JAMA 57(27):2127-2128, December 30, 1911
A study of the last United States Census reports reveals some startling figures. In the whole United Sates more than 10 per cent. of the infants have died in their first year. This high mortality has not been equally distributed, for grouping thirty-seven of the largest cities, each having a population of over 100,000, the death-rate is about 20 per cent., while in our very largest cities t approaches 25 per cent. -- one out of every four. So great is the hazard that no insurance company will issue a policy on this first year. This alarming mortality has aroused many, in and out of our profession, to seek relief.
There was held in Chicago during the summer of 1911, a two-weeks' exhibition, the largest and most comprehensive ever attempted in the interest of child welfare. This idea we copied from New York's exhibit of last year, enlarging and extending in manifold ways to many times the size of that exhibit. This is the culmination of a general interest.
Chicago lost 6,888 babies under one year of age in a single twelve-month. A study of the spot maps of the city shows that certain areas produce most of the deaths and far exceed their relative proportion. It also shows the dire effect of the heated season and that certain diseases predominate. After about three days of hot weather, every day of prolonged heat shows a rapid increase in the mortality. Diarrheal cases lead the list, making the total of enteritis jump from below 50 per cent. to above 80 per cent., with a summer average for this disease between 72 per cent. and 76 per cent. The bulletin of the Chicago Health Department states that at least 80 per cent. of all the deaths under two years in the summer months are due to preventable disease.
Many plans have been devised to relieve these first years of their terrible hazard. Infant welfare movements of many kinds are at work and it will be difficult to measure the influence and determine the exact value of each of these. The baby-tent has its place among them. Designed to meet a need not covered in any other way, it has not only met the immediate needs of the individual sick child, but, by example and instruction to the mother, has often taught her to prevent recurrence in this child and her other children. Organize effort to save the baby is relatively a recent thing. Only a few years ago milk commissions were organized, and the idea has spread rapidly until nearly every city now makes some kind of an effort to guard and protect that part of its population living wholly on milk. The mortality was greatly reduced, but remains frightfully high, especially where the population is dense. It became apparent that the milk-supply was not the only thing to be considered. Since the greatest mortality appeared in the crowded districts, it became evident that better air was needed.
The fresh-air wharfs of New York City and the fresh-air sanitariums of Chicago's lake front were among the first efforts to relieve the congestion of our great cities for the little folks. Sending children to the country for outings and tent colonies for certain diseases had proved so successful in demonstrating the benefits of fresh air that fresh air has become one of the most important things in the care of babies. Even after the profession had come to see the benefits of fresh air, it was hard to convince the mother. But at present, with almost daily articles in the papers and the efforts of the health department, it is not so much a question of knowledge as of inducing the people to act. Chicago's congested districts are at some distance from the lake front. Most of the deaths of babies in the hot summer months occur within quite limited spaces, particularly on the northward side, in the Ghetto and back of the stock yards. The Lincoln Park Sanitarium and the Jackson Park Sanitarium are caring for many babies, but they are inaccessible to a vast majority in Chicago. Mothers with several small children and a sick baby could not be spared from their homes to go several miles and spend all day at the lake front; consequently the little sufferer remained cooped up at home. To reach these infants, often dying without ever having a doctor or even a fair chance for existence, the baby fresh-air tent idea originated seven years ago.
The baby fresh-air tents are located in the areas where the deaths are most numerous, which is among the foreign population, Poles, Lithuanians, Italians and Russian Jews. The tents are placed either on the roofs of buildings or in vacant spaces in the midst of these thickly populated sections, so near the homes that the mother can bring the sick baby at 8 o'clock in the morning, leave it all day in the care of competent nurses and call for it again at 6 o'clock in the evening. This daily contact of the mother with the doctors and nurses is not the least valuable part of this arrangement. Like the Salvation Army in their work on the street corners and tenement districts, these tents have left the Lake Shore Drive to reach the masses where they are near their homes.
The equipment of the tents consists of a hospital tent about 12 by 16 feet, with a double roof, board floor and sides, and screen sides above the chair rail. Each contains eight iron beds, a hammock, electric lights, two electric fans and a telephone; also a receiving tent, about the same size, for examining, bathing and temporary care of the baby. A milk station is maintained in this tent where milk in any modification is prepared for the occupants, or sold to the mother at cost. Certified milk is used for these preparations. The tents are opened about July 1 and closed about September 15. The tents were kept open nights and Sundays only in extreme emergency of either very sick patients or severely hot weather.
