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knowledge concerning the cause of infant mortality; to encourage methods for the reduction of infant mortality. The functions of the association are: To educate and enlighten the public; to stimulate better sanitary organization and administration throughout the country; to promote more adequate registration of births; to correlate existing activities now working independently; to stimulate investigation into causes of infant mortality.”
This beneficent association now holds a meeting annually, and its possibilities for good can scarcely be estimated.
To enumerate all the causes of infant mortality would take too much space, but we may name illegitimacy, poor care of pregnant women, syphilis of the parents, lack of proper care in confinement of the mothers, lack of breast feeding, defects in artificial feeding, poverty, ignorance, unhygienic living of parents, including bad ventilation or the entire absence of it in the home. These can be corrected only by persistent efforts to educate the people. In this physicians have ever been foremost, not only as individual members of the profession, but in their organized capacity in medical societies and in Boards of Health, generally largely composed of physicians. The Health Departments of cities may be truly said to be the guardians of the health of children, just as the Department of Education is the custodian of their mental development. Without health education cannot be effective. The child, representing, as he does, the citizen of the future, always offers the most promising field for preventive medicine; and it is for the child that many of the newer activities of some health departments have been organized. The first work for the protection of children in New York City was some years ago, when the Health Department appointed a corps of physicians in the summer to instruct mothers how to prevent diseases in infants. Since then the summer corps doctors and nurses have been familiar and welcome visitors in thousands of tenement homes. In addition to these men and women who instruct mothers in the care of children, are many nurses from the Health Department who visit the homes and instruct mothers in methods of infant feeding and in hygiene, and who often actually perform the duties of nurses where infants are sick and require their expert attention. In 1911 nearly 95,000 such visits were made to the tenements. That mothers learn much in such an educational campaign it is needless to say, and as a result we find infant mortality in recent years on the decline in New York City, and whereever advances are made in the care of infants and in the bettering of their environment.
For the last several years New York has conducted a campaign against infant morbidity and mortality through the establishment of milk stations. In 1911 75,000 quarts of milk were distributed every week, and with the milk went instruction to the mothers in the care of the milk, in the proper feeding of it, in the importance
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of breast-feeding where this was possible. The visiting nurse became a blessing to hundreds of homes of the poor, for she became an instructor no less than a helper. As a result of this crusade the death rate was reduced 17.7 per thousand among infants.
Already has much been done in other directions to promote the health, the physical development, the progress upward of the young among us. If the foolish people would only permit us, we could by vaccination drive small-pox from the face of the earth. But ever distrustful of our profession, and slow to perceive what is to their own best interest, there will always be found purblind people to oppose this beneficent measure, and thus postpone the day of total delivery. We can stay that dread destroyer of children, diphtheria, by the prompt use of antitoxin; and yet not a few people, including some of our own profession, still throw doubt upon the power of this measure. We can put an end to the eye inflammations of the new-born by the universal use of silver nitrate solution in the eyes of every new-born child, thus cutting out at least 25% of the blindness of the world. After Crede's method of using a 2% solution of this drug was enforced in the Leipzic Clinic the percentage of cases of infantile ophthalmia declined from about it to one-half of one per cent in seven years. Experience has shown that a one per cent solution is quite as efficient as the stronger solution, and no eye irritation follows its use, as it not unfrequently does after the use of the 2 per cent strength. The use of the other silver preparations has not yet proven so certain in results. Why seek a better remedy than the nitrate, which brings decided benefit so surely and cheaply? Over one-third of the patients admitted to the Pennsylvania School for the Blind in seven years were made blind by this form of eye disease. In one New York school for the blind the average annual cost per pupil is $400. Thus every state no doubt pays annually many thousands of dollars for the maintenance of patients needlessly deprived of their sight by the neglect of the doctor or the ignorance of the mother or nurse. Here is room for an educational movement that will richly pay. Why need we mention the awful misfortune of the child that is compelled to grope in utter darkness through an unfriendly world? Great is our responsibility and inexcusable our neglect of this simple measure of prevention, or of prompt treatment should ophthalmia of the new-born set in. Not every state, we fear, has adequate laws touching this most destructive disease. It has recently been shown in congressional debate that the national government is annually expending nearly $1,700,000 in the Bureau of Animal Industries and over $2,000,000 in the Bureau of Plant Industry, all this mighty sum in the protection and improvement of animal and plant life. And yet there was objection to Senator Borah's bill for the establishment of a Children's Bureau whose estimated cost was but $30,000 annually. The purpose of this bureau as set forth in the bill, which fortunately is now a law, is “to investigate and report * * * upon all matters pertaining to the welfare of children and child life among all classes of our people, and it shall especially investigate the questions of infant mortality, the birth rate, orphanage, juvenile courts, desertion, dangerous occupations, accidents and diseases of children, employment, legislation affecting children in the several states and territories.” The bill was promptly signed by the President, who appointed as Chief of the Bureau Miss Lathrop of Chicago, who has had large experience in the study of child life, and who gives promise of administering the new Bureau in such a way as to bring to childhood the greatest blessings.
