Part 19

This last-mentioned feature of the French plan is most interesting. It appears to have been adopted as a result of favorable reports upon the working of a similar plan in Switzerland. The managers of the Montmartre fund, for instance, purchased a great mansion with a magnificent park, and to this delightful spot, not many miles from Paris, the children are sent in batches and kept for two or three weeks at a time, much to their physical betterment. There are several of these “school colonies” maintained by the various school funds of Paris, and the City Government subsidizes them to the extent of about $40,000 a year. The custom of providing a special grant, or subsidy, in aid of these colonies is quite common throughout the whole of France. The importance of these health-building institutions and the provisions made for the medical care of sick children cannot be overestimated. To give an idea of what is meant by medical care alone, it is only necessary to refer to a recent inspection in the New York public schools. Out of 7000 children examined, fully one-third were found to be suffering from defective eyesight, while more than 17 per cent suffered from defects so serious as to interfere with their chances of ever earning a living, as well as with their general health. A similar investigation in the public schools of Minnesota recently showed that there were 70,000 children with defective vision of the most serious nature, less than 10 per cent of whom were provided with glasses. In a very large number of cases the parents are simply too poor to buy glasses. Such children would, in Paris, be provided with the necessary glasses and oculist’s care out of the school funds. And there would be no suggestion of pauperism about it, no humiliation; it is the child’s right. Medical inspection is thorough, and the American witnessing it is very apt to feel ashamed of the farcical “inspections” so common in his great and wealthy country.

For a long time, whenever food was given the managers of the school funds simply issued coupons, or orders upon some restaurant, entitling the holder to so many meals at a given cost. Usually some teacher or charitable worker was deputed to accompany the child to see that it actually got what it was intended to get. There was no system. But in 1877 the Prefect of the Seine appointed a commission to study the question, raised by some Socialists, of how good a warm meal might be provided in the schools at a low cost. Most of the managers of the school funds treated the matter in a very lukewarm, indifferent sort of way, and the commissioners reported that all they had been able to ascertain was that good meals could be provided at an average cost of twenty-five centimes (five cents) each. So the matter dropped and was not again heard of until the trying winter of 1881. Then it was suggested that, purely as an experiment, the children of school age whose parents were receiving poor relief should be fed. The managers of the Montmartre school fund at once volunteered to undertake the experiment, and their example was soon followed by others. They did not long confine the meals to the children of pauper parents, but at an early stage of the experiment extended it so as to include all children. The example of Montmartre was very soon followed, and within a year there were fifteen canteens which had served between them 1,110,827 “portions.” One-third of these “portions” were meat, each weighing twenty grammes, one-third were bowls of soup, and the other third portions of vegetables, these varying with the season. The number of portions paid for by the children was 736,526, and the number given to children too poor to pay, 374,301. It should be said, perhaps, that a most searching investigation was made to make sure of the inability of children’s parents to pay. The total cost of the meals was 59,264 francs, of which amount the children paid 36,776 francs. After a while, when they had gathered experience in the management of the canteens, the managers found that it was possible to increase the size of the portions of meat and, at the same time, to cut down expenses by nearly 50 per cent.

Nowadays the cost of a meal, consisting of a bowl of good soup, a plate of meat, two kinds of vegetables, and bread _ad libitum_, is fifteen centimes (three cents). That is the sum paid by the children, and I have been assured over and over again by those in charge of various canteens that it is more than sufficient to pay the cost. There would be a not inconsiderable profit if all children paid for their meals, but that is not by any means the case. When a child’s parents are too poor to pay the full price, and that fact has been ascertained by the investigators, they are permitted to pay less, even as little as two and a half centimes, or half a cent. The policy is to encourage as many as possible to pay the full price, or such sums as they can muster. But the very poor are never turned away, and in the poorer quarters thousands of children are fed gratuitously, especially in winter, when in Paris, as elsewhere, there is more distress due to sickness and interrupted employment. In the poor quarter of Eppinette the children’s fees amount to only about 20 per cent of the cost, while in the wealthier quarters they amount to 75 or even 85 per cent. In an ordinary industrial district, like Batignolles, the children pay about 45 per cent on a yearly average.

The Municipal Council of Paris makes an annual subsidy to cover the natural deficit of the canteens. These deficits vary from year to year, but the total subsidies required for the three years, 1901–1903, amounted to $200,000. In connection with this question of financial management there are two items worth noticing. One is the fact that private subscriptions to the school funds show a great falling off now that in practice they have become incorporated in the municipal government. It has not been found that citizens are willing to contribute to the funds now that the city has assumed responsibility for them. The other fact is that the expenditure in poor relief on account of children is very much less. Children have always served as the best of all reasons why poor relief should be given. Now, when that plea is made by an applicant for relief, he or she is referred to the school canteens, where the children are sure of being fed.