A trained nurse is in charge of each tent, with one or two assistants. There are assigned to the different neighborhoods a visiting nurse and field nurses, who hunt out these sick and poor babies and send or bring them into the tent. An intern is placed at each tent for half or the whole day as the work may justify. He examines all patients, writes the histories, excludes contagious diseases and prepares the patients for presentation to the doctor who visits the tent on that day. The medical staff consists of three physicians for each tent, each assigned to two days of each week. Each is expected to visit the tent at some hour in the forenoon and have complete charge of all patients entering on his day. Thus each physician has his own patients and prescribes for the others only in emergency. The pediatric society has furnished most of the doctors, the remaining places being filled by physicians of the neighborhood having more or less interest in children.
Only patients under about 2 years of age are received, as those older could not be kept in the beds. Only children of the poor are taken. When it can be determined through the visiting nurse of the district that the parents are able to pay, they are referred to their family physician. A large proportion of these little sufferers are brought in or sent in by the district nurse. When patients fail to return they are investigated by the visiting nurse. Not every mother can be induced to leave her baby in the tent at first, but usually after a few days, if her child is not improving as rapidly as it should, she is prevailed on to do so.
About sixty babies under 2 years of age were cared for the first summer, seven years ago. Each year has shown an increase in the number of tents and the number of patients, until last year eleven tents were established with a total of 1,750 babies. These tents are located in different parts of the city, no two in the same neighborhood.
The total mortality last year, counting all deaths at the tent, at home or in the hospital within three days after being in the tent, was 1.75 per cent. The year before it was a little over 2 per cent., which was the highest for any year. One of the most successful tents last season gave the following summary.
Total number of patients
363
Average number of times each patient was seen
4
Average number in tent each day
12
Total number of deaths
2
Death-rate for the entire season
0.55 per cent.
One of the grateful mothers remarked the summer a tent was established in her neighborhood: "Last year it was all the time funerals, but now the babies are all getting well."
The baby-tent idea has become so popular that many cities have taken up and followed more or less closely the plan that was originated in Chicago. New York City six years ago put up "shacks," where babies have been cared for in the fresh air. Cincinnati, Cleveland, Minneapolis, Nashville, Rochester, and Hartford are some of the other cities caring for infants in fresh-air tents. In Chicago many organizations have become interested and are seeking to do some of this work. Thus far the Elizabeth McCormick fund, through the United Charities, has financed the the tents -- last year at a cost of a little over $5,000.
The purpose of this paper is to present to the profession a feasible means of getting at one of our great problems of the city, that is, to check the high mortality among infants. The baby-tent idea lays no claim to improving the food-supply, as shown in the milk-commission milk, or to the fresh-air idea, which was in existence long before it appeared. But it has adapted these two great ideas in a way and in the place most needed, by scattering tents throughout these congested districts, so accessible that they will meet the need. The number of babies cared for and the low mortality certainly demonstrate the success of the baby-tents and their right to existence and extension to more districts and other cities.
4206 Monroe St.
Dr. J. P. Sedgwick, Minneapolis: There are one or two things I would like to bring before the Section, as they have been of value to us in our work in Minneapolis. We have, running along the ridgepole of the tent, a perforated water pipe connected with the water system of the city, and when it gets too hot in the tent the water is turned on, thus bringing the temperature down. It is not the temperature of the water, but its evaporation that produces the effect, and it certainly does lower the temperature in the tent. The tent has been used four years and the death-rate during the first summer compared with the death-rate in the hospital proper for for the same months of the five years preceding was just one-half. The reduction in mortality may not have been wholly due to the tent, but was partly due to the enthusiasm of the nurses and interest.
Dr. May Michael, Chicago: I would like to add that in Chicago after we employed wet-nurses the mortality was greatly reduced.
Dr. Frank W. Allin, Chicago: Instead of the perforated water pipe, on warm days we have had a cake of ice in a tub placed near the fans, so that the air was blown over the ice and through the tent.