Popular Science Monthly/Volume 28/March 1886/Infancy in the City
By GRACE PECKHAM, M.D.
ACCORDING to Quetelet, "there die during the first month after birth four times as many children as during the second month, and almost as many as during the two years that follow the first year, although even then the mortality is high. The tables of mortality prove, in fact, that one tenth of children born die before the first month has been completed."
The census has shown that the mortality of infants in cities is twice as great as that in rural districts. In New York, in 1883, 28,973 children were born, and 8,068 died in their first year, thirty-three and one fourth per cent; 2,600 children died in their second year, 1,221 in their third year, 787 in their fourth year, and 525 in their fifth year, a total of 13,865 deaths of infants, almost half of the total number of deaths occurring during that year, which was 31,011.
The question arises, What is it in cities that is so hostile to infant life?
The subject is a complex one, and in its analysis we must consider the varying conditions surrounding the different classes. Distinctions of rank are as definitely marked among infants as among adults. There is none of the democracy which obtains in the country. We Lave llie infant of aristocracy, the infant of the middle classes, the in- fant of the poor, the infant dependent upon charity. Each of these inherits an environment peculiar to itself; its house, its nursery and sleeping-apartment, its nurses and attendants, who solve the problems of its food and raiment. Take the matter of inheritance, not of money or lands, but of constitution. The extreme classes found in the city and not in the country, the very wealthy and the very poor, are likely to bestow on their offspring a latent tendency to disease. The ultra- fashionable mother, the self-indulgent father, hand down to their chil- dren overwrought nervous systems and weak physical powers, which result in early death, or more often a life of protracted feebleness. In the lowest classes the untoward effects upon the children of pov- erty, intemperance, and moral obliquity are incalculable.
The city infants belonging to the middle classes often suffer be- cause of the struggle of their parents to maintain a foothold in society, and to mount the steps in social life which will bring them distinc- tion. It would be a long discussion to enter into all the questions of heredity which influence the fate of a child. They are vital questions, however, which require the utmost delicacy in handling, but which are of transcending importance to the individual and to the race. Very little of the common sense, which prevails in preserving and rearing choice stock exists in relation to the human animal. If by chance the infant is well-born—that is, has the germ of a constitution which will unfold untainted by scrofula or epilepsy, or any other foul disease which will rob it of a healthy mental and physical development as life unrolls before it—such inheritance is unequaled. Dr. Ireland has shown the effects of heredity as seen in tracing through three hun- dred and fifty years the health history of the house of Spain. The children, though born to a kingdom and a crown, were cursed with an hereditary ners^ous taint which sometimes passed over a generation only to appear again in various forms and intensities as epilepsy, hy- pochondria, melancholia, mania, and imbecility, till at length it extin- guished the direct royal line.
"With a multitude of hereditary tendencies germinating within it, the city infant opens its eyes upon surroundings which are to influ- ence it scarcely less. About city homes lurk unseen perils to ba- bies. There has been much written and said about the plumbing of city houses and the evils which have sprung from it, so that now, when children are afflicted with diphtheria, immediately comes the question. Are there escaping sewer-gases in the house which they occupy? Dr. J. Lewis Smith remarks that diphtheria appeared in New York in 1858 after an absence of more than fifty years, the most severe cases occurring in the upper part of the city along old water-courses, where in consequence of street-grading, water was stagnant and impregnated with decaying animal and vegetable matter. The infants are more liable to succumb than those older, as the poison acts more quickly on tbeir susceptible systems, and, as they are shut up in the house, they are much more exposed to it. Especially is this true in the tenement- house, where the surroundings of the city infant are at their worst.
Lack of pure air, air untainted with human emanations and sewer- gas, is one of the great causes of infant mortality in cities. It deterio- rates the health of the naturally robust; it robs the delicate of their chances for life; it sows the seeds of contagious diseases; it hastens the fatal termination of those who are sick.
Many mothers, anxious for their children, with mistaken zeal pro- tect them from the fresh air. They are especially afraid of night air, and shut their babies up in rooms which would make a well person giddy and sick to enter in the morning. In the country, houses are built less substantially and in exposed situations, and the fresh, search- ing air will find its way in, in si)ite of unhygienic resistance.
The little ones are too often brought up on the hot-house plan. Mothers, however, are awakening to the fact that babies must have their airings, and among the better classes the nurse takes the baby out every day when the weather will permit. One must admire the beautiful infants in perambulators, the chubby little run-abouts that are to be seen in the city parks and squares. Their handsome faces, finely formed figures, and rosy cheeks, go to show that children in the city, when properly cared for, can become the embodiment of health. In the country the children are usually looked after by their mothers, who have an average amount of intelligence.
