Part 16

The foregoing proposals relate only to the conditions surrounding the child at birth, but it is equally the duty of society to safeguard the whole period of childhood. In its own interest, no less than in the interest of the child, the state should protect every child from all that menaces its life and well-being. Before the British Interdepartmental Committee many witnesses, some of them factory surgeons of long experience, testified to the harm resulting from the employment of mothers and the leaving of infants in the care of children or old persons utterly incompetent to care for them. It was proposed that the employment of married women in factories should be forbidden, except in cases where there are children “absolutely dependent on their wages.” In all such cases “the municipality must make provision for the care of the child while the mother is at work.”[159] As a minimum, this is a good and practicable proposal, though it falls far short of the ideal. Much more commendable for its humane good sense is the method adopted in some of the Socialist municipalities of France. In the case of widows and others with children absolutely dependent upon their earnings, these municipalities pay the mothers a weekly or monthly pension, thus enabling them to stay at home with their children.[160] With characteristic good sense and courage, Mr. Homer Folks has proposed a similar system of pensions to widows and others dependent upon the wages of children, on the principle that the poverty of its parents ought not to be allowed to despoil a child’s life and rob it of opportunities of healthful physical and mental development.[161] That is a perfectly sound principle, it seems to me, which applies with equal force to the working mother; for it is surely just as important to insist that poverty shall not be allowed to rob the child of its mother’s care.

Wherever possible, then, I believe that the effort of society should be to keep the mother in the home with her children, and where pensions are necessary in order that this result may be attained, they should be given, not as a charity, but as a right. It would be a very good investment for society, much more profitable than many things upon which immense sums are lavished year by year. In the meantime, much good might be accomplished by the establishment of municipal _crèches_ or day nurseries in all our industrial centres, so that babies and young children could be properly cared for during the absence of their mothers at work. Something is already being done in this direction by private philanthropy in many cities, but it is exceedingly little when compared with the magnitude of the need. In saying that these institutions should be provided by the municipality, or by the state, I do not mean that any attempt should be made to prohibit private philanthropic effort in this direction, nor that such effort should be in any way lessened; but that the municipality or the state should accept final responsibility in the matter, and provide them wherever the failure of philanthropy makes such a course necessary. In all our great cities, as well as in many of the smaller manufacturing towns, there should be such a _crèche_ or nursery in the neighborhood of almost every primary school, until it is found possible to enable the mothers to remain with their little ones instead of going to work. With trained nurses in charge of such institutions, it would be easy to control the dietary of the infants and to see that they were not given pickles, candy, or other unwholesome things. Yet such a system, no matter how perfected, can only be regarded as a makeshift, a rather uneconomical substitute for the humane system of keeping the mother with her child.

The heavy death-rate in most foundling hospitals, despite all scientific care and the most elaborate equipment, have been accounted for by the lack of maternal interest and affection. In the splendidly appointed Infants’ Hospital on Randall’s Island New York City, little lonely, mother-sick foundlings pined away at an alarming rate and died like flies until the Joint Committee of the Association for Improving the Condition of the Poor, and the State Charity Aid Association, investigated the matter. The Joint Committee wisely decided that every one of the bits of human driftwood was entitled to one pair of mother’s arms, and that no institutional ingenuity could ever take the place of the maternal instinct. They instituted a system of placing-out the children with foster mothers, and the results have been highly gratifying.[162] That is the human way, answering to the universal child-instinct for a mother’s love and presence. The same objection applies to _crèches_ as to foundling hospitals; the difference is only one of degree. These institutions are far better for the children than the neglect or the ignorant handling of “little mothers” from which they now suffer, but they can never compare in efficiency with the personal attention of the mother. There are few mothers, be they ever so ignorant, who would not attend their own children with greater efficiency than any institution nurses could do. In the ultimate result I am convinced that the pensioning of mothers to care for their children adopted by the French municipalities where the Socialists have obtained control is much more economical and effective.

