IS OUR PRESENT HIGH RATE OF INFANTILE 
MORTALITY A NECESSITY? IF NOT, 
HOW CAN IT BE REDUCED? 
BY 
A. W. BAILY, M. D., 
ATLANTIC CITY, N. J. 
[Read before the West Jersey Homoeopathic Medical Society, May 21st, 1890.] IS OUR PRESENT HIGH RATE OF INFANTILE 
MORTALITY A NECESSITY? IF NOT, 
HOW CAN IT BE REDUCED? 
BY 
A. W. BAILY, M. D., 
ATLANTIC CITY, N. J. 
(Read before the West Jersey Homoeopathic Medical Society May 21st, 1890.] IS OUR PRESENT HIGH RATE 0% INFANTILE MORTALITY 
A NECESSITY? IF NOT, f!5w CAN IT BE REDUCED? 
Nature sends'but few children into this world to die in. 
infancy. The economy of nature knows no lavishness at the 
expense of human life ; she is lavish in her efforts to produce 
life and to support and promote it, but here her extravagance 
ends. She has no children to wantonly sacrifice, she recog- 
nizes no over-pfoduction, nor by death does she strive to keep 
down the population. Infantile mortality as it now stands up- 
on our records is due to some other cause than the decree of 
nature. 
I have collected and tabled the deaths for the year I8&9 of 
the cities of Hartford, New York, Newark, Baltimore, St.Louis, 
Minneapolis, San Francisco and Atlantic City, and the result 
shows that 43.7 per cent, of all deaths occur under the age of 
five years. The records are far from being complete, and he 
who would make a careful study of the cause of infantile mor- 
tality, not simply the cause of death as appended to the certifi- 
cate, but the true primary cause, finds many tangled webs to 
unweave. We learn by careful investigation that alimentary 
diseases carry off 34 per cent, of all infants that die, diseases of 
the respiratory tract 17.1 per cent., diseases of the nervous 
system 18.1 per cent.,contageous diseases 13.8 per cent., constitu- 
tional disorders 0.7 per cent., still born and premature births, 5 
per cent., miscellaneous diseases 5.3 per cent. By this show- 
ing we discover that 43 out of every hundred infants that are 
born, die before they reach the age of five years. This is an 
immense loss of life, and we naturally ask, is it necessary? 
Five per cent, of these forty-three are either bom dead <tr 
die from premature birth, and six per cent, are born with some 
constitutional disorder that carries them off before they reach 
the end of the fifth year. This, then, leaves us thirty-nine 
healjthy infants in every hundred that are born, who -have as 4 
much right to live as the other fifty-seven healthy ones, but 
they die. Why do they not live and mature? 
In order to answer this question we must investigate more 
closely the causes of death. To help us we have divided these 
causes into seven classes, namely: premature and stillbirths; 
(4) constitutional disorders; contageous diseases; (4) diseases of 
the* -alimentary and 36> respiratory tracts; (6) of the nervous 
system; and miscellaneous. This division is more or less 
arbitrary, as the cause of death may be secondary to a disease 
iii another class, as convulsions from stomach or intestinal irri- 
tation, or capillary bronchitis from measles or whooping cough. 
But with the lax manner ifr which our records are kept these 
difficulties cannot be well overcome. 
Premature and still birth are responsible for the death of 
five out of every hundred children born. With those who are 
still t>orn the physician has little to do but to certify to the 
fact and pass them over to the care of the undertaker. Pre- 
mature birth may demand a little more attention, for cannot 
at least a small per centage of these births be prevented, and 
the mofher, by proper care and instruction caused to go to full 
term? The experience of every physician will answer in the 
affirmative. 
Constitutional disorders are accountable for seven deaths 
out of every hundred. Under this head are classed all diseases 
of a tubercular diathesis, malformations, cancej-, and con- 
genital syphilis. This seems like a high rate, but if the 
truth were fully told there is no doubt but that the rate 
would be still higher, for we find that very few deaths are re- 
corded as due to congenital syphilis, due no doubt to the de- 
sire of the physician to spare the feelings °f the parents. Of 
all the reports before me only two note any deaths from con- 
genital syphilis, one tables 5, the other 0. Put it seems as if 
something should be done to reduce the rate, for one out of 
fourteen is too high. Whether those who are suffering from 
tubercular or syphilitic disorders should have progeny on whom 
to indict their is a vital question of-social economy, and 5 
about which much has been said and written. I believe that 
they should not have offspring. 