I fancy that I can hear some good reader’s mocking sneer at the idea of being fed at a “common, socialistic trough.” Well, I can only say that, having eaten meals in two or three of the schools, I much preferred them to an average American restaurant “Regular Dinner” at twenty-five cents. Everything is as neat and clean as it could possibly be, and the cooking—well, it bears out the reputation of the French as the master-cooks of the world. There is, apparently, no “graft,” and that is probably due in large part to the fact that the meals are not confined to pauper children, who might, alas! be badly served with impunity. From the first it has been one of the chief aims of the authorities to keep the canteens free from the taint of pauperism. The children of the well-to-do are encouraged to attend—not, indeed, by direct solicitation, but by making the meals and the surroundings as attractive as possible. And the plan succeeds very well. No child knows whether the child next it has paid for its dinner or not. Small tickets are issued, each child going through a little box-office, which only permits of one being in at a time. If a little boy or girl claims to be too poor to pay for a meal ticket, no questions are asked, the ticket is issued, and the child’s name and address noted. By next day, or at most in two days, inquiries have been made. If it is found that the parents can afford it, they are compelled to pay the full price and to refund whatever sum may be due to the canteen for the meals their child has had. If they are found to be really too poor to pay, tickets are issued to the child for as long as it may be necessary. In such cases the account is not charged against the parents. No distinction is made between the tickets of those who pay and those who do not, and it is thus practically impossible for the child who has paid for its meal to jeer at its less fortunate, dependent comrade. Thus the self-respect of the poorest children is preserved,—a most important fact, as every one who has studied the problems of charitable relief knows.

Another highly important factor is the presence of the teachers at the meals. Fully 90 per cent of the teachers use the canteens more or less regularly, though there is absolutely no compulsion in the matter. They prefer to do so on account of the cheapness and wholesome character of the meals. I have myself sat down to a three-cent dinner in the company of a well-known member of the Chamber of Deputies, a Professor of Languages, and several teachers, each one of us having gone through the little box-office and bought his ticket in exactly the same manner as the most ragged urchin. All the children are provided with cheap paper napkins, and the presence of the teachers is a sort of practical education in table manners. The canteen serves, therefore, as a great educational and ethical force as well as a remedy for one of the worst evils arising out of the national poverty problem. The _cantine scolaire_ is a great institution, well worthy of careful study.

If, as the evidence gathered by Mr. Hunter seems to show, we have at least two million underfed children in the public schools of the United States, victims of physical and mental deterioration, the time must come, and the sooner the better, when we must deal with the problem. Some of the Utopians among us would doubtless like to see the all-embracing compulsory system of Vercelli adopted, but it is most likely that we shall find the French methods better suited to our needs.

NOTE.—I am indebted to the publishers of my _Underfed School Children—The Problem and the Remedy_, Charles H. Kerr and Company, of Chicago, for permission to reproduce the foregoing paper in this volume.

APPENDIX B LETTER TO THE ROYAL ITALIAN AMBASSADOR AT WASHINGTON FROM THE CHIEF OF THE BOARD OF EDUCATION OF THE MUNICIPALITY OF VERCELLI, ITALY, DESCRIBING THE SCHOOL-MEALS SYSTEM

NOTE.—I am indebted to the Italian Ambassador at Washington, his Excellency Mayor des Planches, for permission to use the following letter. The translation was made for me by Mr. Teofilo Petriella, of Cleveland, Ohio, an Italian journalist.—J. S.

VERCELLI, September 13, 1905.

The school year, 1904–1905, just over, was the _fifth_ since the school lunch (_refezione scolastica_) was introduced in our City Elementary Schools, _at the complete expense of the Municipality_.

The school lunch is distributed every day during the whole school year. Limited, at the beginning, only to the city schools, it has been extended, since the school year 1901–1902, to the suburban and rural schools.

To-day, therefore, all the male and female pupils of all the classes of all the elementary schools, in both city and suburbs, take part in the lunch. There are 65 schools with 91 classes, attended by an average of 2500 boys and girls.

The lunch consists of bread with another victual (_pane e companatico_). Each pupil gets a very good loaf of first quality wheat bread, weighing 140 grammes for the IV and V classes;[K] 120 grammes for the III class; and 100 grammes for the first two classes.

The victuals served with the bread are: On meat days, raw salt meat (_salame crudo_) in rations of 14 grammes, alternated with cooked salt meat (_salame cotto_) in rations of 20 grammes.[L] On fish days, cheese (either Bernesa or Fontina alternated) in rations of 20 grammes. All is of first quality, and this is daily ascertained by an inspection on the part of the Steward and the Officer of the Board of Health.

