Fighting for Life
Page 25
The way is a simple one. In my official lifetime, the baby death rate has been reduced two-thirds, but this reduction has taken place almost entirely in the class of diseases which we call gastro-intestinal. The diarrhoeal diseases have been met and conquered. The old legend of the deadly first summer is now a part of our folklore. If we are to save the babies represented by the present death rate, we must look for other causes to attack. There is one part of the baby death rate that has been static: there are as many babies dying today during the first month of life as there have ever been. This accounts for one-half of all baby deaths. We have done nothing about it—and we could.
We know that this death rate during the first month of life could be reduced by two-thirds almost at once if every pregnant woman could have proper prenatal care. Here is a reform which might be instituted almost overnight. Instead of a few sparsely located prenatal clinics serving an infinitesimal number of our pregnant women, we might have prenatal care demanded as part of the required studies of every medical student; we might have a prenatal clinic in every hospital and we might have organizations like the American Medical Association conducting graduate courses in prenatal care in every community. The Federal Children’s Bureau, under the Social Security Act, is already planning for many of these clinics, but this is not enough. Thirty years have elapsed since we first knew we could reduce our infant mortality in this simple way and we are still talking about it. It seems to me that women, as a group, might demand this and see that it is done. I cannot see why prenatal care for every pregnant woman is not a possibility and why it should not be accomplished within the very near future.
There are other problems that still need to be solved. Healthy babies need healthy mothers, before and after birth. Our present death rate of mothers from conditions during pregnancy and confinement is almost the highest of any of the civilized countries of the world. England has a rate one-third lower than ours; the Scandinavian countries have long had a rate two-thirds lower than ours in the United States. It is of little use to say that this is due to our midwives; both England and the Scandinavian countries employ midwives in far greater numbers than we do. This is a problem for organized medicine to solve, though prenatal care will go a long way to help. A special committee of the New York Academy of Medicine in a report a few years ago gave it as their conclusion that seventy-five percent of these deaths from septic infection at the time of child birth are preventable and that sixty-six percent of the total deaths are likewise preventable. And yet we do nothing, or very little, about it.
Another—and very serious—unsolved problem in child hygiene is the proper care of the pre-school child. And this ties up with the health problem of the child of school age. We have learned to take care of our babies, but when they pass into childhood they are left to fend for themselves to a large extent. This has been called “the neglected age,” “the in-between-child age” and many other epithets of a like forsaken character. It is probably the most important age of our entire life cycle. Ninety percent of cases of contagious diseases occur before the child is five years old; nourishment which may make or mar the health throughout life is determined at this time; character and habits are formed, and the entire groundwork for life is laid then.
But before we argue as to what should be done for the pre-school child, let us go on to the next group—the child of school age. “School age” is an arbitrary limitation, but from the physical angle it does seem to mark a turning point. The height of physical hazard has passed by the time a child enters school; the dangerous age is over so far as contagious diseases are concerned, but it is just beginning with regard to physical defects. At the risk of repeating myself, and for all the emphasis I can bring to bear, I want again to say that if we might thoroughly examine each child when he first enters school; have one hundred percent follow-up work with enough home visits by nurses to make this possible and, as nearly as possible one hundred percent corrective treatment for all physical defects found, we could solve the distressing problem of how school medical inspection might be made worth while. If we would concentrate almost all of our time and money upon this important early procedure, the remainder of our work to keep children of school age healthy would be easy indeed. Of course, there would be a few years’ interim of seeming neglect of the older children; the same thing happened when we stopped treating sick babies and bent all of our energies toward keeping them well. It is the only solution of the problem that I can see. That it will be done, I doubt. I can only hope.
We first made progress in saving babies when we stopped caring for sick babies and concentrated on keeping the others well. We knew that a few babies might die who otherwise might have had a chance for life, but we also knew that thousands would live in the future because we had the courage to begin at the right place. We have not had that courage in caring for children after infancy. The political angle has been a deterrent: educational authorities concentrating on their particular jurisdiction have called aloud for a physical examination of each school child each year. There has never been and there never will be enough money available to make any such ideal a possibility. It could not, in any event, be the most efficient and sensible procedure. If we would face the problem honestly, we would admit the far greater usefulness of making sure that children are completely healthy when they enter school.
Of course this means extra concentration on the pre-school child. The neglected age should be neglected no longer. These millions which are now being so ineffectually spent on the school child as a matter of routine, would have to be, in large part, spent on the child before he enters school. But by doing this we can solve the problem of health for the school child in short order. School inspection for the detection and control of contagious diseases will still be necessary but these diseases have decreased so in their occurrence that this procedure will take very little money.
