Part 20

“The most striking and perhaps the commonest result of impaired nutrition is the disease generally known by the name of rickets. Though some of its most obvious features are those associated with changes in the osseous system, those are by no means the only effects of the disease. Rachitis is the expression of profound pathological changes occurring in practically all the tissues of the body.

“No other disease illustrates so completely the effects of inadequate nutrition. An infant nursed by its mother and receiving from her a sufficient supply of adequate food, never contracts the disease, however disadvantageous its environment may be in other respects.

“Defect in the diet is the prime and essential cause of rachitis; while, as might be expected, the most advanced forms of the disease are to be seen when the effects of inadequate food are intensified by unhygienic environment....

“The effects of rachitis on the general constitution are extremely severe. The relationship between the nutrition of the infant and the condition of the child and adult has received but little attention. But there can be no doubt that the defects of nutrition occurring in infancy are of paramount importance in regard to the development of the adult. The cases of retarded physical and mental development in the child and the adult are numerous at the present time, and it is probable that their chief cause lies in defective nutrition during the period of infancy.

“Rachitis is a disease attended with a high mortality with which it is never credited, for the disease itself is seldom, if ever, fatal. In consequence of the cachectic condition and the extreme debility associated with advanced rachitis, the specific infectious diseases, such as measles, pertussis, and others, are associated with a much higher mortality in these cases than in others. Associated more or less closely with rachitis is a large class of disorders, such as bronchitis, diarrhœa, laryngismus stridulous, convulsions; these are attended with many fatal issues.”—_The Nutrition of the Infant_, by Ralph M. Vincent, M.D., pp. 226 _et seq._

III MIDWIFERY AND DEATH

Dr. Thomas Darlington, President of the New York Board of Health, says: Any movement for a proper regulation of midwives has my earnest support. Under the laws of New York as they now exist there is no adequate regulation. It is very easy for a woman to become a midwife in this city. She is required, it is true, to come to the department of health with a certificate from some school of midwifery, here or abroad, or to present statements from two physicians as to her fitness and character, but the _status_ of the school does not enter into the consideration, and that it is not difficult to obtain the indorsement from the two doctors is indicated by the great degree of incompetency and carelessness to be found in the ranks of the 800 midwives of New York City. Under the laws now existing we have no right to demand further proof of qualification. If the applicant meets the slight requirements, we must put her down as a “registered midwife.” She brings this phrase prominently into use in her solicitations for business in her neighborhood, and it inspires confidence—a good deal more confidence than it should. Thus are the people deceived by the laxity of the law. A measure was introduced in the legislature, providing for a much stricter supervision of midwives than is now the case. The bill had the support of this department and of the medical societies of standing, and yet, because of ignorance and indifference concerning the evils of the practice, it failed to reach a place on the statute books. My own opinion is that the midwife should, before being allowed to practise, undergo a schooling at least as long and as careful as that of the trained nurse.

Dr. Henry C. Coe, Professor of Gynecology at Bellevue Hospital, New York, and Chief Surgeon of Gynecology and Obstetrics at the General Memorial Hospital, New York, says: Midwives are responsible for the majority of cases sent to public hospitals. It is a sad commentary on the mediæval customs of obstetrics that such facts, known to all doctors, should be ignored by coroners. The remedy is plain,—to have educated midwives, as in Germany.

Dr. J. Clarence Webster, of the Rush Medical College, Chicago, says: The midwives are, as a class, uneducated and untrained. They are responsible for the great majority of maternal deaths. Every gynecologist who works in a large charity hospital can give evidence of the morbidity among poor women resulting from infection where the attendant was a midwife. The splendid results obtained by the lying-in hospitals and dispensaries, where women are attended by skilled physicians and trained nurses, are chiefly due to a rigid technique, the essential feature of which is cleanliness. It is a disgrace to every city that the benefits of such institutions cannot be extended to all poor women. Any surgeon who would dare to operate under the conditions observed by midwives would be denounced not only by the medical profession, but also by the enlightened laity. Yet the latter are apparently indifferent to the work of the midwife, and allow her to carry on her dangerous career uncensured. The extension of the benefits of scientific obstetrics is chiefly due to the persistence and self-sacrifice of the medical profession, but the doctors are unable, unaided, to do what remains to be done.

