Part 2

To the child as to the adult the principal evils of poverty are material ones,—lack of nourishing food, of suitable clothing, and of healthy home surroundings. These are the fundamental evils from which all others arise. The younger children are spared the anxiety, shame, and despair felt by their parents and by their older brothers and sisters, but they suffer terribly from neglect when, as so often happens, their mothers are forced to abandon the most important functions of motherhood to become wage-earners. The cry of a child for food which its mother is powerless to give it is the most awful cry the ages have known. Even the sound of battle, the mingled shrieks of wounded man and beast, and the roar of guns, cannot vie with it in horror. Yet that cry goes up incessantly: in the world’s richest cities the child’s hunger-cry rises above the din of the mart. Fortunate indeed is the child whose lips have never uttered that cry, who has never gone breakfastless to play or supperless to bed. For periods of destitution come sooner or later to a majority of the proletarian class. Practically all the unskilled laborers and hundreds of thousands engaged in the skilled trades are so entirely dependent upon their weekly wages, that a month’s sickness or unemployment brings them to hunger and temporary dependence. Not long ago, in the course of an address before the members of a labor union, I asked all those present who had ever had to go hungry, or to see their children hungry, as a result of sickness, accident, or unemployment to raise their hands. No less than one hundred and eighty-four hands were raised out of a total attendance of two hundred and nineteen present, yet these were all skilled workers protected in a measure by their organization.

It is not, however, the occasional hunger, the loss of a few meals now and then in such periods of distress, that is of most importance; it is the chronic underfeeding day after day, month after month, year after year. Even where lack of all food is rarely or never experienced, there is often chronic underfeeding. There may be food sufficient as to quantity, but qualitatively poor and almost wholly lacking in nutritive value, and such is the tragic fate of those dependent upon it that they do not even know that they are underfed in the most literal sense of the word. They live and struggle and go down to their graves without realizing the fact of their disinheritance. A plant uprooted and left lying upon the ground withers quickly and dies; planted in dry, lifeless, arid soil it would wither and die, too, less quickly perhaps but as surely. It dies when there is no soil about its roots and it dies when there is soil in abundance, but no nourishing qualities in the soil. As the plant is, so is the life of a child; where there is no food, starvation is swift, mercifully swift, and complete; when there is only poor food lacking in nutritive qualities starvation is partial, slower, and less merciful. The thousands of rickety infants to be seen in all our large cities and towns, the anæmic, languid-looking children one sees everywhere in working-class districts, and the striking contrast presented by the appearance of the children of the well-to-do bear eloquent witness to the widespread prevalence of underfeeding.

Poverty and Death are grim companions. Wherever there is much poverty the death-rate is high and rises higher with every rise of the tide of want and misery. In London, Bethnal Green’s death-rate is nearly double that of Belgravia;[2] in Paris, the poverty-stricken district of Ménilmontant has a death-rate twice as high as that of the Elysée;[3] in Chicago, the death-rate varies from about twelve per thousand in the wards where the well-to-do reside to thirty-seven per thousand in the tenement wards.[4] The ill-developed bodies of the poor, underfed and overburdened with toil, have not the powers of resistance to disease possessed by the bodies of the more fortunate. As fire rages most fiercely and with greatest devastation among the ill-built, crowded tenements, so do the fierce flames of disease consume most readily the ill-built, fragile bodies which the tenements shelter. As we ascend the social scale the span of life lengthens and the death-rate gradually diminishes, the death-rate of the poorest class of workers being three and a half times as great as that of the well-to-do. It is estimated that among 10,000,000 persons of the latter class the annual deaths do not number more than 100,000, among the best paid of the working-class the number is not less than 150,000, while among the poorest workers the number is at least 350,000.[5] The following diagram illustrates these figures clearly and needs no further comment:—

This difference in the death-rates of the various social classes is even more strongly marked in the case of infants. Mortality in the first year of life differs enormously according to the circumstances of the parents and the amount of intelligent care bestowed upon the infants. In Boston’s “Back Bay” district the death-rate at all ages last year was 13.45 per thousand as compared with 18.45 in the Thirteenth Ward, which is a typical working-class district, and of the total number of deaths the percentage under one year was 9.44 in the former as against 25.21 in the latter. Wolf, in his classic studies based upon the vital statistics of Erfurt for a period of twenty years, found that for every 1000 children born in working-class families 505 died in the first year; among the middle classes 173, and among the higher classes only 89. Of every 1000 illegitimate children registered—almost entirely of the poorer classes—352 died before the end of the first year.[6] Dr. Charles R. Drysdale, Senior Physician of the Metropolitan Free Hospital, London, declared some years ago that the death-rate of infants among the rich was not more than 8 per cent, while among the very poor it was often as high as 40 per cent.[7] Dr. Playfair says that 18 per cent of the children of the upper classes, 36 per cent of the tradesman class, and 55 per cent of those of the working-class die under the age of five years.[8]