V

The importance of impure milk as a contributing cause of infant mortality is now pretty generally recognized. The splendid work of Mr. Nathan Straus has done much more, perhaps, than anything else, to emphasize this fact. In view of some rather caustic criticisms of charity in the preceding pages, it may be well if I embrace this opportunity to explain my position somewhat more fully. No one, I think, recognizes more fully than I do the important experimental work which has been done by philanthropic enterprise. Such work, of which that of Mr. Straus is a conspicuous example, has blazed the path for much municipal and state enterprise. It would be impossible to overestimate the value of the work done by social settlements and such bodies. For the charity which denies justice and seeks to fill its place, I have no sympathy, but for the charity which adopts as its motto the fine phrase adopted by the ablest journal of philanthropy in America,[H]—“Charity to-day may be Justice to-morrow,”—I have nothing but praise.

I have long held the opinion that the milk supply of every city should be made a matter of municipal responsibility. Some ten years ago, while residing in England, where the subject was then beginning to be discussed and agitated, I devoted a good deal of time to the propaganda of the movement for the municipalization of the milk supply. In view of the splendid achievement of the _gouttes de lait_ in France, it was natural that we should have attached much importance to the sterilization of the milk, and I remember with what enthusiasm some of us hailed the introduction of the system into St. Helen’s, Lancashire, the first English city to adopt it. I am convinced now that sterilization is unnecessary and a grave mistake. Undoubtedly it is well that dirty or impure milk should be sterilized, but it would be still better to have clean, pure milk which needed no sterilization. The testimony of Dr. Ralph M. Vincent before the British Interdepartmental Committee[163] and, more emphatically still, the splendid results of the Rochester experiment under the leadership of Dr. Goler[164] show that this can be attained. Every municipality in America could adopt, and should adopt, the plan. “Now that the way has been shown, upon ‘city fathers’ indifferent to the childhood of their cities, upon health officers and departments warped into unbudgeable routine, upon near-sighted charity workers and unknowing givers who care for the suffering, but do not get at causes, will rest the responsibility for the continuance of a part of that fearful tally of dead babies which each summer’s week jots down on a town’s death-roll—your town and ours.” In these direct, unequivocal words _Charities_ sums up the whole question of responsibility.

The purely experimental work of such philanthropic efforts as that of Mr. Straus has been done. The practicability and value of municipal control of the milk supply has been abundantly proven, and there is no longer need of private charitable effort and experiment. There lurks a danger in leaving this important public service to philanthropy, a danger well-nigh as great as in leaving it to private commercial enterprise. The dangers arising from the amateurish meddling of “near-sighted charity workers and unknowing givers” is much greater than is generally recognized. Many of these charitable societies drag out a precarious existence, their usefulness and success depending upon the measure of success attending the efforts of the “begging committees.” Generally speaking, they are less economical, and, what is more important, less effective, than municipal enterprises, besides being based upon a fatally unsound and demoralizing principle. I know of one large city in which a number of public-spirited citizens have for some years interested themselves in the supply of sterilized milk for infants. Notwithstanding that they receive each year in subscriptions a much larger amount of money, in proportion to the milk supplied, than Rochester’s deficit, they charge the parents more than twice as much as the latter city for the milk.

Nor is this all; there are other, weightier objections than this. There are no regular depots for the distribution of the milk, under the direct supervision of the Committee, but it is handled by drug-store keepers and others. No sort of control is exercised over the sale. Any child can go into the store and buy a bottle of milk. This is what happens: small children, sometimes not more than four or five years old, are sent by their parents to buy the milk. These little children are, naturally, ignorant of the importance which the medical advisers of the charity attach to the subject of modifications of the milk to suit the age of the child to whom it is to be given, with the result that babies less than three months old are given milk intended for babies eighteen months old, while the latter are half starved upon the modified milk intended for the former. Another evil, not, I am told, peculiar to this particular charitable society, is the selling of milk irregularly and in single bottles. When the mothers have the money, or when they are not too busy to go for the Pasteurized milk, they buy a single bottle, but at other times they send out to the grocery store for cheaper milk, or else feed the babies upon ordinary table foods. Of course, there should be a system of registration adopted; every child’s name should be enrolled, together with the date of its birth, and no less than a full day’s supply should be sold. That is the custom where the matter has been taken up by the municipal authorities. The result is that the children can be weighed and examined more or less regularly; facilities are offered for the periodical visiting of the homes of the infants and their inspection; mothers can be taught how to care for their little ones; and, instead of leaving it to chance, or depending upon the word of an ignorant mother, or a child, the attendants in charge are able to regulate the supply so that at the proper time each child gets milk of the proper strength and richness. How far the abuses I have named are prevalent in philanthropic experiments of this kind, I do not know, but I am convinced that there should be no room for such well-intentioned but disastrous muddling. The whole milk supply of every city should be the subject of municipal management and control, and special arrangements should be made for dealing with the milk intended for infant consumption. Personally, I should like to see the principles of the Rochester system extended to cover the entire milk supply of the city, and, in some one of our great cities, the further experiment of a municipal farm dairy for the supply of all milk necessary for hospitals and similar institutions upon the most hygienic principles possible. This has been done to some extent in Europe with success.