Contageous diseases kill fourteen out of every hundred that 
die. In this class are included diphtheria, scarlet fever, mea- 
sles, small-pox and whoopine cough. These are essentially dis- 
eases of childhood and we find a high mortality under this head 
as compared with the rate in adult life from the same causes. 
They are due to a morbific essence conveyed from one person 
to another, hence isolation is practiced as the great preventive. 
I find, on investigation, that Atlantic City has arateof onlya frac- 
tion above one-fourth that of the general rate. Now this is 
remarkable from the fact that we Tiave continually coming to us 
children who have been exposed to one or another of these dis- 
eases in their own homes, and are brought here for protection, 
and, no doubt, bring with them the diseased germs, but the dis- 
ease does not spreau, and only now and then we havV1 a few 
cases, and these usually of a mild character. For this there 
must be a reason; the difference between 14 per cent, and 3.6 
per cent, is too great to be simply accidental. Our city is much 
the same as all cities, we have the rich and the poor, those who 
are careful about hygienic surroundings and those who are care- 
less, and our unusually low death rate can be due to only two 
causes,—first we have an abundant supply of pure air, which, 
whether one will or no, permeates everything; and secondly, the 
peculiar quality of i-alt air prevents decomposition to a great 
extent, and thus morbific germs do not find a suitable soil in 
which to develop. There is a lesson in preventive medicine to 
be learned from this. Escape from the presence of the disease 
by going to some locality •fvhere the air is pure, but when this is 
not practicable, admit fresh air, the best that can be secured, 
and abundance of'it, into the home of the patient. 1 am of 
the impression that we as physicians do not teach hygiene to 
our patients as we should, we do not make them understand 
how to take care of themselves and prevent sickness. It is <not 
enough that works on hygiene are published for the public', 
how many of our families possess a copy, or if they have, pay 
am attention to its teachings. In this matter of eontiiyen'ns 6 
disease as it relates to infantile mortality we are too lax, and 
many a little one has been sacrificed because good fresh air has 
been thoughtlessly denied. It is unnecessary to call attention to 
the importance of removing filth and careful investigation of 
sewer connections; for these are matters of every day discus- 
sion. But the infant and adult are not treated alike regarding 
fresh air. Throne is kept in the house shielded from the out- 
side air, especially if it be a little cool, while the youth or 
adult goes out freely and secures fresh air in abundance. Why 
should not the infant have the same privilege? Why should it 
not have the same chances of life? WJiy should the nursery be 
kept at a temperature that will be uncomfortable for a 
healthy adult? Often coutageous diseases are spread in jnst 
this manner, for in such an atmosphere they will develop 
quickly. These parents need to be taught common sense, and 
need to learn that fresh air is the hest antidote for morbific 
germs. Among the poorer classes perhaps even more work needs 
to be done. In addition to the necessity for fresh air they must 
learn the absolute necessity of cleanliness. On us, then, a$ 
physicians devolves the duty of educating these people who 
come under our care. 
The same things can be said in almost the same words 
regarding fresh air in diseases of the respiratory tract. These 
include capillary bronchitis, pneumonia, congestion of the 
lungs and croup, and carry off evety year 17 per cent, of all the 
infants that die. This living in a contaminated atmosphere, or 
too hot or too dry an atmosphere lays the foundation for future 
trouble. The mucous membrane is kept in an irritable condi- 
tion, nerve force is depleted and some unavoidable or accidental 
exposure or sudden change in the atmosphere results disastr- 
ously. I do not believe in reckless exposure, neither do I any 
more believe in the other extreme; either is equally perni- 
cious. But there is a happy medium which comes into the lives 
of too few infants, that would result in greatly pulling down 
the mortality from respiratory disorders. 