And yet the experts say that the baby of the tenement is born physically equal to the baby of the mansion.[9] For countless years men have sung of the Democracy of Death, but it is only recently that science has brought us the more inspiring message of the Democracy of Birth. It is not only in the tomb that we are equal, where there is neither rich nor poor, bond nor free, but also in the womb of our mothers. At birth class distinctions are unknown. For long the hope-crushing thought of prenatal hunger, the thought that the mother’s hunger was shared by the unborn child, and that poverty began its blighting work on the child even before its birth, held us in its thrall. The thought that past generations have innocently conspired against the well-being of the child of to-day, and that this generation in its turn conspires against the child of the future, is surcharged with the pessimism which mocks every ideal and stifles every hope born in the soul. Nothing more horrible ever cast its shadow over the hearts of those who would labor for the world’s redemption from poverty than this spectre of prenatal privation and inherited debility. But science comes to dispel the gloom and bid us hope. Over and over again it was stated before the Interdepartmental Committee by the leading obstetrical authorities of the English medical profession that the proportion of children born healthy and strong is not greater among the rich than among the poor.[10] The differences appear after birth. Wise, patient Mother Nature provides with each succeeding generation opportunity to overcome the evils of ages of ignorance and wrong, with each generation the world starts afresh and unhampered, physically, at least, by the dead past.

“The world’s great age begins anew, The golden years return.”

And herein lies the greatest hope of the race; we are not handicapped from the start; we can begin with the child of to-day to make certain a brighter and nobler to-morrow as though there had never been a yesterday of woe and wrong.[B]

II

In England the high infantile mortality has occasioned much alarm and called forth much agitation. There is a world of pathos and rebuke in the grim truth that the knowledge that it is becoming increasingly difficult to get suitable recruits for the army and navy has stirred the nation in a way that the fate of the children themselves and their inability to become good and useful citizens could not do.[11] Alarmed by the decline of its industrial and commercial supremacy, and the physical inferiority of its soldiers so manifest in the South African war, a most rigorous investigation of the causes of physical deterioration has been made, with the result that on all sides it is agreed that poverty in childhood is the main cause. Greater attention than ever before has been directed to the excessive mortality of infants and young children. Of a total of 587,830 deaths in England and Wales in 1900 no less than 142,912, or more than 24 per cent of the whole, were infants under one year, and 35.76 per cent were under five years of age. That this death-rate is excessive and that the excess is due to essentially preventable causes is admitted, many of the leading medical authorities contending that under proper social conditions it might be reduced by at least one-half. If that be true, and there is no good reason for doubting it, the present death-rate means that more than 70,000 little baby lives are needlessly sacrificed each year.

No figures can adequately represent the meaning of this phase of the problem which has been so picturesquely named “race suicide.” Only by gathering them all into one vast throng would it be possible to conceive vividly the immensity of this annual slaughter of the babies of a Christian land. If some awful great child plague came and swept away every child under a year old in the states of Massachusetts, Idaho, and New Mexico, not a babe escaping, the loss would be less than those that are believed to be needlessly lost each year in England and Wales. Or, to put it in another form, the total number of these infants believed to have died from causes essentially preventable in the year 1900 was greater than the total number of infants of the same age living in the following six states,—Connecticut, Maine, Delaware, Florida, Colorado, and Idaho. Even if the estimate of the sacrifice be regarded as being excessive, and we reduce it by half, it still remains an awful sum.