Then we have medical inspection of school children, so auspiciously inaugurated in our own State, as it has been in a number of other States for some years. This is certain to result in the discovery of many defects and diseases which will be remedied by being referred to the family physician for correction. Many pupils pass as mentally dull because of defective sight or hearing or a physical condition below the normal. Too young and ignorant to discover what is wrong, such children grope along, struggling through their daily tasks severely handicapped, and meeting with frequent punishment. Dr. W. A. White of the Government Asylum at Washington says that many apparently mentally defective children are so only because of removable physical defects. "Here is a boy," he says, "who is apparntly mentally defective; all he needs is an adenoid operation. Here is another who is tremendously irritable, and . really it would seem as if he might be a murderer when grown up.
The whole difficulty is myopia, which is easily correctable. * * * Here is a defective girl four or five years behind psychologically. There is a girl who will become a prostitute or criminal or both. Now is the time to tackle the problem of whether she will or not.” The doctor truly remarks that we have been too long in dealing with the finished product in trying to solve the problem of criminality and prostitution, and long experience shows the futility of this plan. The true remedy consists in dealing with the child and striving to remove all of its defects. To indicate the extent of these defects I quote from a recent journal some facts from foreign observations, as well as some in this country:
“Dr. Hall in Leeds found half the children in a slum school suffering from rickets. In the Edinburgh schools 40 per cent had diseases of the ear. The British Dental Association, examining 10,500 school children, found only 1,508 sets of good teeth, or 14 Der cent, free from decay. In the Dundee schools half those examined had defective vision. The superintendent of schools in Alameda, Cal., says that out of 3,600 pupils more than three hundred are afflicted with physical defects observable even to the layman. The Bureau of Municipal Research, reporting for this country, says: 'In rural as well as in city schools nearly one in three will have trouble with the eyes; nearly one in five will be mouth-breathers, because of too large tonsils or adenoid growths; every now and then there is one with nervous trouble or St. Vitus' dance, and certainly more than one in every school who is obviously predisposed to tuberculosis.'”
Such reports as these certainly indicate that the harvest is ripe for the reaper, and what a rich harvest it is to be in happier, more useful, and more contented lives, in a better and more productive citizenship.
We hear much of the influence of heredity, and all must admit that this is powerful. Unfortunately we can control but to a
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limited extent this influence until the science of eugenics has made greater progress. A number of states have introduced laws whose purpose is to reduce the propagation of criminals. Not all men agree as to the wisdom of such measures, but certain it is that we should exert every possible effort to lessen the production of children of criminal and defective stock. To quote a distinguished physician and author: “We go on marrying and giving in marriage criminals, lunatics, epileptics, inebriates and syphilitics and breeding more of their kind. We go on hanging and jailing criminals and ignoring the children from whom the criminals are made. We go on paying out for the cure of crime and its evil congeners more money than we spend for our children's education. We go on with maudlin sentiment and savagely oppose practicality and common sense in matrimony—society's very corner stone! And we pretend to be an intelligent social system” (Lydston.) Since young people will rush with little thought into marriage with the diseased, the degenerate, the physically and morally unfit, is it not time that the State shall at least make some effort in the direction of the prevention of the wholesale propagation of criminals, defectives and paupers, with their consequent mountain of taxation? says The American Practitioner.
There are about half a million insane and epileptic, feebleminded, blind and deaf; there are 80,000 prisoners and 100,000 paupers—all of whom cost the United States over a hundred million dollars a year.
When young people marry in cities, especially in America, there may be almost no knowledge of the other's ancestry, even of their immediate family. But the young man or woman of today has the right to know the ancestry of both his or her child's parents. Each has a right to exact a health standard as well as a moral one. It would be a great help if family genealogies were kept, showing what each individual died of and from what diseases he had suffered.
If our best efforts in the production of a better race of children shall fail and eugenics remain a science of the future, we may at least seek to cultivate the still newer science of euthenics, which aims to improve the existing generation by bringing about a better environment, which is even more powerful in shaping the lives of children than is heredity itself. Efforts at changing the environment of poor children in the cities have been made for years, and in not a few instances young people taken from surroundings of the vilest character have developed into the highest type of citizens. One such child has reached a gubernatorial chair in a Western State, and many others have attained to places of respectability and great influence.
But such cases will always be exceptional. The vast majority of children must be reared in their own homes, and it therefore