232 ERRONEOUS IDEAS ON INFANT MORTALITY 



apparently normal, surroundings good case is considered safe by 

 the nurse and closed. One month later comes the death certificate. 

 What has happened? The nurse's visit was made at a bad time 

 for observation of true conditions. The mother was shifted to her 

 own responsibilities. Wrongly or rightly, after about 10 days' trial 

 of breast feeding, the mother is led to try the bottle. She tries 

 mixture after mixture, thought out by herself and assisted by 

 neighbors. She continues to experiment until the baby's condi- 

 tion is alarming, when she calls in a physician, who removes all 

 food for 48 hours to give the starving baby's stomach a rest. 

 Vitality is now so low that a few hot days sap up what remains 

 of its strength. A second visit of the nurse would have probably 

 prevented this death. 



A study of the infants, especially of the poor and middle class, 

 whose mothers are not influenced by social aspirations, shows 

 that most are first fed on the breast, and after two weeks' trial 

 for various real or imaginary suppositions, artificial feeding is 

 resorted to. About one month after birth is the time for a 

 nurse's visit or, still better, a revisit, in all cases, even in the 

 safest-appearing cases. 



The impression is universal that the death rate depends partly 

 on the intelligence of the people, and that the poor, dwelling in 

 slums and tenements, because of their ignorance, have a higher 

 death rate than the wealthy, intellectual, social classes. 



In the care of infants, excluding the question of sanitation, lack 

 of which is more often due to poverty, the wealthy mothers have 

 no more, if not much less, knowledge of the care of infants than 

 the average dweller of the slums. Among the wealthy a trained 

 nurse is employed for the infant, and, when well or sick, the 

 advice of specialists on diseases of children and infant feeding 

 is secured. When the hot summer months come, they can spend 

 the entire term in the country or at the seashore. 



Every city tries to compensate the poor by offering them the 

 comforts of well-equipped hospitals, and the services of these 

 same specialists who visit the hospitals. In summer many phil- 

 anthropic and charitable organizations send children to the sea- 

 shore or country for varying periods. A directory of hospitals 

 and charitable organizations in any large city is a voluminous and 

 imposing volume. Have you, however, studied the true state of 

 affairs in your city ? 



The following information, which I gathered from all of the 

 hospitals of Philadelphia, makes an interesting study of these 

 institutions in their relation to infant mortality: 