Unfortunately, there is no reason to suppose that the infantile death-rate in the United States is nearly so far below that of England as is generally supposed. The general death-rate is given in the census returns as 16.3 per thousand, or about two per thousand less than in England. But owing to a variety of causes, chief of which is the defective system of registration in several states, these figures are not very reliable, and it is generally agreed that the mortality for the whole country cannot be less than for the “Registration Area,” 17.8 per thousand. Similarly, the difference in the infantile death-rate of the two countries is much less than the following crude figures contained in the census reports appear at first to indicate:—

═════════════════════════════════╤═════════════════════════════════ UNITED STATES │ ENGLAND AND WALES ─────────────────────────────────┼───────────────────────────────── Deaths at all ages, 1,039,094│Deaths at all ages, 587,830 Deaths under 1 year, 199,325│Deaths under 1 year, 142,912 Deaths under 5 years, 317,532│Deaths under 5 years, 209,960 ═════════════════════════════════╧═════════════════════════════════

In the English returns the death of every child having had a separate existence is counted, even though it lived only a few seconds, but in this country there is no uniform rule in this respect. In Chicago, for instance, “no account is taken of deaths occurring within twenty-four hours after birth,”[12] and in Philadelphia a similar custom prevailed until 1904.[13] Such facts seriously vitiate comparisons of the infantile death-rates of the two countries which are based upon the crude statistics of census returns.

But while the difference is much less than the figures given would indicate, it is still safe to assume that the infantile death-rate is lower in this country than in England. Such a condition might reasonably be expected for numerous reasons. We have a larger rural population with a higher economic status; new virile blood is being constantly infused by the immigration of the strongest and most aggressive elements of the population of other lands; our people, especially our women, are more temperate. All these factors would tend naturally to a lower death-rate at all ages, but especially of infants.

RACHITIC TYPES

That with all these favorable conditions our infantile mortality should so nearly approximate that of England, that of every thousand deaths 307.8 should be of children under five years of age—according to the crude figures of the census, more if a correct registration upon the same basis as the English figures could be had—is a matter of grave national concern. If we make an arbitrary allowance of 20 per cent, to account for the slight improvement shown by the death-rates and for other differences, and regard 30 per cent of the infantile death-rate as being due to socially preventable causes, instead of 50 per cent, as in the case of England, we have an appalling total of more than 95,000 unnecessary deaths in a single year.

And of these “socially preventable” causes there can be no doubt that the various phases of poverty represent fully 85 per cent, giving an annual sacrifice to poverty of practically 80,000 baby lives. If some modern Herod had caused the death of every male child under twelve months of age in the state of New York in the year 1900, not a single child escaping, the number thus brutally slaughtered would have been practically identical with this sacrifice. Poverty is the Herod of modern civilization, and Justice the warning angel calling upon society to “arise and take the young child” out of the reach of the monster’s wrath.

III

If our vital statistics were specially designed to that end, they could not hide the relation of poverty to disease and death more effectually than they do now. It is impossible to tell from any of the elaborate tables compiled by the census authorities what proportion of the total number of infant deaths were due to defective nutrition or other conditions primarily associated with poverty. No one who has studied the question doubts that the proportion is very great, but it is impossible to present the matter statistically, except in the form of a crude estimate. There is much of value in our great collections of statistics, but the most vital facts of all are rarely included in them.

In the great dispensary a little girl of tender years stands holding up a baby not yet able to walk. She is a “little mother,” that most pathetic of all poverty’s victims, her childhood taken away and the burden of womanly cares thrust upon her. “Please, doctor, do somethin’ fer baby!” she pleads. Baby is sick unto death, but she does not realize it. Its breath comes in short, wheezy gasps; its skin burns, and its little eyes glow with the brightness that doctors and nurses dread. One glance is all the doctor needs; in that brief glance he sees the ill-shaped head and the bent and twisted legs that tell of rickets. Helpless, with the pathetically perfunctory manner long grown familiar to him he gives the child some soothing medicine for her tiny charge’s bronchial trouble and enters another case of “bronchitis” upon the register. “And if it wasn’t bronchitis, ’twould be something else, and death soon, anyhow,” he says. Death does come soon, the white symbol of its presence hangs upon the street door of the crowded tenement, and to the long death-roll of the nation another victim of bronchitis is added—one of the eleven thousand so registered under five years of age. The record gives no hint that back of the bronchitis was rickets and back of the rickets poverty and hunger. But the doctor knows—he knows that little Tad’s case is typical of thousands who are statistically recorded as dying from bronchitis or some other specific disease when the real cause, the inducing cause of the disease, is malnutrition. Even as the Great White Plague recruits its victims from the haunts of poverty, so bronchitis preys there and gathers most of its victims from the ranks of the children whose lives are spent either in the foul and stuffy atmosphere of overcrowded and ill-ventilated homes, or on the streets, underfed, imperfectly clad, and exposed to all sorts of weather.

