Dr. HENRY DWIGHT CHAPIN, of New York, read a paper on "Home Treatment of the Sick Children of the Poor."

HOME TREATMENT OF THE SICK CHILDREN OF THE POOR.

The problem of the poor, the inefficient and the unfortunate is of importance alike to the philanthropist and the sociologist. A discussion of the causes of misfortune is perplexing and usually results in a wide difference of opinion even in those whose experience should enable us to expect wisdom as to this question. The cause, as well as the cure, must be both individual and social. It is not intended here to take up the social aspect of the problem, as this is especially fraught with difficulty and uncertainty. Doubtless in the future evolution of society a more just and equable arrangement will be gradually worked out whereby a fairer chance will be given to those not especially favored in strength and alertness. In the meantime our efforts must be directed mainly at the individual. He must be educated and strengthened, physically, mentally and morally, so as to make the best of himself and the resources at hand. Having this in mind, a most discouraging fact is that large numbers of the poor are hopelessly handicapped at the very beginning of life by ailments that are alike preventable and serious in their future consequences. The first few years of life are, biologically speaking, the most important ones we live. At this time the beginning organism has stamped upon it the potential vigor that lasts, or the seeds of early degeneration and decay. A fairly accurate way of studying the general health of any class in the community consists in looking at its death rate. This forms the most precise and easily obtainable item of vital statistics. A high death rate among the very young is of special import because it predicates a much larger amount of sickness than a given death rate in later life. The natural recuperative powers in early life are good, and it is not

to be expected that so many will succumb to attacks of illness as when degenerative conditions are more in evidence. Having these facts in view, a glance at the comparative deaths of young children and adults in this community will be of interest. The following figures stand for Greater New York during 1898, 1899 and 1900:

It is seen from these figures that over one-third of the yearly deaths occur in infants and very young children. If the deaths occurring in later childhood are added, we find that almost half of our mortality occurs in the period of growth and development. An inspection of the death rate during the first six months of 1901 shows substantially the same condition. In going over the deaths by wards, we find the poorest and most densely populated have an exceedingly high death rate among the children. As an illustration, a study has been made of the death rate in various individual wards during the first six months of 1901. The Tenth ward, now famous as the "Red Light District," extends east of the Bowery, south of Rivington street, west of Norfolk and north of Division streets. It is largely inhabited by Russian and Polish Jews, living in great crowding and poverty. They are, however, a frugal, virile race, and the general death rate among them is not unusually high. During the first half of the year there were 473 deaths in this ward, 208 of which were of infants and little children under five years, or almost half the total deaths were at this early age. In comparison with this will be cited the Twentysecond ward, extending north of Fortieth street, west of Sixth avenue and Central Park to the river and south of Eighty-sixth street.

Total deaths out of a much larger population during the same six months, 2,057, of whom 561 were under five years, or

only a little over one-quarter of the number. Two other comparisons will be made, between the Seventeenth and Twenty-first wards. The Seventeenth ward stretches south of Fourteenth street, between Fourth avenue and the Bowery and Avenue B and north of Rivington street. Total deaths during first six months, 1,283, of whom 446, or about one-third were under five years. The Twenty-first ward extends from Twenty-sixth street north to Fortieth street, and from Sixth avenue to the East river. Total deaths from January to June, inclusive, 815, only 178 of which were under five years, or about one-fifth of the number. These figures show the heavy sickness and mortality among little children living in the poorest wards, the two cited showing that so far this year they furnish approximately one-half and one-third of the deaths, while in the two up-town wards, one-fourth and one-fifth are the comparative figures. The worst months for little children, July, August and September, are not included in this study.

No more important question can come before this Conference than what practical means can be taken to lower this large death rate at the very beginning of life and the enormous amount of sickness and misery that go with it. Many agencies are at work in this direction, such as dispensaries, hospitals, fresh air homes and excursions. All these accomplish much good, and sickness, with consequent loss of life, would be much greater without their benevolent aid. The most powerful factor in the continued wellbeing of the child, the home, is by these agencies left out of the account by the necessity of the case. The object of the present paper is to inquire whether more cannot be done at the fountain head of trouble. A charity that relieves the individual but does nothing to study and relieve faulty conditions is often only temporary in its results. Modern charity places the stress of effort in improving conditions that underlie a given evil rather than in employing all its energy in dealing with the individual victims of such an evil. We believe that both sickness and death among little children in the poor and crowded parts of the city can be decreased by constant visits of competent advisers who have knowl

edge of the causes, prevention and treatment of disease. In other words, a home dispensary is here advised as most competent to grapple with this grave problem. If a child could be seen early in an illness, the trouble might often be cut short and lasting disability sometimes avoided. There are frequently faulty conditions at the home that must be corrected before recovery or a recurrence of the trouble can be avoided. In order to recognize such conditions, a visit must be made by some one competent to appreciate them. The mother, wearied with many household cares and ignorant withal, frequently does not take the ailing child to the dispensary until the sickness has become severe, and then the fatigue and exposure of the journey may do harm, especially in inclement weather. From lack of knowledge and proper appliances she is often unable to carry out the orders of the doctor properly, especially in the matter of diet and infant feeding. If the mother could easily procure a doctor from a nearby station, she would be encouraged to send early for any complaining child and thus be guided by advice that would frequently result in checking the illness at the outset. No elaborate or expensive plant would be required for such a work. All that is necessary is a room or office in a tenement-house, which could serve a given poor district. Every morning and as in the case of a private physician. doctors could be procured for a small work at the beginning of their career. The doctor, after carefully examining the child, leaves written orders for the diet, medical treatment and general care of the case. He is followed by a trained nurse who sees that these orders are carried out. This means that the baby's food is prepared by the nurse herself until the mother is personally trained in all the necessary details. The food for older children is also prepared in a nutritious and appetizing form. The bed is made comfortable, utensils cleaned and such important details as ventilation regulated as well as possible under the circumstances. Each day, or twice daily, the doctor and

afternoon calls can be left, Many young and competent salary to undertake such a

nurse repeat their visits until such services are no longer required. The educational effect upon the mother would be an important factor in such a work. Any physician who has served much in dispensaries must be struck by the helpless ignorance of many poor mothers when their children are sick, so far as nursing and care are concerned. On account of other labors, they are also often physically unable to give their children the proper care. It must be done for them; simply telling them what to do is not enough. In contagious diseases, if proper isolation cannot be secured, an effort must be made to get the case to the municipal hospital devoted to such purposes. The mortality and crippling effects of contagious diseases, such as diphtheria and scarlet fever, in tenement-houses are very large. When the cases are treated at home, the hap-hazard nursing and care not only retard recovery but contribute to the wide spread of the infection. Many cases, however, with proper nursing and attention would do very well at home. In cases also of prolonged critical illness, or where special surgical treatment is required, the visiting doctor can see that the child is taken to a suitable hospital. When the child is discharged, it would be the duty of the doctor and nurse to see that the convalescence is properly watched. Much good of hospital care is lost by the patient having a recurrence of disease in a wretchedly appointed home, especially in the case of children. The connection between the hospital and the home should be more intimate. The Babies Wards of the Post Graduate Hospital send a paid visitor to the home of every case discharged, hoping thereby to make the work permanent. All children's hospitals, working among the poor, should employ this feature. Most dispensaries will send out visiting physicians for those too ill to go out, but this is usually a subsidiary part of their work. What is here urged is a more thorough and systematic plan of treating the sick children of the poor at their homes. Such treatment consists not only in prescribing, but in affording means of carrying out the orders by careful nursing and attendance upon all necessary details of the