But the greatest factor in infantile mortality is diseases of 
the alimentary tract, including all diarrlueal disorders, marasmus, 7 
inanition, indigestion, etc. These disturbances of the natural 
processes result in the death of a little more than one-third of 
all infants that die; exactly twice as fatal as diseases of the 
respiratory tract. To my mind there is no legitimate reason 
for this. It cannot be that more infants are born physically 
weaker in the one direction, than in the other. The cause must 
be looked for in some influence outside of the infant, therefore 
it may properly be classed as preventive. Among these dis- 
orders cholera infantum stands at the head. No doubt many 
deaths are recorded as due to this trouble when a more correct 
diagnosis would place them under ilio-colitis, entero-colitis, diar- 
rhoea, etc., but we must take the records as wefindkhem. Heat seems 
to be the great predisposing cause of all these disorders where 
diarrhoea is a pronounced symptom; but there are other causes 
as rife and perhaps more sure in their effects, and first of all I 
would place diet. A sudden change of diet; spoiled food, as 
sour milk, unripe fruit or vegetables, or indigestable food may 
bring on trouble; but more frequently a condition of the stom- 
ach and bowels has been ingendered by long and persistent im- 
proper feeding which only requires some little cause as a sud- 
denly hot day, a bottle of sour milk or protrusion of a tooth, 
to produce a stubborn, and perhaps fatal diarrhoea. Diet, then, 
is one of the greatest questions the physician must solve. What 
food shall baby eat, and how shall it be given? The old 
monthly nurse knows all about it, and too often the question 
of diet is left for her to settle for the first week or ten days till 
baby is taken with looseness of the bowels and the doctor's ad- 
vice is sought. It is beyond question that the food nature sup- 
plies for the infant, when good, is far superior to all else, and 
when the mother has a good full breast of milk the question of 
what the food shall be is easily settled. But how shall it be 
given ? A good food may become injurious from being given in 
an improper manner. Milk, as a rule, is not secreted by the 
mother till forty-eight or seventy-two hours after delivery, but 
there is secreted a watery fluid which baby may have. The seeds 
of disease are often planted before babv is six hours old. The 
nurse declares he is hungry, and he is stuffed with sweetened 8 
water, brandy and water, gin and water, cracker and water, milk 
and water, cat-nip tea and a score of other diabolical mixtures; 
and right here is the beginning of many cases of infantile diar- 
rhoea or indigestion that may end fatally. The obstetritian has 
not finished his labor, and should not leave the house till he has 
given orders regardingdiet for the infant in languagethat cannot 
be mistaken. The infant needs no food for twelve to eighteen 
hours after birth, and by that time nature has usually given a 
supply. How often shall baby be nursed? Not more frequently 
than once in three hours. Digestion only partly takes place in 
the stomach, and an interval of rest is required after the stom- 
ach is empty that repair may take place in the glands and they 
become ready to throw out afresh supply of digestive fluid. It 
is a well known fact that the early secretion of the gastric fluid 
after the ingestion of a meal is mildly acid, and as digestion 
goes on the fluid becomes more acid This is one of natures 
wise economies as the faintly acid fluid does not harden the 
food. If then fresh milk is taken into the stomach while the 
last meal still remains there one of two things will result; either 
the fresh milk will meet with too much acid and be coagulated 
into a hard curd, or else the food nearly digested will be de- 
prived of a sufficient supply of acid to complete digestion, by 
the throwing out of fresh gastric fluid of a less acid nature, hi 
either case the ultimate result will be the same, and the mother 
will tell the doctor that baby is passing undigested curds of 
milk, and she cannot understand it, because he has had abso- 
lutely nothing but the breast. And that may be the truth. 
Time, then, between meals is a very important factor in the 
feeding of an infant. 
bight here let me sav something about water. An infant 
should have water to drink five or six times a day. A baby is 
not always hungry when it cries, more frequently it is thirsty 
and milk will not quench its thirst. A baby needs water, and 
a generous supply of it. I have more than once stopped a dis- 
ordered condition of the stomach and bowels where either 
diarrhoea or constipation were pronounced symptoms by hav- 
ing the child fed regularly and not too often, and using a good 
supply of water, and that without any medicine. 9 
Bat sometimes nature does not supply the expected food, and 
we must rely upon some substitute. What an array stares us 
in the face, and all claiming to be the best food, the only good 
food, good as mother's milk, a perfect substitute for it, etc., etc., 
ad infinitum. 