For nearly half a century rachitis, or “rickets,” has been known as the disease of the children of the poor. It has been so called ever since Sir William Jenner noticed that after the first two births, the children of the poor began to get rickety, and careful investigation showed that the cause was poverty, the mothers being generally too poor to get proper nourishment while nursing them.[14] It is perhaps the commonest disease from which children of the working-classes suffer. A large proportion of the children in the public schools and on the streets of the poorest quarters of our cities, and a majority of those treated at the dispensaries or admitted into the children’s hospitals, are unmistakably victims of this disease. One sees them everywhere in the poor neighborhoods. The misshapen heads and the legs bent and twisted awry are unmistakable signs, and the scanty clothing covers pitiful little “pigeon-breasts.” The small chests are narrowed and flattened from side to side, and the breast-bones are forced unnaturally forward and outward. Tens of thousands of children suffer from this disease, which is due almost wholly to poor and inadequate food. Here again statistical records hide and imprison the soul of truth, failing to yield the faintest idea of the ravages of this disease. The number of deaths credited to it in 1900 was only 351 for the whole of the United States, whereas 10,000 would not have been too high a figure.

Seldom, if ever, fatal by itself, rickets is indirectly responsible for a tremendous quota of the infantile death-rate.[15] In epidemics of such infectious diseases as measles, whooping-cough, and others, the rickety child falls an easy victim. In these diseases, as well as in bronchitis, pneumonia, convulsions, diarrhœa, and many other disorders, the mortality is far higher among rickety children than among others. Nor do the evils of rachitis cease with childhood, but in later life they are unquestionably important and severe. There is no escape for the victim even though the storms of childhood be successfully weathered, but like some cruel, relentless Nemesis the consequences pursue the adult. The weakening of the constitution in infancy through poverty and underfeeding cannot be remedied, and epilepsy and tuberculosis find easy prey among those whose childhood had laid upon it the curse of poverty in the form of rickets.

An epidemic of measles spreads over the great city. Silently and mysteriously it enters and, unseen, touches a single child in the street or the school, and the result is as the touch of the blazing torch to dry stubble and straw; only it is not stubble but the nation’s heart, its future citizenry, that is attacked. From child to child, home to home, street to street, the epidemic spreads; mansion and tenement are alike stricken, and the city is engaged in a fierce battle against the foe which assails its children. In the tenement districts doctors and nurses hurry through the sun-scorched streets and wearily climb the long flights of stairs hour after hour, day after day; in the districts where the rich live, doctors drive in their carriages to the mansions, and nurses tread noiselessly in and out of the sick rooms. Rich and poor alike struggle against the foe, but it is only in the homes of the poor that there is no hope in the struggle; only there that the doctors can say no comforting words of assurance. When the battle is over and the victims are numbered, there is rejoicing in the mansion and bitter, poignant sorrow in the tenement. For poor children are practically the only ones ever to die from measles. Nature starts all her children equally, rich and poor, but the evil conditions of poverty create and foster vast inequalities of opportunity to live and flourish.

Dr. Henry Ashby, an eminent authority upon children’s diseases, says: “_In healthy children among the well-to-do class the mortality_ (from measles) _is practically nil, in the tubercular and wasted children to be found in workhouses, hospitals, and among the lower classes, the mortality is enormous, no disease more certainly being attended with a fatal result_. William Squires places it in crowded wards at 20 to 30 per cent of those attacked. Among dispensary patients the mortality generally amounts to 9 or 10 per cent. In our own dispensary, during the six years, 1880–1885, 1395 cases were treated with 128 deaths, making a mortality of 9 per cent. Of the fatal cases 73 per cent were under two years of age and 9 per cent under six months of age.”[16]

These are terrible words coming as they do from a great physician and teacher of physicians. Upon any less authority one would scarcely dare quote them, so terrible are they. They mean that practically the whole 8645 infant deaths recorded from measles in the United States in the year 1900 were due to poverty—to the measureless inequality of opportunity to live and grow which human ignorance and greed have made. Moreover, the full significance of this impressive statement will not be realized if we think only of its relation to one disease. The same might be said of many other diseases of childhood which blight and destroy the lives of babies as mercilessly as the sharp frosts blight and kill the first tender blossoms of spring. The same writer says: “It may be taken for granted that no healthy infants suffer from convulsions; those who do are either rickety or the children of neurotic parents.”[17] And there were no less than 14,288 infant deaths from convulsions in the United States in the census year. It would probably be a considerable underestimate to regard 10,000 of these deaths, or 70 per cent of the whole, as due to poverty.