In recent years the pre-school child has received a fair share of attention from the psychologists. But we have been so absorbed in the field of mental hygiene and the behavior problems of young children that we have almost totally neglected their health and its implications. It may be well to have a well behaved child; it is of greater importance to have a child who can be well behaved. We are already in danger of making the bearing and bringing up of children such a complicated process that many women are afraid to undertake it. Children have always been “bad”; they used to be corrected in various old-fashioned ways, and they outlived the badness in a majority of instances. There is more juvenile delinquency today than there was thirty years ago. Ordinary child “badness” was not considered to be a pathological condition then. Nowadays if a child is anything but a little robot he is taken to a child psychologist to have the cause discovered. The net result is that mothers are unduly apprehensive and children are watched so closely that the tension is disastrous for both.
Children are natural exhibitionists. They love to be noticed and they like to hold the center of the stage. We may well be starting toward breeding a race of little prigs, if not worse. A few years ago I received a report from one of the most prominent nursery schools in this country. In it were listed over three hundred actions which mothers were encouraged to observe in their children: whether they started walking with the right or left foot, whether they noticed this or that, all simple and normal actions and of no consequence to the development of the child. The report gave me a mental picture of maniacal mothers and children to match. Overanxiety on the part of mothers is extremely bad for children who find themselves the focus of this anxiety. Probably there are children who need this kind of expert care. But I am sure it is overdone and need not be so universally applied as it is today.
It would be most inappropriate to end my story with an account of unsolved problems. Looking back over my experience of thirty years with children I find the good and the bad intermingled in my remembrance. There were small failures but greater successes, heavy handicaps and great opportunities, side by side. For a clearer
picture I must compare the beginning and the end. In a recent issue of “The Child,” a U. S. Children’s Bureau publication, I find encouragement. The infant mortality in the United States in 1936 was 57 per thousand live births. Not as low as it should and could be—but lower by more than half when compared to the rate of thirty years ago. The provisional rates for 1937 show that during that year 2,775 fewer babies died than during 1936—that is the lowest infant death rate in the history of this country and compares favorably with the baby death rate in any country of the world.
We are making gains in maternal mortality too. For so many years we have had a black record here: the only countries which could show a worse one were Chile, Lithuania, Northern Ireland and Australia. In 1936 our maternal mortality rate was 57 per ten thousand live births —the lowest ever recorded in the United States. Still, the rate is 28 deaths to ten thousand live births in Norway, 30 in the Netherlands and in Italy, 32 in the Irish Free State and 33 in Sweden.
There is no adequate reason why we should not equal these figures. We know how. I hope to live to see the day when death from the preventable disorders of the first month of life has been almost completely abolished: when maternal mortality in the United States is as low as human knowledge can make it; when the pre-school child receives the simple care that assures him of a healthy life. All of these things may be accomplished by the use of already available knowledge. It is to be hoped that we will use this knowledge.
I have stood at the corner of Fifth Avenue and Forty-second Street in New York City and watched the crowds pushing and milling back and forth with set expressions and determined faces, all bent on getting somewhere at the cost of the men or women at their elbows. I have stood there and wondered. Wondered deeply and been sadly perplexed. Should we bring more and more babies into this troubled world? Should we try to keep them alive and well? What is to become of them? Are they to be simply more cannon fodder? There is no clear and certain answer. But the occasional discouragement that gives rise to such questions is only a momentary reaction.
I have faith in the ultimate decency of mankind. I believe that this salvaging of human life has been worth while. I can still see the light in a mother’s eyes when her baby was assured of health. When I think back over the long years of hard work and struggle, my joy when ideals were realized and my determination to try over again when things were blackest, my loyal friends and co-workers—I come back to the place where I started. Of course I would do it again. I would not have any of it different in any way. It was a magnificent opportunity, a great and heart-warming experience, a happy road to follow. A glorious, an exhilarating and an altogether satisfactory life.
A few months ago I happened to read the following excerpt from a little booklet called: “So Near the Gods,” published by the Society of the New York Hospital:
“A child born this year will probably live fourteen years longer than one born twenty-five years ago. Expectancy of life has been increased through the prevention of disease and death during the first two years of life. There has been no greater gift than this in all the history of mankind.”
Perhaps this holds the most fitting tribute that I can pay to everyone, not only in our New York Bureau of Child Hygiene but to all the thousands of other consecrated workers who have carried on.
INDEX
The links below refer to the page references of the printed edition of this book. While the numbers do not correspond to the page numbers or locations on an electronic reading device, they are retained as they can convey useful information regarding the position and amount of space devoted to an indexed entry. Because the size of a page varies in reflowable documents such as this e-book, it may be necessary to scroll down to find the referenced entry after following a link.