Babies who are constantly held and watched and tended do not thrive. They grow fretful, uneasy, and pale, no one knows why. The aristocratic baby is at a disadvantage in this respect, unless money — as it may sometimes—procures an intelligent, faithful nurse, a fos- ter-mother.
To intrust an infant to some baby-tenders is almost as much an act of abandonment as that of the heathen nother, who throws her babe into the jaws of the crocodile of the sacred river. The children who have grown up through a wretched childhood to a crippled and deformed maturity caused by the carelessness of nurses, who have let them fall or otherwise injure themselves, are not a few. Neverthe- less it must be said that when the number of nurse-girls who take care of little ones alien to them is considered, the patient devotion and painstaking fidelity they show to fretful children spoiled by in- dulgent parents are marvelous.
If the rich children are spoiled by over-attention, this can not be said of the children of the poor. The little waif bom in the tenement- bouse, if it has no brothers or sisters, is often locked up by its mother and left an hour or two by itself while she goes out to work, to gos- sip, or to shop. If she goes out by the day, an obliging neighbor (and the poor are wonderfully helpful to each other) will let the child come into her apartment, where it can sit on the floor or the dirty bed and play, or cry, or sleep, as it will. The neighbor's nerves are not weak as far as children's crying is concerned. The day-nurseries which benevolence has established for the care of these little ones are truly a blessing to poor mothers, who earn their living by washing and scrubbing. The babies are well fed, amused, and generally well cared for, far better than in their own homes; the mothers pay from five to ten cents a day out of their wages. But more often the poor baby has brothers and sisters, and they take care of it almost entirely.
Many city infants perish from bad feeding. More especially is this true of the tenement-children. The youngest member of the family is placed at the common table at an incredibly tender age. Often in the dispensary in response to the question, " With what are you feed- ing your baby?" comes the reply, " It eats what we all do." With these people, even if they are not extremely poor, milk or anything else purchased especially for the baby, is an item of extra expense, and therefore it is considered easier and cheaper to feed it with the rest of the family. The sins of feeding among the poor people are monstrous. Coffee, tea, brandy-and-water, as well as beer, had been fed to babies from their nursing-bottle! With such a regime of feed- ing for the poor and middle classes, it is no wonder that two and a half times as many infants perish of diarrhceal disorders as of any other disease.
City infants of all classes are at a disadvantage in regard to their food. Unfortunately, city mothers who nurse their own children are fewer than those in the country. The search for a wet-nurse is one of the most disheartening. The supply is in no way proportioned to the demand. A woman of the poorer classes who has any home at all must stay in it and look after it for her husband, even if she were willing to give up her child for the sake of the money. The woman who applies for the position as wet-nurse has either been deserted by her husband or has had none. She must depend upon her own exer- tions for the support of herself and her child. If she finds a place as wet-nurse she earns from twenty to thirty dollars per month and a good home, for it is only the well-to-do who can afford to hire her. She usually rules the household with a rod of iron. Since, as a gen- eral thing, she comes to take care of a puny child who can not live without mother's milk, and recognizes that the family are dependent upon her, she is exacting and aggravating, oftentimes almost beyond endurance. It is only because the thralldom will not last forever that it is tolerated. The wet-nurses obtain their positions through agencies which exist in the large cities and through advertisements. The ne- cessity for a thorough investigation of the health and status of the applicant for such a position by the family physician is imperative, and in recommending one he takes upon himself a grave responsibility. The wet-nurse will generally try to deceive as to the age of her baby, that she may make her milk appear desirable. The best evidence is the mother's own infant, which should be seen if possible. And it must be remeniberc'd that even hero another imposition may be practiced— a neighbor's baby can be borrowed for the occasion. The flattering testimonials of fidelity and satisfactory conduct in previous positions are often from employers who have departed for Europe or some other quarter of the globe, and are therefore inaccessible. When suc- cess has rewarded the search for a wet-nurse, there is no guarantee that her milk will remain satisfactory for any length of time. If she has the true maternal instinct, she mourns for her own child, and it is not long before, deprived of its proper nourishment, it sickens and, more often than not, dies, and the grief of the mother dries up her milk.
The question of artificial feeding becomes, then, one of paramount importance, since the largest proportion of city infants must subsist in this way. In summer it is indeed a difticult task to raise an in- fant in the city. New York physicians know very well that a large proportion of artificially fed infants who enter the summer months die before the return of cool weather, unless saved by removal to the country.