Dr. Francis Quinlin, President of the New York County Medical Association, says: All reputable physicians who have given the matter the slightest consideration are of one mind in regard to the menace to life in the ignorant work of the great majority of midwives. The New York County Medical Association has let slip no opportunity to throw the weight of its influence on the side of remedial measures. That little has been accomplished so far is due to the fact that the midwife, as she exists to-day, is a time-honored institution, difficult to uproot. Most midwives have apparently no conception of the scientific cleanliness which is rightly regarded by physicians as being of prime importance. The most ordinary antiseptic precautions are ignored, with the result that, every day, women who have been attended by midwives are brought to hospitals suffering from blood-poisoning. In their habits of carelessness the midwives also carry from one house to another the germs of infectious diseases. In the interest of a host of poor mothers and of children whose lives are valuable to the nation, I say that the practice of midwifery should come under a much closer scrutiny of the law than is now the case.

Dr. Eleanor B. Kilham, Head of the Maternity Department of the Women’s Infirmary, New York City, says: That much injury results to mothers and children from the unrestrained practice of midwives there can be no doubt in the mind of any physician who has been brought in contact with the conditions. There is an opportunity here for an important reform, and I am very glad to know that something is being done in this direction.

(These letters are quoted from _Success_, April, 1905.)

IV MUNICIPALIZATION OF THE MILK SUPPLY AND THE DANGERS OF STERILIZATION

“The real solution of the milk problem is not the supply of sterilized milk of doubtful purity, but rather the supply of clean milk from sources above all suspicion. The transport of milk from long distances under present conditions, as to cooling, transit, etc., may render sterilization all important, but the necessity for sterilization indicates the presence of avoidable organic impurity, and to obtain a naturally pure milk supply is the really important thing....

“If we municipalize water because the public health aspect is of such vital importance, then from the same standpoint we should municipalize the milk supply. We nearly all need milk—many live on it exclusively; its supply is as regular as the water supply, and its distribution demands even greater care for a longer time. The milkman calls more regularly than the postman and the milk bill comes in as regularly as the rate card. Like the liquor trade, the milk trade is a simple one, and the dividends of modern dairy companies show that it is profitable....

“We should bear in mind that, although under present conditions of supply any stringent enforcement of the most thorough sanitary regulations on farmers, or any distinct raising of the legal minimum of fat in milk, would certainly tend to raise the price of milk to the consumer, and any rise in price would be most unfortunate, yet a high standard of production and distribution is essential. The only way to get both low price and a better article is by means of the enormous economies in distribution, cartage, etc., which would at once result from municipal ownership....

“Finally, it has been shown that all successful attempts to solve the question have been those in which the aim has been other than the ordinary commercial one, and those organizing the supply have been interested in the public health, and in which there has been thorough organization on a large scale both in supply and distribution. These facts alone show that the only solution possible under modern conditions is that suggested by the municipal ownership and control of the milk supply.”—F. Lawson Dodd, M.R.C.S., L.R.C.P., L.D.S., Eng., D.P.H., London, in _The Problem of the Milk Supply_.

Sir Richard Douglas Powell, in his lecture to the Congress of the Sanitary Institute at Glasgow, in July, 1904, said: “There can be no doubt that scientifically conducted dairy farms on a large scale, with urban depots for the reception and dispensing of pure milk in clean bottles at a fair price to the poor, would pay, and would be a most laudable employment of the municipal enterprise that is often devoted to matters of much less urgent public interest and importance. Apart from the primary benefit of affording a pure milk supply at a fair price, the object lesson to mothers and families in food cleanliness would be beyond price.”

Mrs. Watt Smith, an expert employed by the _British Medical Journal_, author of _The Milk Supply in Large Towns_, in her evidence before the Interdepartmental Committee on Physical Deterioration, condemned the policy of the English Infants’ Milk Depots, saying: “The milk comes from an uninspected source; they get it from a local dealer.... _Then they sterilize that milk to make it safe. It is like purifying sewage to make it into clean water._ It is not right.” Dr. Ralph M. Vincent also condemned the sterilization process for the same reason, and, in addition, insisted that sterilization impaired the nutritive value of the milk, causing at least one specific disease, scorbutus.—Report of the Committee, Vol. II, Minutes of Evidence.