There is no perfect substitute for mother's milk, the best 
is good cow's milk. The trouble we have with cow's milk is 
that the casein forms into harder and larger curds than that 
of human milk, which are soft and flaky. By some means 
these hard curds must be prevented from forming, and herein 
lies a great deal of the value of the many foods especially pre- 
pared for children. By a careful and proper admixture they 
break up the large, hard curds and render the milk more easily 
digested. Oat meal or barley water added to the milk often 
does as well. Condensed milk is not as good for the child 
from the large amount of sugar it contains, but often we are 
compelled to use it because the peculiar process of evaporation 
it has undergone, together with the presence of the sugar 
keep the curds small and soft. One cow's milk is often 
preferable if it can be secured. In large cities this is not possi- 
ble; but the milk should come from cows that are allowed free 
pasture, plenty of water, and in the winter are given good food 
and well housed. The milk should be rapidly cooled as soon as 
drawn from the cow, and kept cool till prepared for the infant. 
It should also be kept as much as possible from contact with 
the air. 
A good food being selected only a part of the work is done; 
regularity in feeding must be insisted upon, and as we now 
have a food not as rapidly digested as human milk, a longer in- 
terval should be required between feedings. And now the doc- 
ter meets the hardest battles he must fight to prevent sickness. 
Cleanliness is a thing fearfully neglected in the preparation of 
infant food. Bottles are not kept clean; after being used they are 
scalded out with hot water and that drives the milk into the 
glass, they should be first carefully rinsed with c<dd water, 
afterwards scalded; they are allowed to stand in the kit'heri, 
nursery or sick room empty and uncorked, and so collect ini 10 
purities anddirt, and all the smells of the contaminated air,' they 
never see the sunshine, and become sour. A long tube is used 
and becomes a hot-bed for the breeding of tyrotoxicon; nipples 
are not washed and turned inside out and washed again but 
are transferred from bottle to bottle; and the food is half 
mixed with the milk or not mixed at allr and given at any tem- 
perature from almost cold to being so hot the child can hardly 
take it. And then the milk is often kept in the same ice-chest 
in an open jar, with meat, and butter and vegetablesT and 
it absorbs impurities from these with fearful rapidity— 
and the minister speaks of the mysterious workings of 
Providence that has taken the little one away from fond 
parents. I find that many mothers are willing to learn, 
and by instructing our patients on these points we may prevent 
a vast amount of suffering and save many infant lives. There 
is no reason why the mortality among infants should be so 
great; there is no reason why the dreaded second summer 
should haunt the mind of every fond mother; there is no reason 
why dentition should be attended with the great disturbance of 
the stomach and bowels that every physician is constantly meet- 
ing, except the reason that can be found in the improper care 
of the infant. Not only does this lie in the food; want of fresh 
air, want of proper clothing or being over-clothed are pregnant 
sources of trouble. But if the matter of food were attended 
to properly such causes as marasmus, inanition, indigestion, 
cholera infantum, diarrhoea and often convulsions would not be 
appended so frequently to the certificate of death. This is 
medicine, the highest scientific, though perhaps' 
not the most lucrative attainment of the physician. As the 
child grows older, and his diet naturally becomes more ‘varied, 
great care must be exercised that he be not fed the food of 
adults too early or in too great variety. It is 4 safe and good 
rule to give in answer to the question, “ how soon may baby 
by replying, give nothing but liquid food until lie has ten 
teeth, and even then let the food be largely liquid. 
Nervous diseases, especially convulsions,.are-frequently the 
outgrowth of other troubles. One third of all deaths that are 11 
attributed to nervous causes, result from convulsions, and 
many of these, no doubt, should be credited to some irritation 
of the stomach and intestines. Many of these troubles, there- 
fore, also come undpr the head of preventive diseases. 