Aberdeen, Lady, 173
Academy of Medicine, 114, 141, 142, 254
Adams, Maude, 18
Addams, Jane, 210, 213
Alcott, Louisa M., 16, 17
Allen, William H., 82
Altman’s, 19
American Association for the Study and Prevention of Infant Mortality, 143
American Child Hygiene Association, 143, 144
American Medical Association, 254
American Woman’s Party, 195
Amherst College, 5, 9
Amster, Dr. J. Lewis, 97, 98, 99
Arnold, Mary, 146
Arnold Constable & Company, 19
Asserson, Dr. Alice, 40
Association of Baby Health Stations, 145
Association for Improving the Condition of the Poor, 159
Astor, Lord, 174, 175
Aunt Abby, 19, 20, 21
Baby Health Stations, 126, 127, 128, 129
Bacon, Josephine Daskam, 211
Baker, Arvilla, 5
Baker, Mary Louise, 5
Baker, O. D. M., 2, 3, 4, 11, 24
Baker, Robert Nelson Millerd, 5
Barrett, Rachel, 235
Barrymore, Ethel, 18
Bensel, Dr. Walter, 57, 61, 66, 74, 84, 85
Bernhardt, Sarah, 18
Biggs, Dr. Herman M., 66, 84
Blackwell, Dr. Elizabeth, 31, 32, 33, 35, 189
Blackwell, Dr. Emily, 32, 33, 34, 35
Blauvelt, Dr. Alonzo, 66
Bloomer, Amelia, 15
Board of Education, 150
Brown, Arvilla, 4
Brown, Jenny, 4, 5
Brown, Merritt Holmes, 4
Bruere, Henry, 82
Bureau of Child Hygiene, 66, 87, 96, 100, 102, 108, 120, 122, 131, 139, 140, 146, 153, 156, 168, 170, 171, 173, 180, 185, 188, 202, 211
Bureau of Municipal Research, 82, 84, 109
Catt, Carrie Chapman, 195
Chapin, Dr. Henry Dwight, 177, 178, 179, 181, 245
Chevalier, Albert, 18
Chevalier, Miss, 43
Child Labor Amendment, 186, 187
Coghlan, Rose, 203
College Equal Suffrage League, 192
Collier, Willie, 18
Collins, Lottie, 18
Copeland, Dr. Royal S., 99, 100, 102, 155
Cronin, Dr. John J., 90
Cushier, Dr. Elizabeth, 44
Daly, Dan, 18
Danforth, Arvilla, 4
Danforth, Samuel, 4
Daniel, Dr. Annie Sturges, 41, 42, 43
Dansville, New York, 13, 14, 15, 90
Darlington, Dr. Thomas, 64, 65, 67, 68, 84, 95
Daughters of the American Revolution, 183, 184
Davis, Katharine Bement, 103
de Lille, Dr. Armand, 172
Delmonico’s, 19
Dental hygienists, 157
Department of Health, 26, 28, 54, 61, 64, 69, 71, 90, 108, 124, 130, 145, 150, 152, 154, 160, 166, 177, 185, 244
Diet Kitchen Association, 145
Division of Child Hygiene, 84, 87
Eastman, Crystal, 182
Embler, Elizabeth D., 235
Empire Theatre, 18
Farrar, Dr. Lillian K. P., 40
Fifth Avenue Hotel, 17
Fones, Dr. Alfred C., 156
Foundling babies, 118, 119, 120, 121
Fowler, Dr. Robert W., 90
Fox, Della, 18
General Slocum disaster, 60
Goldwater, Dr. S. S., 206
Goodrich, Annie, 145
Goodwin, Nat, 18
Haight, Anna, 12
Hall, George A., 186
Harriman, Mrs. J. Borden, 128
Harvard College, 4, 9
Hedges, Job E., 90
Hess, Dr. Alfred, 142
Heterodoxy, 182
Holt, Dr. L. Emmett, 144, 245
Hoover, Herbert, 144
Hopper, DeWolf, 18
Hovey, Dr. Bleeker L., 4
Howe, Julia Ward, 39
Howells, William Dean, 16
Hurst, Fannie, 182
Hylan, John F., 97, 99, 103
Influenza epidemic, 154, 155
Irving, Henry, 18
Irwin, Inez Hayn
es, 182
Jackson, Dr. James H., 14, 15, 17
Jackson, Dr. Kate J., 17, 27
Joline, Mrs. Adrienne, 145
Kahler, Hugh MacNair, 14
Kendrick, Dr., 6
Kenyon, Josephine Hemingway, 211
Kerr, Anna, 90
Kilham, Dr. Eleanor B., 44
Kinkead, Cornelia D., 12
Kinkead, Dr. John, 27
Knox, Margaret, 133
La Follette, Fola, 182
Laighton, Dr. Florence M., 40, 47, 51, 203
Lambert, Dr. Alexander, 125
Lathrop, Julia, 138
Lederle, Dr. Ernst, 57, 76, 80
LeFevre, Dr. Caroline H., 40