INSTITUTIONALISM AND BABY.

Bruce Herald, Volume L, Issue 31, 27 April 1914, Page 4

INSTITUTIONALISM AND BABY.

Last week I dealt with the grievous effects of undue warmth and stuffiness and lack of ventilation in European hospitals for babies, and showed how this brought about a condition, known as Hospitalism, which is entirely absent from the Society's Baby Hospital in Duncdin. Our article concluded: "Hospitalism is the. curse of European Baby Hospitals, and accounts for their high death rate. The reason why we have 110 hospitalism at the Karitane Hospital is the fact that wo are not afraid of pure, cold, air, but dread warm, muggy air. Of course the Avorst of all things is careless change from warm, stuffy rooms to cold air and draughts, especialv if there is also carelessness as to clothing." In a German book published last year by Dr Ludwig Meyer, of Berlin, it is shown that in the' early part of last century the infantile death rate in foundling hospitals often reached 50 per cent., and sometimes almost every babv died in spite of there being a real desire to keep them alive. Until quite recently things were not much better cveu in the costly and extravagant baby wards and baby hospitals established in the great cities of Germany and Austria, Even now the high death rates in these institutions, and the slow progress and feeble vitality of the inmates strike with astonishment anyone who has seen what can be brought about by simple rational care and hygiene. The authorities of European baby .hospitals still think comparatively little of an infantile death rate of 20 or oO per cent., because such figures are so much lower than they have grown accustomed to ami regarded as inevitable. In the Karitane Hospital the death rate has averaged only 10 per cent, for the last three years and certainly would oo less than 0 per cent, but for the fact that such a large proportion of practically hopeless premature babies and others are sent in in a moribund conddition and die within a day or two of admission. If a baby is capable of surviving a week after coming under care, we find death a rare event. It is interesting to contrast this with Institutionalism in other countries. By Infantile Institutionalism I mean the prejudicial effects on babies which have been found -to obtain where foundlings and others are brought together in large numbers for rearing artificially in institutions which are not necessarily hospitals. So far as the fate of the children is concerned, it is impossible to draw any hard and fast distinction between Institutionalism and Hospitalism. But the fact that in foundling homes most of the babies may be received in perfectly good health makes the high death rate of such institutions even more inexcusable than the high infantile mortality of hospitals. One can say with perfect confidence that the infantile mortality certainly ought not to exceed 5 or 10 per cent, in any ordinary institution for the care of babies where say, three-fourths are admited healthy and only one fourth suffering from malnutrition or actual sickness., How, then, can the civilised world justify itself in regard to the callous indifference which has obtained, and still obtains, almost everywhere as to the fate of babies entrusted to the guardianship of institutions? In our time no country in the world —not even Australasia—has been exempt from institutions where the baby death rat# has averaged from .'lO to 40 per cent of those admitted, and there have been plenty of instances in the world where the death rate has risen to double these ligures—only a fifth to a sixth of the inmates surviving.

AMERICAN FIGURES. In the transactions of the American . Association for the study and prevention of infantile mortality for 1910 there is published a preliminary account of the investigations of a committee set lip to inquire into the "Mortality in Institutions for Infants.'' A large endowment for this purpose was left by a wealthy American named Russell Sago, and the findings of the committee not only produced a profound impression, but led to revolutionary changes in the care of children who could not be reared by their mothers. The reports were drawn up less than five years , ago, and wore based on published statistics and information received directly from 22 institutions, most of them covering a series of years. Seeing that the figures were supplied by the institutions themselves it will readily be inferred that in 110 case would they be more, unfavourable than the actual facts warranted. On the other hand, it is noted that some of the institutions tended to show less than their normal death rates owing to the practice of boarding-out delicate children in private families, while "in other cases it was found tftat moribund infants were returned to their mothers, and in such cases they appear as 'returned to mother,' and their deaths are not reported.'' The following is a broad summary of tile statistics for the 22 institutions reported on:— Total number of infants under two years of age received in the 22 institutions, 56,451. Number of deaths reported, 22,743. Ratio of deaths per cent., 40.3.

ANALYSIS OF DEATH BATES. Average for the six best institutions: Under 30 per cent. Average for six institutions: Between 30 and 40 per cent. • Average for three institutions: Between 40 and 50 per cent. Average for three institutions: Be? tween 50.and 60 per cent.

Average for two institutions: Between 60 and 70 per cent. Average for the two worst institm tions: Above 70 per cent. ' Cpnnnenting oli these figures, the report said that though it is a common impression that the death rates in institutions had been greatly diminished in recent years, the actual statistics made it i apparent that the latest death rates ' were only 4 per cent, lower. than the average for the series of preceding years. The point of view of some of those who are in charge of theso America* Baby Institutions is illustrated by the following facts: — (1) In the printed report of a prominent home for the care of infants occurs the following statement. After referring to a change of practice, whereby nursing infants were boarded out in private families instead of being kept together in the institutions, the report says:—"The mortality has been reduced from about 100 per cent. t.o about o4 per cent. A later report of the same institution shows a further reduction to less than 20 per cent." (2) The physician in charge of an institution where the practice of board-ing-out children in family homes has prevailed during recent years says: — "During my period of observation, covering more than a year, every motherless infant under the age of one year admitted to the institution died before reaching the age of two years." (3) The superintendent of an asylum for infants sent the following report:— "I. send you the infant statistics required. During the past 20 years the death rate among the children two years and under was 75 per, cent."