230 ERRONEOUS IDEAS ON INFANT MORTALITY 



cause of the milk flowing too rapidly through the nipple and inat- 

 tention to other seeming trifles affecting the feeding. Many 

 physicians never personally observe the bowel movements, but 

 may occasionally ask the mother about the presence of undigested 

 fat, curds, blood and mucus. It is needless to say how little reli- 

 ance can be placed upon such reports. 



We may evolve fanciful theories about the causes of infant 

 mortality, we may show its relation to climatic conditions, humid- 

 ity, location of the city, mean temperature and influx of ignorant 

 foreign population; but we overlook the cornerstone of those 

 preventable deaths, due to gastro-intestinal disturbances, when 

 we ignore the. relation of the medical profession and infant feed- 

 ing to the problem. 



Fresh-air tents, piers, visiting nurses and milk stations are all 

 auxiliaries in this battle. Fresh air gives stimulation. The modi- 

 fied milk stations supply some or all of the nourishment, depend- 

 ing on many circumstances. Visiting nurses may correct errors 

 of living or hygiene, but infants must have the proper diet to 

 thrive on. 



This inaction on the part of the greater number of physicians 

 seems sufficient evidence that they would willingly give up this 

 branch of infant feeding to their assistants, who would under- 

 take the work. The physician could readily give it up to the 

 nurses without feeling that medical duties were being usurped. 

 The work of Health Departments in reducing infant mortality 

 would be greatly augmented by the training of a corps of munici- 

 pal nurses in infant feeding, or a corps of physicians similarly 

 trained and assisted by a corps of trained nurses to teach the 

 mothers how to prepare the food and give it to the infant. 



The present method of utilizing the services of trained nurses 

 to educate mothers in two or three visits of five to thirty minutes 

 is a mistake. Of this time part is taken up with the recording 

 of the history of the infant, together with a study of the sur- 

 roundings. I believe, not only from an economic standpoint, but 

 also from the more efficient services to be obtained, in the em- 

 ployment of trained social workers to visit the homes, to obtain 

 histories and to aid in the campaign of education. This would 

 leaves the. nurses sufficient time to spend in caring and nursing 

 the sick infants and supervising the feeding. I believe that such 

 a well-trained corps would make mortality from diarrhoea and 

 enteritis a thing of the past. 



There seem to be objections advanced against the giving of 

 free medical services, and even nursing. Chief among these ob- 

 jections has been the fear of paternalism. 



The cries of paternalism, socialism, destruction of the indi- 