Each ration costs from seven to eight cents of a franc.[M]

Every school morning each teacher, within 15 minutes of the commencement of school (from 9 to 9.15), ascertains the number present by roll-call, fills out an order in three copies, keeping for himself the one attached to the stub and sending, by the ushers, the other two to the City Steward.

The Steward keeps one of these duplicate copies for the office accounts and registrations, while sending the other back to the teacher, along with the requested rations in a closed basket.

The office of the Steward, after having received all the requests from all the teachers, as above said, and after having classified same by degree, locality, and number, sends the orders of purchase to the different supply-contractors.

At 10 o’clock, in a suitable place, under the direction and supervision of the City Steward, the baskets are made up, one for each class. The baskets, once ready, are automatically padlocked—the teacher having the necessary key—and forwarded by proper servants to the several suburbs, while others take the rest, on pushcarts, to the city school buildings.

The School Trustees of the respective boroughs, the Principal and the Steward in the City School, visit the different classes to make sure of the regular and exact proceeding of the beneficent institutions.

So much, answering your favor of August 15th.

Truly yours,

The Mayor, per the Chief of the Board of Education, Cero Lucca.

Footnote K:

Twenty-eight grammes equal one ounce avoirdupois. The children in classes IV and V get loaves, therefore, weighing five ounces each.

Footnote L:

_Salame_, here translated “salt meat,” is really the best kind of salted dry sausage made of pork sirloin.

Footnote M:

One U. S. dollar equals about 492 francs; 100 Italian cents equal one franc, so that one cent of a franc equals about one-fifth of an American cent.

APPENDIX C

I THE QUESTION OF HEREDITY

In his testimony before the British Interdepartmental Committee on Physical Deterioration, Dr. Alfred Eichholz, one of H. M. Inspectors of Schools, a Doctor of Medicine, and formerly Fellow and Lecturer of Emmanuel College, Cambridge, said:—

“I have drawn a broad distinction between physical degeneracy and hereditary deterioration. The object of my evidence is to demonstrate the range and the depth of degeneracy among the poorer population, and to show that it is capable of great improvement—I say improvement purposely even within the areas of the towns—and to show that there is _a lack of any real evidence of any hereditary taint or strain of deterioration even among the poor populations of our cities_. The point which I desire to emphasize is that our physical degeneracy is produced afresh by each generation, and that there is every chance under reasonable measures of amelioration of restoring our poorest population to a condition of normal physique.

“I draw a clear distinction between physical degeneracy on the one hand and inherited retrogressive deterioration on the other. With regard to physical degeneracy, the children frequenting the poorer schools of London and the large towns betray a most serious condition of affairs, calling for ameliorative and arrestive measures, the most impressive features being the apathy of parents as regards the school, the lack of parental care of children, the poor physique, powers of endurance, and educational attainments of the children.... _While there are, unfortunately, very abundant signs of physical defect traceable to neglect, poverty, and ignorance, it is not possible to obtain any satisfactory or conclusive evidence of hereditary physical deterioration_—that is to say, deterioration of a gradual retrogressive permanent nature, affecting one generation more acutely than the previous. There is little, if anything, in fact, to justify the conclusion that neglect, poverty, and parental ignorance, serious as their results are, possess any marked hereditary effect, or that heredity plays any significant part in establishing the physical degeneracy of the poorer population. In every case of alleged progressive hereditary deterioration among the children frequenting an elementary school, it is found that the neighborhood has suffered by the migration of the better artisan class, or by the influx of worse population from elsewhere. _Other than the well-known specifically hereditary diseases which affect poor and well-to-do alike_, there appears to be very little real evidence on the prenatal side to account for the widespread physical degeneracy among the poorer population. There is, accordingly, every reason to anticipate RAPID amelioration of physique so soon as improvement occurs in external conditions, particularly as regards food, clothing, overcrowding, cleanliness, drunkenness, and the spread of common practical knowledge of home management. In fact, all evidence points to _active, rapid improvement, bodily and mental, in the worst districts_, so soon as they are exposed to better circumstances, even the weaker children recovering at a later age from the evil effects of infant life. (P. 20.)

“To discuss more closely the question of heredity may I in the first instance recall a medical factor of the greatest importance: the small percentage of unhealthy births among the poor—even down to the very poorest. The number of children born healthy is even in the worst districts very great. The exact number has never been the subject of investigation, owing largely to the certainty which exists on the point in the minds of medical men—but it would seem to be not less than 90 per cent.

