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L'ideé de progrès. int. de soc. 19: 190, March 'II. Wörner, G. Einführung der Beitragsdifferenzierung bei der öffentlichen Krankenversicherung. Z. ges. Staatswiss. 76:74, Jan. '11. Rev. Wyman, Bruce. State Control of Public Utilities. Harv. Law Rev. 24:624, June '11. The medical aspect of the problem.-The first and last word about infant welfare should be spoken by the competent representatives of medical science and practice, especially by the pediatrists. The starting-point for social organization is set by the physician, and he must be the guide and counselor at every step of the process. The chief purpose of these papers is to describe how the community can best co-operate with preventive medicine. There is, indeed, a previous question which should be mentioned at once, although its complete answer can be given best after the facts have been presented. Is it socially desirable to prevent infant mortality? There are some persons who assert that the high rate of infant mortality is a wholesome factor in natural selection, in which the feeble and useless are eliminated, while the vigorous survive. If this assertion is well founded all the humane effort now to be outlined is worse than waste; it is directed to an antisocial end. Whether the claim is true or not can be ascertained in part by an examination of the actual methods and results of infant-welfare organization; therefore the disquieting and skeptical objections may be taken up later, or left to fall of their own weight. Causes of infant mortality.-The chief immediate, pathological causes of infant mortality are gastro-enteritis, pulmonary diseases, congenital weakness, nervous disorders, injuries due to violence, and accident. Back of these immediate causes are the physical conditions of the parents, inherited by the children. Thus many cases of congenital feebleness and still-birth are due to tuberculosis, syphilis, or other enfeebling maladies of father or mother, or both. Alcoholism of the mother kills the babe. The poison affects the foetus during pregnancy and the milk during lactation (Budin). The first hours and days are most fatal because the infant is then least able to resist unfavorable influences. External physical conditions, as crowded and ill-ventilated dwellings, severe and damp winters, hot weather in summer, cause infant mortality. Diarrhea is more general in summer, chiefly, perhaps, because the bacteria multiply more rapidly in milk at that season. Pulmonary affections increase in cold temperature, if infants are improperly exposed. These unfavorable conditions are largely due to the economic situation and personal qualities of the parents. Poverty, which is itself an effect of many causes, offers a depressing environment for a helpless babe. The mother may be obliged to work at an exhausting occupation up to the time of confinement, then to resume employment before her strength is restored, and to neglect the nursing and care of the offspring when life depends on these ministries of motherhood. To poverty is due, for the greater part, the defective dwelling conditions from which young children suffer so much. The ignorance of mothers, and of foster-mothers, is a cause of infant sickness and mortality. Ignorance of physiology and hygiene, and of the feeding and care of infants, leaves the mothers a prey to dangerous popular prejudices and superstitions. Examples are given of the abandonment of breast-feeding from erroneous beliefs; of the supply of solid foods, tea, coffee, beer, wine, and spoiled milk, because the mothers did not know the danger of such false methods of feeding. 'References on causes and also general works on preventive methods: P. Budin, The Nursling; G. Tugendreich, Die Mutter- und Säuglings fürsorge; Ford, Die sexuelle Frage. Illegitimacy is causally related to infant feebleness and mortality, although not always directly. Back of all these direct and personal causes is social ignorance and neglect. The communities of people, cities, states, and nations have yet to be made conscious of the ravages of death which a concerted and intelligent organization and administration might diminish. The present study does not pretend to cover the ground proper for medical writers, but it is a contribution of observations from travel, interviews, and reading to the problem of organization and direction of community methods in various countries. ITALY2 The necessity for vigorous efforts to ameliorate conditions is quite fully recognized by many physicians, philanthropists, and public leaders in Italy. Dr. Pezzetti gives startling statistics of infant mortality which have compelled attention: Within the first thirty-six months of life there die in Italy annually about 270,000 babies. This enormous figure acquires grave significance from the fact that this great mortality does not occur merely among individuals born dead or feeble to resist, but in great part among those born in good conditions, victims of ignorance, carelessness, lack of assistance, misery.3 He traces this loss to inherited disease or weakness, syphilis, tuberculosis, alcoholism, nervous disorders, starvation of tissues. He describes the deplorable condition of poor and, especially, unmarried mothers, many of whom have been as girls overworked in school and in factory, and have been deprived of nutritious food, play, recreation. In 1881 there were 1,601,669 women wageearners in Italy. Dr. Pezzetti ascribes the first place among the fatal maladies of infancy in Italy to diseases of the digestive system.4 Of 267,775 deaths, 59,063 were due to derangement of digestive organs—in the first year of life 47,255 out of 171,855. But the real fact is more serious, because other illnesses are aggravated by defective 'I am indebted for valuable counsel, bibliography, and documents to Dr. Filippetti, of Milan, Dr. Dohrn and Consul-general Wever, of Naples. 'Dr. Giuseppi Pezzetti, Opere ed istituzioni eretti in Italia a vantaggio della prima infanzia Milano, 1907. IV. Congresso int. d'assist. pub. e priv., IV (1906), 213 ff. |