One of the most benevolent institutions which has been devised is the Floating Hospital of the St. John's Guild of New York, which daily in summer takes its freight of pallid, almost dying, infants, suf- fering from faulty nutrition, out into the fresh ocean-breezes for the day.
Cow's milk coming from a long distance is unfitted for infant feed- ing; but, if it can be obtained fresh, it is the best substitute for moth- er's milk. It must be diluted the first six weeks one half, the next six weeks one third, and after three months a fourth, and at five or six months it can be given pure. The feeding-bottle should be perfectly sweet and clean. It has been found both in private practice and hos- pital experimentation that milk which has been prepared with the ex- tract of pancreas can be used more successfully than any other. In- fants' foods abound in the market, whose inventors claim all sorts of merits for them. For a while one food will prove advantageous, when, having obtained a reputation and come into extensive use, less care is taken in its preparation, and through the suffering of many in- fants it is proved unworthy of longer confidence. Goat's milk is good for city infants, because it can be obtained fresh, and the animals can be kept by poor people at little expense.
Many an infant suffers from irregularity of feeding and overfeed- ing. There is in the popular mind but one interpretation of a baby's crying, "It is hungry," and immediately it is given more food to eat, when already its tiny stomach is distended and irritated. Infants' meals should be regulated by the clock.* This prescription, unaided
- An infant under three weeks should be fed every two hours, or twelve times in the
twenty-four, receiving one to one and a half ounce of cow's milk each time, if artificially fed. At three months the child should be fed every three hours, or eight times in the by anything else, has often restored a nursing baby to equanimity and to health.
Of less vital importance to a child perhaps than its food, yet claim- ing no little attention, is the clothing. The mothers of to-day have learned by experience how to clothe their children better than their mothers clothed them. It hardly seems possible that at one time the fashion of dresses low in the neck and with short sleeves was well-nigh universal for infants. The babies of the aristocratic and middle classes are, as a general thing, warmly and properly clothed. Careless attendants sometimes dress them too tightly, not allowing room for the expansion of the chest and lungs and interfering with the stomach. The senseless extravagance displayed in embroidered dresses for small children is reprehensible, and too fine dressing which prevents young children from obtaining proper exercise and trammels their freedom of play interferes with their health and development. American mothers are often very blameworthy in this respect.
The effects of disease on city infants are much more wide-spread than upon those in the country, not only of disease caused by improper feeding, to which we have already alluded, but more especially of tho?e of a contagious nature. All sanitarians recognize this, and bewail it as one of the greatest evils of the present tenement system that so many children are crowded together in such houses, which become hot- beds of diphtheria, scarlet fever, and measles.
The terrible stories with reference to baby-farming which used to fill the columns of the newspapers are not so often seen in these days. Owing to the ventilation of the subject, the abuse has been very much lessened. But the question may be asked, "Who supply the baby- farmers? A few are those who would abandon their offspring, no matter how, to hide their shame, but for the most jiart they are poor women who are without a home, and must win a support the best way they can for themselves and their infants. They go out as wet-nurses; return to the factories and shops; or engage in general house-work.
The women who find their way, utterly destitute, to the lying-in institutions of a great city, amount to a considerable number in a year. Any of these coming to Kew York can go to Charity Hospital by ob- taining a permit from the Superintendent of the City Poor. They leave the Maternity from ten days to two weeks after confinement. If they wish they can go with their infants to Randall's Island, or they can leave their children there while they go out to seek employ- ment. At almost all other institutions the women are obliged to pay at least twenty-five dollars for board and care during confinement, or stay with their children three months. They can and often do remain with them a year.
twenty-hour, receiving three ounces of milk at each feeding, which at six months is in- creased to four. The times of feeding should be fixed, but of course the amount taken will vary more or less with the individual. The charity infant who has opened its eyes in an institution is peculiar to the city. Its chances for life are less than those of any other class. Most of these babies if bottle-fed will die, as has been demonstrated in some of our nurseries. This is not because the infants are especially unhealthy when they come into the world. It is surprising, when one considers what hardships, physical and mental, the mothers have endured, that the children should be as robust and well-formed as they generally arc.
In view of the disastrous effects of artificial feeding, the plan now adopted is to have a woman nurse her own baby and one other. In this way the mortality has been greatly reduced. The public infant is probably best cared for when sent into the country and boarded with farmers, and this is now extensively done by some of the institutions.