“I have sought confirmation of my view with medical colleagues in public work, _e.g._ public health, poor law, factory acts, education, and in private practice in poor areas, and I have also consulted large maternity charities and have always been strengthened in this view. _In no single case has it ever been asserted that ill-nourished or unhealthy babies are more frequent at the time of birth among the poor than among the rich, or that hereditary diseases affect the new-born of the rich and the poor unequally._ The poorest and most ill-nurtured women bring forth as hale and strong-looking babies as those in the very best conditions. In fact, it almost appears as though the unborn child fights strenuously for its own health at the expense of the mother, and arrives in the world with a full chance of living a normal physical existence.... The interpretation would seem to be that Nature gives every generation a fresh start.”

[Q. 558. There is a fresh chance of getting rid of rickets with every generation?]

“Yes; rickets, malnutrition, low height, poor weight, anæmia, and all the other circumstances of neglected existence. It is from the moment of birth that the sad history begins,—the large infant mortality, the systematic neglect, the impoverishment of the constitution,—the resulting puny material which is handed over to the school to be educated.

“... It seems clear that every generation receives its chance of living a good physical life, and when to the fact of the large proportion of healthy new births we couple the evidence of improving health and physique in children who pass up the poorer elementary schools, _it seems clear that we are not dealing with a hereditary condition at all, but with a systematic postnatal neglect by ignorant parents, and that heredity, if it makes for anything, makes for recuperation, and so do the other social forces which are brought into play in dealing with the poorer population_.” (P. 31.)—Report of the Committee, Vol. II.

Dr. Edward Malins, M.D., President of the Obstetrical Society of London and Professor of Midwifery in the University of Birmingham, was examined upon the same subject. From the Report of the Committee (Vol. II, p. 136), the following extracts are taken:—

“3124. You have been good enough to attend here in consequence of certain evidence that we received the other day in which it was stated by Dr. Eichholz, on the authority of other medical men, that if people are going to have children, they will have healthy children as though Nature were giving every generation a fresh start, and he went on to say that healthy births were about 90 per cent in the poor neighborhoods, and he suggested that we should go to the London Obstetrical Societies to ascertain how far their experience bore out this statement. What are you able to say on this point?—What I have to say at the present time is more a matter of observation and of opinion. _We have not the figures at present to prove the accuracy of it, but I think the testimony of experienced observers would be in accordance with the views expressed by Dr. Eichholz_, though perhaps not to such a large extent. I should say that from 80 to 85 per cent of children are born physically healthy.

“3125. Whatever the condition of the parents may be? Whatever the condition of the mother may be antecedently.

“3126. And you think the deterioration sets in later?—I do, materially so. _The weight of children at birth as far as I know—and I have weighed a great many—is generally not below the average; the average keeps up very much no matter what the physical condition of the mother may be for the time._ Since receiving this information we have instituted at the Obstetrical Society of London, in connection with Lying-in Charities and Hospitals in London, a tabulated form for ascertaining these facts—what the weight of children is at birth; their physical condition, and whether there is an increase or otherwise during the time a woman is under observation. That time is not very long, not more than 10 days or a fortnight generally.

“3127. Will you be able to furnish us with these facts when collected?—Certainly. I will give the information later on, but I think there is a general consensus of opinion, at all events irrespective of figures, which I am not able to give, that the average is kept up no matter what the condition of the mother may be.

“3128. That proves what you say in your _précis_,—that Nature intends all to have a fair start?—Yes.”

II MALNUTRITION

“One of the most striking things about children suffering from malnutrition is their vulnerability. They ‘take’ everything. Catarrhal processes in the nose (adenoids), pharynx, and bronchi are readily excited, and, once begun, tend to run a protracted course. There is but little resistance to any acute infectious disease which the child may contract. One illness often follows another, so that these children are frequently sick for almost an entire season. Their muscular development is poor, they tire readily, are able to take but little exercise, and their circulation is sluggish. Mentally, they are usually bright, often precocious. Many would be called nervous children.”—_The Diseases of Infancy and Childhood_, by L. Emmet Holt, M.D., LL.D., p. 231.

“General malnutrition is the commonest pathological feature of infant life. Probably 50 per cent of all infants in this country (England) suffer from a greater or less degree, and this large proportion is caused undoubtedly by the extremely unsatisfactory methods of substitute feeding at present in vogue. Illness, in the usually accepted sense of the word, is not present. No specific disease can be diagnosed, and unless the indications are realized, the degeneration is allowed to proceed until marasmus or some acute disorder supervenes....

“Marasmus represents the extreme result of gradual and long-continued malnutrition. Extreme wasting is the cardinal, and indeed only, specific symptom. The term is not applicable to those cases where the wasting is the result of exhaustion due to the incidence of specific disease, such, for instance, as tuberculosis....