratory after another: X-rays in abundance, basal metabolism tests, blood counts and blood chemistry, gastric contents analyzed, and other tests too numerous to mention. It took five weeks. Her pain had continued all during this time with increasing intensity; she was on the verge of a collapse. She had had no medical treatment; nothing could be done until a diagnosis was made. At last she went back to the doctor. He was seated before a desk covered with reports from all of her various technicians. He said that now he had a clear diagnosis: every report pointed to sinus trouble and his advice was that she go either to Egypt or to Arizona for the winter! This patient was a working woman. Her meagre savings would not be enough to pay for all of the laboratory reports and the doctors’ bills. The prescription, so hard come by, was fantastic. Now she has gone into Christian Science and, so far as I know, is completely well.
I believe that this ultra-specialization is one of the reasons that medicine has its back to the wall and state medicine is on its way. It may be more efficient in the long run, but sick people need immediate help, understanding and humanity almost as much as they need highly standardized and efficient practice. The medical profession is mostly composed of high-minded men, but organized medicine as it exists today in the United States has surrounded the profession with too many taboos and too strong a cult for success to allow it to meet the everyday needs of the mass of the people. I have a great sense of pride in my profession. I know it is moving forward. But I regret the road it has chosen to take.
In the technique of caring for children, I know we have made definite and gratifying progress—although in certain details our attitude has almost described a complete circle in the past thirty years. During my first years in the Department of Health we undertook to change the habits of a vast tenement population. It was not an easy task, but it was clearly necessary. It was understood by all well-informed persons that babies could be fed on nothing but milk, modified for their age and weight, during their entire first year of life. We were very earnest and sure about this. The newspapers loved to publish sad stories about the iniquities of people who would give the baby bits of bacon or cabbage from the family dinner table. It was good publicity but it filled us all with horror that it could be so. Sour milk was supposed to be lethal poison—for babies anyway. Nothing but milk, until the first birthday brought the baby to the beginning of the dreaded carrot-spinach regime. Slowly, but surely, we have now got away from these fetishes, and admitted some virtue in the dire practices of the tenement mothers. Today, babies are fed vegetable purees even as early as five months and spinach and carrots are not the vital magic they were once considered. Many doctors today are using types of sour milk such as buttermilk and koumiss for baby feeding; orange juice is being largely supplanted by tomato juice, and we are catching up with the old time mothers.
There was a period when the vitamin idea threatened to undermine the mentality of many young mothers. Vitamin D was poured into and onto babies and young children in such vast amounts that doctors were forced to call a halt. All of us need a proper amount and a proper proportion of all the vitamins. These can be obtained in any well balanced diet; all human need for them can be met in this simple way. There are times when a greater supply of one or the other may be indicated, but not through self-medication. The doctor, and only the doctor, should make the decision about this.
I suppose the hardest lesson a mother can learn is that babies are very simple little folk and that they need very simple care. The fact becomes very clear when you are dealing with them in large numbers. Saving babies—en masse—is the easiest job in the world. No one can claim much credit for a successful baby-saving campaign. But it does need common sense. The simpler the procedure for any organized attempt to save babies is, the better the results will be. Because this is so, the greatest chances for success in any such crusade will lie among those families which we call underprivileged and which are certainly poor. Among our well-to-do population babies are too well cared for. The baby death rate, in New York City at least, bears testimony to that fact: it is higher in the “better” districts than it is in the “poorer” ones. There are several reasons for this. One is that over-elaborate care is economically impossible in poor families. Another is that the mothers in the tenement districts are willing to learn: they will follow directions no matter how strange and outlandish they may seem. And then, babies in the less favored part of our population have acquired an immunity toward disease that the well protected baby has little or no chance to obtain. I, for one, should not like to start a baby-saving campaign among the wealthier class. I am sure it would fail. And I am equally sure that I, or anyone else, by following simpl
e rules, could reduce the baby death rate in any town or city and under the worst conditions in the poorer sections.
The same problem can be seen among children of a slightly more advanced age: undernourishment, for instance, is not found among the children of the poor to the extent that it may be found among the children of the rich. In the tenements the cause of undernourishment may be too little food, the wrong kind of feeding, lack of ventilation, bad family conditions or overstimulation. These conditions are not hard to correct among the poor; there are many helping hands held out to supply the obvious need. But among the well-to-do it is not a question of too little food or the wrong kind; it is rather that the super-abundance does not tempt the child’s appetite. The child who “will not eat” is seldom the child who has not sufficient food. Overstimulation and overexcitement are far more common among the children of the rich than among the children of the poor. A child can be too well-bred to be healthy—and that is a sad commentary upon our civilization.
There is still much work to be done in the field of child hygiene. Every baby can have a chance for life. This cannot be given by the mother and father alone; it needs more help than that. Our goal will be reached only when public health officials, social welfare agencies, doctors, nurses and parents work together. And this is not so difficult as it sounds. We all know how it can be done; we have known it for many years. We simply do not follow the line that will be surely successful.
Because statistics are strange and unreliable things, I do not want to quote them. I have seen strong men so disturbed as to the accuracy of statistics that they have forgotten the facts they represent. I do not want to be led into this blind alley. I am interested in the child and want to keep first in our minds that we are talking about children and not about their representation as fractions. In dealing with children we are not facing a scientific problem which can be measured wholly in percentages. We are dealing with a human group with only one factor in common—that of age. We are dealing with little Susan and John and Mary and Thomas. They are our children. Each one carries all the potential possibilities of all humanity. Whatever the statistics say, each has a right to live. And each can live. We have not yet made that literally true, but in time we can reach this heart-warming goal. Even with conditions as they are today we have come a long way along this road. Millions of children are living today who might have died without organized care. Our baby death rate has gone down, in New York City, from 144 per thousand births to less than 50 per thousand births this last year. During the hot and enervating summers we have seen the baby deaths decrease from fifteen hundred a week to around sixty a week. I expect to live to see the day when any city or town will hide its head in shame if its baby death rate goes over twenty-five per thousand births.
Fighting for Life Page 24