VI

It is a delightful and scientifically correct principle which those Utopia builders have embodied in their schemes of world-making who have advocated the restriction of matrimony to those women who have undergone a thorough course of education and training in eugenics and household economy. Most persons will agree that such a system of education for maternal and wifely duties would be a great boon, if practicable. But so long as hearts are swayed by passion, and the subtle currents of human love remain uncontrolled by law, such proposals must remain dreams. Even the modest suggestion of Mrs. Parsons that a “matrimonial white list” be created by establishing continuation schools for training young women in the domestic arts and the principles of child-rearing and giving them certificates or diplomas, as well as certificates of health,[165] is so far in advance of anything yet attempted that it sounds almost Utopian. Still, there is nothing fanciful or impossible in the proposal itself.

The preservation of child life must depend largely upon the dissipation of maternal ignorance. Until mothers are enlightened, the infantile death-rate must remain needlessly and unnaturally heavy. And so long as industrial occupations absorb our young girls in the very years which should be spent at home in practical training for the responsibilities of wifehood and motherhood, there must continue to be a very large number of marriages productive of poverty, misery, and disease, because of the ignorance and inefficiency of the wives. So the fight against maternal ignorance, the ignorance which breeds disease and poverty, appears as an almost Sisyphean task. So long as such industrial conditions prevail, ignorance will continue to sap the foundations of family life and mock our efforts at reform. In such important matters of domestic economy as knowledge of food values and how to spend the family income to the best advantage, what but failure can be expected when a young woman worker graduates from mill labor to wifehood? Even where such a young woman, or girl growing into womanhood, feels the need of training in these important matters of domestic economy, she is prevented by the fact that the family cooking and buying are necessarily done during the hours she is at work. By the time she returns home after her day’s labor, little or nothing remains to be done except washing the dishes. Even were it otherwise, she would in most cases be too tired to help. After confinement in a shop or factory for ten or twelve hours, at monotonous tasks entirely devoid of interest or attractiveness, it is natural and right that she should seek recreation and pleasure. Further confinement, either in the home or a school, is extremely liable to prove injurious.

For these reasons, and others obvious to the reader, I am not very sanguine that much can ever be accomplished by evening classes for working girls. The British Interdepartmental Committee suggests that “continuation classes for domestic instruction” should be formed, and attendance at them, twice each week during certain months of the year, made obligatory, only those employed in domestic service being exempted from compulsory attendance. Realizing that it would be an injury to the girls to impose this attendance and study upon them in addition to their already too long hours of employment, the committee very properly suggests that some modification of the hours of work would have to be introduced, so that in fact the hours of instruction would have to be taken out of their ordinary working time.[166] With such a provision as this, a system of compulsory instruction in domestic science might very well be adopted. It is probable, however, that the principal effect would be a considerable diminishing of the employment of girls and young women within the ages prescribed for compulsory attendance at the continuation classes.

The suggested curriculum for such classes is interesting. “The courses of instruction at such classes should cover every branch of domestic hygiene, including the preparation of food, the practice of household cleanliness, the tendance and feeding of young children, the proper requirements of a family as to clothing—everything, in short, that would equip a young girl for the duties of a housewife.”[167] The further suggestion is made that the members of these continuation classes should visit from time to time the municipal _crèches_—the establishment of which is strongly recommended—and receive there practical instruction in the management of infants. This is such a comprehensive and courageous proposal that one would like to see it given a fair trial.