Dr. George W. Goler, whose work in Rochester has been so much referred to, says: “For two more years the milk was Pasteurized, though considerable trouble was had with sour milk and in finding a man to furnish reasonably clean milk. After the first year four stations in all were required for the needs of four quarters of the city. Then, in 1899, we established our central station on a farm, and _instead of Pasteurizing milk, with all its contained filth and bacteria, we strove to keep dirt and germs out of the milk_, and began to sterilize all of the utensils, bottles, etc., and to put out milk that was clean. Clean milk, or milk approximately clean, having no more than 20,000 bacteria per cubic centimeter needs no application of heat to render it fit food for babies. _Heat applied to milk alters it, makes its curd tougher and more difficult to digest, often gives rise to indigestion, diarrhœa, or constipation in the infant_, and, further, the application of heat to milk in the operation of Pasteurizing or sterilizing leads people to think they may cure a condition that is more easily prevented by care in the handling of milk used for food.”—“But a Thousand a Year,” reprinted from _Charities_, August 5, 1905.

V A COMMISSIONER OF CHARITIES ON CHILD LABOR

“The objection that is offered most frequently, and perhaps with most effect, to further restriction of child labor, is the _alleged fact_ that in a great many instances the _earnings of these little children are needed to supplement the incomes of widows_, of families in which the husband and wage-earner may be either temporarily or permanently or partially disabled, and that without the small addition which the earnings of these little boys and girls can bring in, there would be suffering and distress. It would be easy, I think, to overestimate the extent to which that is true.... So we should not admit that that side is more serious than it is, but do let us cheerfully, frankly, gladly add that there would be many cases in which the proposed legislation (for the restriction of child labor) would deprive many families of earnings from their children, and that _we propose ourselves to step into the breach and provide that relief in good hard cash that passes in the market_.... If larger means are necessary to support these children so that they need not depend on their own labor, by all means let us put up the money and not push the children for a part of their support before the time when they should naturally furnish a part of their support.... In the long run it is never cheap to be cruel or hard. _It is never wise to drive a hard bargain with childhood._”—Extract from an address by Homer Folks, Commissioner of Charities, New York.

NOTES AND AUTHORITIES

I. THE BLIGHTING OF THE BABIES

Footnote 1:

The Theory and Practice of Infant Feeding, by Henry Dwight Chapin, A.M., M.D.

Footnote 2:

Registrar General’s Report, 1886, pp. 32–126.

Footnote 3:

Population Française, Levasseur, vol. ii, p. 403.

Footnote 4:

Tenement Conditions in Chicago, by Robert Hunter, pp. 154–157.

Footnote 5:

Poverty, by Robert Hunter, p. 144.

Footnote 6:

The Diseases of Children, by Henry Ashby, M.D., Lond., and G. A. Wright, B.A., M.B., Oxon., p. 12.

Footnote 7:

Transactions of the National Association for the Promotion of Social Science, 1882, p. 388.

Footnote 8:

Mulhall’s Dictionary of Statistics, p. 133.

Footnote 9:

Report of the Interdepartmental Committee on Physical Deterioration. Evidence.

Footnote 10:

_Idem._ Evidence of Dr. Eichholz and Others.

Footnote 11:

Parliamentary Paper [Cd. 1501] containing a Memorandum by Sir William Taylor, the Director-General, Army Medical Service.

See also a letter to the _London Times_, February 2, 1903, by General F. Maurice.

Footnote 12:

Tenement Conditions in Chicago, p. 157.

Footnote 13:

Information received from the Commissioner of Health.

Footnote 14:

Trans. Nat. Ass’n for the Promotion of Social Science, 1882, p. 387.

Footnote 15:

The Nutrition of the Infant, by Ralph M. Vincent, M.D., p. 246.

Footnote 16:

Diseases of Children, Ashby and Wright, p. 228.

Footnote 17:

_Idem._, pp. 44–45.

Footnote 18:

Figures quoted from a newspaper report of an interview with Mr. Straus.

Footnote 19:

See the Article, But a Thousand a Year, in _Charities_, August 5, 1905; Infants’ Milk Depots and Infant Mortality, by Dr. G. F. McCleary; The Problem of the Milk Supply, by Dr. Lawson Dodd, etc.

Footnote 20:

Report Interdepartmental Committee, vol. ii, p. 442; Vincent, _op. cit._, pp. 268 _et seq._

Footnote 21:

Report of the Health of the City of Birmingham, 1902, by Dr. Alfred Hill. Quoted by Vincent, _op. cit._, p. 272.

Footnote 22:

Vincent, _op. cit._ Also Testimony before the Interdepartmental Committee contained in the Report Evidence.

