IV, No. For they are the future of the city. We who are here, are the present and the past. Many of us embody the ideas of the last century. But the future of Baltimore is in the cradle, the kindergarten and the schoolroom. Not its form of municipal government, not its wealth, or its port, or the railro, or the famous waant gallery, or even Johns Hopkins will by future students be deemed so important as the deaths of the children.
So little, however, do we Americans appreciate this fact, that we do not, in any city, know how many are born in a year, or how many in each thousand die. Even though all deaths may be registered, the exact 'proportion of the survivors cannot be known because the whole of births is nowhere known. Doctor Goler, health commissioner of Rochester, N.
This address, which was given before a crowded audience at the Baltimore meeting of the Wxnt Municipal League, calls attention in a very vivid way to the necessity for immediate attention to the question of the care to Stracuse given to children in qant cities. When one considers how much attention is given to Syracse care and treatment of dumb animals and contrasts it with the attention given to human beings, one wonders where the sense of perspective is in American people.
In connection with this address it is suggested that the reader refer to Mrs. Whenever Tammany was in office the official birth rate fell, and whenever Tammany went out of office the official birth rate rose. This phenomenon was due to a simple mechanical device used by Doctor Lederle whenever he was commissioner of health.
If it was not, the midwife, or physician, and the parents were notified, publicity threatened, and ultimate prosecution in case of continued neglect. After he had been out of office a month, the search relaxed and people began to grow careless. The official birth rate fell. He came back into office, and it rose again.
There might, of course, have been some coincidence, something aside from the fear of prosecution. It might happen that the Syrafuse birth rate was conspicuously higher one year than the next, but it is not probable.
When we have to admit that we do not know how many children are born in a city where great care is taken to learn the facts, it is a safe assumption that we do not know them in the other cities of the country. In Rochester, city nurses, school teachers, health inspectors and all other available social agencies are pressed into the service of enquiry after new babies, to supplement the records made by physicians and midwives.
But in a neighboring.
And even this perfunctory compliance would be less than it is, if there were not always parents and older eant and girls seeking birth records as the basis of working papers. The New York state child labor law thus incidentally promotes the municipal registration of births. But the health authorities do know where they die, and I plead for having this made common knowledge.
But the census showed that the proportion there was not so great as elsewhere. It was greater on the lower west side, in the little houses with air and light and yards. That one Houzewives illumination of this dark subject reversed our preconceived ideas.
In not one city is there a widespread, alert, interest in knowing where, within its borders, the children chiefly die. Yet this is obviously the first thing to be learned. No city publishes a continuing series of maps showing from day to day, or from week to week, or even from month to month, or year to year, the location of deaths. Many boards gather, with more or less accuracy, for their own use and exhibit in their own offices this" data, the exclusive possession of the commissioners.
But I have tried in vain to subscribe to the series of municipal maps, in YN city, whereby I could see at a glance in what streets and blocks and boroughs, or wards, or districts, children died on each day of the year. Their deaths are not thought important enough to justify so expensive a publication. We need a series of infant mortality maps showing deaths of children before the first birthday and before the fifth birthday, and those of children of the age of compulsory school attendance, between entrance at school and the sixteenth birthday.
Still other maps should show the nature of the disease. No city tells the geographical facts so aant and continuously that the newspapers are interested in publishing them as news. Let us effectively ask the newspapers to introduce these items among their Sunday morning war news. We wish to know, at the beginning of every new week, how many babies were born during the preceding week, how many died, and of what, and where?
And how many children died before the fifth birthday, and how many before the sixteenth? So long as mothers did not know that children need not die, we were not so keen for the disheartening, shameful knowledge of the and place of the deaths week by week. We strove for reation, not intelligence. A generation ago we could only vainly mourn. To-day we know that every dying child accuses the community.
For knowledge is available for keeping alive Housedives well so nearly all, that we may justly be said to sin in the light of the new day when we let any die. To this statement the exceptions are those born with non-venereal fatal malformations, and those who develop obscure disorders of the heart or other organs, the mystery of which science has not yet penetrated.
Even venereal disease can now be combatted both before and after birth. Prince Morrow long ago pointed out that, since we are kept in ignorance of this cause of death, our vital statistics are vitiated and our activities so far paralyzed. Important and interesting in the future weekly maps and chronicles will be the itemized reports from all the institutions, voluntary and municipal, to which children are entrusted.
For they are killed by the same agencies in institutions as outside of them. Without such full and exact records, our effort to save all the lives can never be wholly successful. If we knew that cholera or bubonic plague were imminent for the yearwe should interrupt other activities to prevent that one danger, and no expenditure would be too great for the life-saving task. For either disease would stir our imagination. Or if word should reach this company that one child was being killed in the streets, how we should rush to its rescue!