VII

The efficient work done by the school nurses in New York City, and elsewhere, though sadly restricted in its scope, suggests far wider possibilities. If nurses were appointed in far greater numbers, at least one to each large school, their functions might be enlarged. If, as has been suggested, they were to receive special social training, possibly at the expense of part of their present medical training, they might attend to the needs of those below school age as well as of those enrolled at school. Above all, they might be made a potent means of educating the mothers. It has been found that visiting nurses attached to the schools receive cordial welcome as a rule, are not viewed with suspicion as other officials or philanthropic visitors are, and have a correspondingly greater influence. The weak point in such a proposal lies in the fact that the school nurse would not, if her work was based upon the school registration, reach those families not represented in the schools. Thus the most important cases of all, educationally, young mothers with their first babies, would not be reached.

Elsewhere I have referred to the efforts made in some cities to educate mothers by the distribution of leaflets and pamphlets upon the subject of infant feeding and general care. Some of these leaflets and pamphlets which I have seen are models of concise lucidity, and their wide distribution among mothers intelligent enough to profit by them would be of great value. One of the first difficulties presented when this plan is attempted upon a large scale is the efficient distribution of the literature. To accomplish anything at all, the literature must be printed in the various languages represented in the city’s industrial population, and it is no easy matter to see that each mother gets literature in her own language. Quite recently, I heard of a tenement in which there were families representing no less than fourteen nationalities, and in which lived Mrs. O’Hara, a German, speaking little English! Added to this difficulty is the expense of distribution. If sent by mail,—and in large cities no other method seems possible,—the cost is enormous. To send a single circular to the registered voters of New York City, for instance, requires an expenditure of upwards of $60,000 for postage alone.[168] There would seem to be no good reason why the Federal Government should not authorize the Health Boards to send all such educational matter through the mails free of cost. Why should the Health Department of a city not have the privilege of a local frank? Nothing could well be more foolish than the system under which the city, while performing a national service, must pay the national post-office for doing its share of the work.

Many of the mothers, especially of our immigrant population, are quite unable to read, and literature is wasted upon them. It will be seen, therefore, that the propaganda of health by literature is subject to several important restrictions. While admirably adapted to simple, homogeneous communities in which there is a small percentage of illiteracy, it fails to meet the needs of our great cosmopolitan cities. If it were possible to have all births reported at once to the Health Department by telephone, in order that each case might be visited by special maternity nurses, it would be comparatively easy to give special, personal attention to those cases in which literature would be worthless. This plan has been adopted in Australia with conspicuous success. The State Children’s Department appoints women inspectors to visit the children of the poor. These nurse inspectors have to report, not only upon the condition of the homes, but of the children. The mothers are furnished with printed instructions as to the kind of food to be given, the proper quantities, methods of preparation, and times of feeding. If the child does not thrive satisfactorily, the nurse inspector calls in one of the physicians of the department. If milk cannot be properly assimilated, something else is tried. In short, all that skill and care can do to protect the lives of the infants is done, with the result that the infantile death-rate has been reduced from 15 per cent to 8 per cent.[169]

VIII

I would not leave this subject without insisting upon the urgent need of State or Federal supervision of the manufacture and sale of patent infant foods. The mortality from this one cause alone is enormous. There has been no satisfactory or comprehensive inquiry into this important matter in this country, and it is therefore impossible to get reliable figures. In Germany, where the law requires that the death certificate of an infant under one year of age must state what the mode of feeding has been as well as the cause of death,—a wise provision which might with advantage be adopted in this country,—it is possible to ascertain approximately the extent of the evil. The records show that of children fed on artificial food 51 per cent die during the first year, while only 8 per cent of the children exclusively nursed by their mothers die during the same period.[170] No one familiar with the work of our infants’ hospitals can fail to be impressed by the large number of cases of illness and death in which artificial feeding appears as a primary or contributing cause. I have gone over the record books of many such hospitals in different parts of the country, with the almost invariable result that artificial foods appeared to be the source of trouble in many cases. Most of the patent foods, one might almost go farther and say all of them,[171] are unhealthful because of the starch they contain, which the little infant stomachs cannot digest. Many of the cheaper kinds of patent infant foods upon the market are, as previously stated, little better than poisons. The testimony of the greatest authorities upon the subject of infant feeding, backed by the grim eloquence of hospital records and the death-rates, points irresistibly to the need of some strict supervision of the production and sale of artificial foods for children. Whether this should be done by the establishment of certain standard formulæ, or by compelling the makers to submit certified samples for official analysis, is a question which only a body of experts should decide.