Footnote 23:

Mass and Class, by W. J. Ghent, p. 182.

Footnote 24:

From the newspaper report of an interview referred to above.

Footnote 25:

A Noviciate for Marriage, by Mrs. H. Ellis.

Footnote 26:

Twentieth Annual Report of the N. Y. Bureau of Labor Statistics, p. 61.

Footnote 27:

_Charities_, April 1, 1905.

Footnote 28:

See, _e.g._, the _Fortnightly Review_ for 1876, the _Contemporary Review_ for 1882, and the various Transactions of the National Society for the Promotion of Social Science.

Footnote 29:

Methods of Social Reform, by W. S. Jevons.

Footnote 30:

Report of the Proceedings of the Third International Congress for the Welfare and Protection of Children,—Speech of Mr. Hartley, B. N. Mothersole, M.A., LL.D., p. 166.

Footnote 31:

_Idem._

Also the Transactions of the Nat. Soc. for the Promotion of Social Science, p. 384.

Footnote 32:

Primitive Folk, by Élie Reclus, p. 35.

Footnote 33:

See the Comparative Summary of Legislation upon this Subject in Dangerous Trades, edited by Prof. T. Oliver, pp. 53, 54.

Footnote 34:

_Vide_ Report of the Interdepartmental Committee on Physical Deterioration and the frequent discussions in the British Press.

Footnote 35:

Transactions of the National Society for the Promotion of Social Science, 1882, p. 363.

Footnote 36:

_Idem._, p. 382.

Footnote 37:

Statistisches Jahrbuch für das Deutsche Reich, 1904.

Footnote 38:

Diseases of Children, by Ashby and Wright, pp. 14 _et seq._

Footnote 39:

See, _e.g._, Infants’ Milk Depots and Infant Mortality, by G. F. McCleary.

Footnote 40:

Report on Les Crèches, by Dr. Eugène Deschamps, Congrès International d’Hygiene et de Démographie à Paris, 1900.

Other works consulted include: How the Other Half Lives, by Jacob A. Riis; The Battle with the Slum, by the same author; The Diseases of Infancy and Childhood, by L. Emmet Holt, M.D., LL.D.

System of Medicine, edited by Clifford Allbutt.

Antenatal Pathology, by J. W. Ballantyne, M.D.

The Study of Children, by Francis Warner, M.D., London, F.R.C.S., F.R.C.P.

The Nervous System of the Child, by the same author.

In the preparation of the text free use has also been made of the files of the following journals: _British Journal of Children’s Diseases_; _British Medical Journal_; _New York Medical Journal_, _Archives of Pediatrics_; _Lancet_, _Journal of the American Medical Association_, etc.

II. THE SCHOOL CHILD

Footnote 41:

The Handwriting on the Wall, by J. C. Cooper, p. 222.

Footnote 42:

Education and the Larger Life, by C. Hanford Henderson, p. 85.

Footnote 43:

Poverty, by Robert Hunter, p. 11.

Footnote 44:

Hunter, _op. cit._, p. 216.

See also Mr. Hunter’s article, The Heritage of the Hungry, in the _Reader Magazine_, September, 1905.

Footnote 45:

Address to the National Educational Association, September 24, 1904, as reported in the newspapers.

Footnote 46:

See Dr. Warner’s excellent little books, Mental Faculty; The Study of Children; The Nervous System of the Child, for a discussion of nervous signs and the whole subject of child health.

Footnote 47:

The tendency of children to give such answers has been frequently noted and pointed out by foreign investigators. In general, I think it can safely be said that children are prone to hide their poverty and to exaggerate in an opposite direction.

Footnote 48:

Report to State Board of Charities. R. Hunter, The Heritage of the Hungry.

Footnote 49:

The Hunger Problem in the Public Schools—What the Canvass of Six Big Cities Reveals. Special correspondence in the _Philadelphia North American_, May 21, 1905.

Footnote 50:

_Idem._

Footnote 51:

_Idem._

Footnote 52:

_Idem._

Footnote 53:

Testimony before the Interdepartmental Committee on Physical Deterioration, the Royal Commission on Physical Training (Scotland), Reports of the London School Board on Underfed Children, etc.

Footnote 54:

Quoted by G. Stanley Hall, in Adolescence.

Footnote 55:

_Idem._

Footnote 56:

Final Report (1882–1883) of the Anthropometric Committee appointed by the British Association in 1875.