But one class is left for us to consider, namely, miscella- 
neous diseases, and here we have a heterogeneous collection, in- 
cluding heart and kidney complications, primary or secondary; 
miasmatic diseases, erysipelas, hemorrhage, violence, accidents 
and a number of more or less rare troubles. Altogether this 
•class is responsible for five per cent, of the death rate. 
Let us now concisely draw some conclusion from the fore- 
going facts, and in doing so we will take into account only the 
four principal classes, namely, contagious diseases, diseases of 
the respiratory and alimentary tracts, and of the nervous sys- 
tem, without pausing to argue the possibility of reducing the 
mortality from constitutional taints, miscellaneous causes or 
premature birth. 
The statistics quoted show infantile death rate from con- 
tagious diseases 14 per cent., respiratory diseases 17 per cent., 
digestive diseases 34 percent, and nervous diseases 18 per cent., 
making a total of 83 per cent. In Atlantic City the death rate 
from contagious diseases is 3.5 per cent., respiratory 12 per cent., 
alimentary 26 per cent., and nervous diseases 14.5 per cent., 
making a total of 56 per cent. This is per cent, less than 
the general average; and even this is hardly a just comparison, 
for we have hundreds of children coming here every summer 
suffering with some acute or subacute disorder of the stomach 
and intestines, till our percentage of sick children during the 
months of June, July, August and September is far above that 
of any other city of the United States, and still our death rate 
is one-third below. Figures do not show the grand result; only 
you physicians who have seen the effect upon your patients can 
form a correct idea of the advantage of a pure atmosphere. 
And here let me say that mountain air is. often as efficacious 
as salt air, but the little patient is subject there to greater 
diurnal changes in temperature than at the sea shore, besides 
losing that tonic effect of salt air which so effectually stimu- 12 
lates the fagged-out nerve force, promoting healthy, normal 
assimilation. This reduction of per cent, is due purely to 
atmospheric influence. What, therefore, may he asked, would be 
the result were proper hygiene in regard to diet and clothing 
observed ? Is it too much to assert that at least fifty percent, 
of the infants that now die, die unnecessarily ? 
A theory may look well upon paper which a busy physi- 
cian finds impossible to put into practice. I am well aware of 
the fact that a large majority of infants suffering from these 
disorders cannot secure a change of climate, but they can be 
surrounded by cleanliness. 1 contend that the best time to 
treat diarrhoeal disorders in infants is before the disease attacks 
the child ; in other words, keep the child's digestion in such 
condition by suitable and well-prepared food, given in a proper 
manner, that there will be no soil for these diseases to grow 
upon, and that a few hot days and nights may be passed in 
safety. It appears to me that this is practicable. I believe 
the physician should be as careful in prescribing food and other 
hygienic measures as he is in selecting his remedy, for oft-times 
these simple, though vital means are of far more value than even 
a well-selected prescription. We are the legitimate educators 
of the public ; through us, and through us alone must the 
masses learn the laws of hygiene; and if we are careless in in- 
structing, is it a wonder that they are careless in learning ? 
Just as soon as we as a profession awake to the enormous in- 
fantile mortality which every year is entered upon our records, 
and come to realize there is no necessity for it; just so soon as 
we begin to stir ourselves, so soon will the masses begin to 
think and act. One reason we are not awake to this matter is 
the lack of fuller and better reports from our bureaux of vital 
statistics and boards of health. Too often ignorant men con- 
trol these matters. In writing, a few weeks ago to a commis- 
sioner of public health of one of our sister cities, I touched on 
this subject, and in reply he said, “I am called by the politi- 
cians a crank and a fool, with an emphatic adjective attached, 
forde-iring to issue more complete reports." How, I would 
ask, are we physicians to know of these matters except through 
our published reports; and have we not a right to demand that 
they be full and complete, and compiled b}' competent men ? 
We have grown so accustomed to the little cofiin and white 
crape upon the door, that we almost feel as if this was one of 
the sad things in life to which we must bow without redress. 
But it is not so; this high rate of infantile'nTortality can be, 
and should be reduced.