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INFANCY We may now assume that the child whose career we are following is properly registered and launched into infancy. The fundamental problem in this stage is to keep the delicate things alive. The mere business of being a baby, it has been said, ought to be classed as an extra-hazardous occupa tion. It is far more hazardous than it need be, but, on the other hand, it is far less hazardous than it was a few years ago, in certain places where at tention has been given to removing some of the more obvious dangers. Wherever experiments have been intelligently tried, the results, as in the case of ante-natal care, have been almost theatrical.

Reference has been made to the New Zealand city where, in five years, an infant mortality rate which we would be tempted to consider low was actually cut down to half what it had been. Our largest American city can show an improvement almost as encouraging, considering its much less favorable general conditions. There are actually fewer babies dying now every year in New York City than there were in 187o, when the population was only about a third what it is now. Ten years ago in New York City fifteen out of every hundred babies born alive died before they were a year old.* At present this figure has been reduced to less than ten. That means that ninety of every hundred babies now being born may expect to live through their first year, instead of only eighty-five. It means also, what is equally or more important, that these ninety reach their first birthday anniversary in much better condition than the eighty-five ten years ago, and are much more likely to live through their second and third and fourth and succeeding * The figure was one hundred and fifty-three per one thou sand births for the decade 1896-1905 for Manhattan and Bronx, assuming that ninety per cent of the births were registered at that time; in 1914, when the registration of births was almost complete, the rate was ninety-eight.

years, .and not merely to "live through" them, but to " live" them in full health and vigor. It will be harder to save the ninety-first baby, and the ninety second, ninety-third, ninety-fourth, and ninety fifth, as they have already done in the far-away little city in the southern seas, but it can probably be done.

The saving which has been effected in New York and other large cities, in Europe as well as in Amer ica, has been largely among babies over a month old, and it has been brought about almost entirely by attention to what the sanitarians call "hygienic and dietetic errors." The combined efforts of pri

vate philanthropy and the Department of Health, through milk stations and other educational work, have succeeded in materially reducing the preva lence of diarrheal diseases, and incidentally, by improved nutrition, increasing the child's resist ance to pneumonia and other infectious diseases. This has been done by encouraging mothers to nurse their babies, teaching them how to meet their simple but imperative needs of pure air and clean and suitable food with the resources at their command, supplementing these resources when necessary, and furnishing expert counsel in 'emer gencies. Improvement in the milk supply and in the water supply and in housing conditions and the general standard of living have also undoubt edly been factors, operating less directly and over a longer period, but still of fundamental importance.

By these means fatalities from acute gastroin testinal diseases have been extraordinarily, and those due to respiratory diseases appreciably, re duced, and the way has been made clear for further reduction.

By these means also the gravity of the causes operating at or before birth to produce death in the first month of life has been brought into light; for the mortality from congenital diseases has re mained practically stationary, while the improve ment in the other important groups has been going on, until they have ousted diarrheal diseases from the unenviable first place among the causes of infant deaths, and are responsible for forty per cent of the total number. Even here, however, though some of the causes remain obscure, we are already in position to do as much as has been done with respect to the infectious diseases of the diges tive organs. A large proportion of these deaths in the first days of infancy are due to lack of adequate care before or at birth or immediately after, and to ante-natal infection, and they can be avoided by providing the proper care, and by preventing the infection in such ways as we have indicated.

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