Footnote 57:

The figures quoted are taken from an excellent little pamphlet, The Cost of Child Labor,—A Study of Diseased and Disabled Children, published by the Child Labor Committee of Pennsylvania.

Footnote 58:

Poverty,—A Town Study, by B. S. Rowntree.

Footnote 59:

In the pamphlet, The Cost of Child Labor, above referred to.

Footnote 60:

Annual Report of the Massachusetts State Board of Health, 1877.

Footnote 61:

Growth of St. Louis School Children, by William T. Porter. Report of the Academy of Science of St. Louis, vol. vi, pp. 263–380.

Footnote 62:

Special Report of Anthropological Investigation of 1000 white and colored Children of the New York Juvenile Asylum, by Dr. Hrdlicka.

Footnote 63:

Report of the Royal Commission on Physical Training (Scotland), p. 30.

Footnote 64:

State Maintenance, by J. Hunter Watts, p. 10.

Footnote 65:

Adolescence, by G. Stanley Hall.

Footnote 66:

Feeble-minded Children in the Public Schools, by Will S. Monroe.

Footnote 67:

The Cost of Child Labor, pamphlet quoted above.

Footnote 68:

G. Stanley Hall, _op. cit._, vol. i, p. 401.

Footnote 69:

A Study in Youthful Degeneracy, by George E. Dawson, in the Pedagogical Seminary, iv, 2.

Footnote 70:

American Journal of Psychology, October, 1898.

Footnote 71:

Dr. Eichholz, Evidence before the Interdepartmental Committee on Physical Deterioration.

Footnote 72:

Reported in the _New York Times_, May 10, 1905.

Footnote 73:

Overpressure in Elementary Schools, by James Crichton-Browne, M.D., LL.D., F.R.S., printed by Order of the House of Commons.

Footnote 74:

See Journal of the Royal Statistical Society, February, 1893.

Footnote 75:

Hansard’s Debates, 1883.

Footnote 76:

Justice, Organ of the Social Democratic Federation, vol. i, No. 35, September 13, 1884.

Footnote 77:

Letter to the _London Times_, September 26, 1901.

Footnote 78:

Report of the Committee; Evidence, p. 484.

Footnote 79:

_Idem._

Footnote 80:

Beretning om Kristiania folkeskolevæsen,—various yearly reports.

Footnote 81:

School Luncheons in the Special Classes of the Public Schools—A Suggestive Experiment, by Elizabeth Farrell, in _Charities_, March 11, 1905.

Undernourished School Children, by Lillian Wald, a letter in _Charities_, March 25, 1905.

Footnote 82:

Hungry Children in New York Public Schools, by E. Stagg Whitin, in the _Commons_, May, 1905.

Hungry Children are Poor Scholars, an unsigned article in the Official Journal of the Brotherhood of Painters, Decorators, and Paperhangers of America, May, 1905.

Footnote 83:

See American Charities, by Professor Warner, for a careful statement of this point.

Footnote 84:

Sixth Biennial Report of the Board of Control and Superintendent of the Minnesota State Public School for Dependent and Neglected Children.

Other works consulted include: Mentally Deficient Children: Their Care and Training, by George E. Shuttleworth; The History of the Treatment of the Feeble-minded, by Walter E. Fernald; After Bread, Education, by Hubert Bland, 1905; Official Report of the National Labor Conference on the State Maintenance of Children, held at the Guildhall, London, Friday, January 20, 1905, Sir John Gorst, M.P., Presiding; Report of Investigations into Social Conditions in Dundee, Scotland—The Medical Inspection of School Children; Report to the Municipal Council of Paris on the Annual Expenditures in Connection with the _Cantines Scolaires_; Various Reports of the U. S. Commissioner of Education; Reports of the Department of Education in many American and Foreign Cities.

The Pedagogical Seminary.

Special Reports on Educational Subjects, issued by the Board of Education (England).

III. THE WORKING CHILD

Footnote 85:

Politics, by Aristotle, A. IV, 4.

Footnote 86:

Architecture, Industry, and Wealth, by William Morris, p. 138.

Footnote 87:

_Idem._

Footnote 88:

Farfolloni de gli Antichi Historici, by Abb. Lancellotti (Venice, 1636), quoted by Karl Marx in Capital, English edition, p. 427.

Footnote 89:

Marx, _op. cit._, p. 428.

Footnote 90: