What has accomplished this result? Primarily, two causes: first, the
attention of the Board of Health, whose department of child hygiene now
receives a larger annual appropriation than any other (in 1913 it will
have more than $600,000, a fifth of the entire budget); and, second,
the work of the New York Milk Committee, a semi-public organization
composed of many of the chief physicians and philanthropists of the
city.
Eight years ago there was not one infants’ milk station in New York.
The babies of the poor were obliged to live on what milk could be
found easily for them. Few could afford and still fewer could find
what is known as “Grade A” milk, which sells in the commercial market
for from fifteen to twenty-five cents a quart, and which is thoroughly
inspected and certified. At the close of 1912 there were seventy-nine
such stations in the city. At every one Grade A milk was sold at the
nominal price of eight cents a quart, so as to be in easy competition
with ordinary commercial milk. Every day thousands of mothers with
their babies throng these stations. However, their chief purpose is
not the mere selling of pure, rich milk. They serve principally as
dispensaries. The milk is used by the city as a lure by means of which
ignorant mothers are brought within the reach of the physicians of
the Health Department. With the milk, thorough instruction and advice
as to the care of infants is given gratis. The old idea that mothers
know entirely how best to care for their own children has been proved
erroneous. Not all mothers in a large city know how to care for their
children. Many of them are virtually as helpless as the children
themselves. They have to be taken in hand, trained, and taught in the
care of their offspring as completely as the children themselves are
taken in hand a few years later in the public schools.
In addition to the seventy-nine dispensaries of milk and medical
knowledge, the city maintains a large corps of trained nurses who make
visits, especially during the summer, to the homes to complete the
instruction. In the poorer districts, every child under a year old is
visited by a city nurse at least once in ten days. The average cost is
fifty cents a month for each child. At the same time the inspection of
the general milk-supply has become thorough. The city’s inspectors now
cover all farms within two hundred miles from the city hall, and the
sources of supply are thus kept in proper sanitary condition.
The city also gives ice in summer to those families (with children)
that are unable to buy it. In the summer of 1912, 900,000 pounds were
thus distributed. This is in addition to the accepted efforts to secure
better playgrounds, better ventilated schools, etc.
A decade ago the summer death-rate among children in New York was from
two to three times as high as the winter death-rate. For the last four
years it has been steadily decreasing, and in 1912 it was almost as low
as the winter death-rate. Deaths from diarrheal diseases among children
have been reduced to a minimum through the concentrated efforts of a
few years. The next work to be taken up will be the winter deaths from
respiratory diseases. This is a more difficult problem.
Yet the greatest problem in infant mortality has still to be solved.
This is the care of the “institution” baby. As in England and in
France, the largest number of deaths among New York children occur
among the illegitimate and those lacking a mother’s care during the
early months of life. In 1911 more than forty per cent. of the deaths
of infants under one year in Manhattan occurred in institutions.
The institutions that receive foundlings are too few and too poorly
equipped. One day Mr. J. Pierpont Morgan saw in the street, within
a block of his home, a poor woman hugging despairingly to her
breast a new-born infant. In consequence, he caused to be built the
million-dollar lying-in hospital on Stuyvesant Square, which has
already been the means of saving many an innocent life. But that
superb hospital, large as it is, has not the facilities for taking
care of more than a small number of the infants that require such an
institution.
The material agencies, efficient and marvelous as they have become,
have not been the chief aid in the reduction of the death-rate,
especially among children. Public education has really had more to do
with it. Even those in direct charge of the work in infant mortality do
not assert that the entire credit for the satisfactory progress should
be given to the milk stations, the dispensaries, and the hospitals.
Pamphlets, lectures, newspaper articles, and school-room instruction
are at the base of the advance. Publicity has proved to be a greater
force than milk inspection. Certain popular newspapers in New York
have the power to achieve definite radical reforms in modes of living
whenever they choose to prosecute a vigorous campaign. Just as the
newspapers can expose corruption in any of the city’s departments, so
almost as readily they can uproot or at least substantially lessen
certain sanitary evils. A case in point is their campaign against the
fly last summer. By means of wide-spread and vigorous news articles and
editorials they succeeded in so rousing the mass of the people that
the fly pest was visibly reduced. Health Department officials testify
readily to this.
The work of the social settlements, of the mothers’ clubs, of
the neighborhood nursing associations, of the diet-kitchens, all
contribute to the general education that is bringing about a condition
of excellent public sanitation. This work is necessarily of slow
growth. Its effect is not nearly so evident as that of vaccination, of
smallpox segregation, or of typhoid diagnosis. It is not so simple as
establishing proper sewers or purifying the water-supply; but it is no
less important.