L. EMMETT HOLT, M. D. 205 



Nor is the problem of infant mortality to be solved simply 

 by a pure milk supply or the establishment of milk depots, 

 valuable as these are. In no previous year have so many 

 agencies for saving infants been at work as in 1910, and yet 

 the infant mortality during the hot months of June and July 

 has been greater than for several previous years. We must 

 then get out of our minds the idea that the problem of infant 

 mortality is to be solved by attacking a single cause or two 

 or three causes. Many causes must be taken into consider- 

 ation. 



What is needed is a broad, intelligent, comprehensive pol- 

 icy in attacking this great problem which will embrace all 

 the factors involved. For the formulation of such a policy 

 the organizations which are working for social betterment 

 look to the medical profession. Before such a policy can be 

 framed there must first be known the facts of infant mor- 

 tality; for our vital statistics are still very imperfect, notably 

 in the registration of births, the causes of death in the early 

 weeks of life and the causes of death in still births. We 

 must not only know the facts. It is still more important to 

 understand the causes which underly these facts. These are 

 not given in vital statistics and are not apparent upon the 

 surface. 



In planning our campaign it is necessary to know along 

 what lines progress is being made, if there is any progress, 

 and also in what direction we are losing. In New York City 

 during the last twenty years a notable reduction has been 

 effected in the mortality from acute gastro-intestinal diseases, 

 also in the conditions grouped under the heading of maras- 

 mus, inanition, malnutrition over three months old. These 

 are the results largely of a better milk supply and better 

 methods of feeding. 



However, in acute respiratory diseases we are losing ground; 

 also in the deaths attributed to congenital debility and prema- 

 turity. These are perhaps to be explained by the great con- 

 gestion of the population and the more difficult conditions of 

 living. 



The duty of the medical profession with reference to infant 

 mortality is not merely to advance knowledge in the diagnosis 

 and the treatment of the sick infant ; this is extremely important 

 and much has been done in these directions in the last twenty 

 years. Of vastly greater importance is what has been accom- 

 plished along lines of prevention, and it is in this direction that 

 progress in the future is to be made. Disease is to be prevented 

 by pointing out its causes, indicating how these causes may be 

 removed, and the organization of social agencies for the pur- 