Yet how little we care when the children die by hundreds. A dozen years ago, Doctor Goler achieved in Rochester a spectacular cut in the death rate of little children during the summer, by affording clean milk, handed out by skilled nurses, subject to the direction of competent physicians, to the least intelligent mothers, who had ly been under the care of midwives, or incompetent medical men, or even of quacks.
Every municipality attempting such work now knows that, in the first, second and third summer, it can get conspicuous cuts in the death rate. By the records of the best milk stations, however, we stand accused. For how can we answer the question: Why do we not assure clean milk to all? Why does any corner grocery still purvey foul milk? Why is the milkman not made as responsible a servant of the public as the postman? Is not life more than letters?
We have all the knowledge and power requisite; why then do we not apply this knowledge and this power? The only answer that Hiusewives itself is that, in a given city, the whole people do not yet know that this is so.
Convincing evidence is moreover accumulating that Hojsewives is a limit beyond which the reduction of infant mortality by means of milk stations cannot be carried. We have not the requisite foundation of knowledge for acting intelligently upon these less conspicuous, but not less effective, causes of infant mortality. The government of the United States is responsible for the administration of Washington, and pays half the cost.
Yet the city was paying wages so low that it was impossible for these humblest employees to keep their families in good health. It will probably never be possible to learn where children die of slow starvation due to insufficient pay allowed their fathers by the cities, until there are more representatives who, like Mr. Berger, insist upon knowing.
In a general way, we are aware that bad housing, also, is a cause of infant mortality. But for want of maps, the degree of identification is imperfectly seen. We are not equipped to show the relation clearly even in one city between housing and the deaths of children. Vaguely we know that little children especially need sunshine and fresh air. In New York City, it is difficult in teal parts to walk on the sidewalks on sunny days, because of the crowds of baby carriages, with babies sleeping in them.
The visiting nurses tell mothers in the tenements that one way to keep babies alive and well is to keep them out of doors in sxe air and sunshine. But why, if they are to benefit by the air and sun, must they be on the sidewalks? Why are we all, from East-port to San Diego, so infatuated with back fences that we keep the children in the streets, and leave the wonderful inheritance of land behind their homes sacred to unsewered filth below ground and the family wash overhead?
Why should the family wash not be provided for in a reasonable part of the space? Why should it be forever a fetich to which the oncoming generations are sacrificed?
Parks, playgrounds, ants, water sports, athletic fields, and school gardens we have begun, hither and yonder, in one city or another to provide. But we have been slow, indeed, to reserve the most accessible spots for the most needy candidates, the backyards as gardens ading their homes, assured by the municipality to the tenderest, youngest little ones. In Greater New York where land is fabulously costly, a larger wnat is idle behind the houses than is embraced in all the parks and playgrounds, which we establish so far away that only the older boys and girls can reach them.
Thus enormous parks in the Borough of the Bronx are usually empty most of the week, a dozen [miles distant from the congested district where babies need outdoor life all the time. Not far from Seward Park, in the yearfive little pupils in one primary school were killed by being run over. We waste both costly city land and precious lives.
If we do not adopt the proposed changes because they are good and reasonable, and adapted to saving life, by making air, light and sunshine accessible to those who most need them, we shall be driven to them by sheer necessity of keeping boys and girls away from ice-wagons, trucks, motor cars, motor cycles, and trolley cars.
My plea is that, wisely applied, vastly smaller sums devoted to the land in the rear of the homes would save thousands of young lives. Whenever, by the popular use of current infant mortality maps, the public becomes enlightened as to particular blocks in which children die in largest proportion, it will doubtless be relatively easy to apply to back yards the right of eminent domain, or whatever other right the municipality asserts when it takes private land for parks and streets.
The obvious place to begin is wherever the infant mortality rate is highest. If, as has been suggested, there are yards so foul that they do not lend themselves to the transformation into gardens, what a stimulus to action that hideous fact affords!
Wherever the map reveals a high infant mortality rate, there should obviously be permanently in charge of the garden a highly skilled nurse to teach the mothers, and a physician from the board of health. We act as though boys and girls needed the care of the city only on entering school. Then we provide, indoors, teachers, doctors, and nurses, as a matter of course. The expensive element will be the salaries for professional men and women who may reasonably be expected to reduce the death rate by detecting the earliest symptoms of ailing children, guarding the quality of the milk supply, observing while there is yet time all such sinister s and omens as mothers with the best intentions so commonly fail to note until too late.
This will be not the least of the benefactions conferred, when we urbanize our minds sufficiently to make collective use of our priceless heritage of wasted land behind the houses in our cities. I wish to record my conviction that a close connection exists between our lack of intelligent action and the irresponsible position of women in relation to municipal activities. It is typical in one respect.