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physical, mental, and moral cretins, or strong men and women, fathers
and mothers of virile sons and daughters, depends upon the decision of
the nation. If the responsibility of this is fully recognized, and the
employment of children under fifteen years of age is forbidden
throughout the length and breadth of this great country; if the nation
realizes that the demand for the protection of the children is the
highest patriotism, and enfolds every child within its strong,
protecting arms, then and not till then will it be possible to look with
confidence toward the future, unashamed and unafraid.

- - -

Footnote E:

“Messenger boys” includes errand boys in stores.

Footnote F:

No inquiry was made among mine workers because, on account of the
large number of boys whose fathers have been killed or permanently
disabled, the data would be less representative. (See Roberts’
_Anthracite Coal Communities_, p. 176.)

Footnote G:

Mostly foreign born or the children of foreign-born parents, Slavs and
Italians. The entire absence of reference to school matters is
suggestive. Most of them never entered a school.




IV
REMEDIAL MEASURES

“But pity will not right the wrong,
Nor doles return the stolen youth;
When tasks are done without a song
And bargains wrung at cost of truth,
’Tis mockery to talk of ruth.”
—DAVID LOWE.


I

Having stated the problem of poverty, as it bears upon the child, as
plainly and comprehensively as possible, I would fain leave it without
further comment, feeling with Whewell that, “Rightly to propose a
problem is no inconsiderable step towards its solution,” and believing
that once the facts are known, and their significance understood, reform
cannot be long delayed. Beyond the measures briefly suggested in the
preceding pages, I would gladly leave the whole subject of remedial
action untouched, regarding the purpose of this book as fulfilled in the
statement of the problem itself. But when I have submitted the substance
of the evidence herein presented to those whose knowledge and experience
entitle them to be regarded as experts, or to popular audiences in the
form of lectures, they have, with scarcely an exception, expressed the
view that the statement of such a problem should be accompanied by some
suggestions as to its solution; some indication of social and individual
duty, lest the result be heaviness of heart and blackness of despair.

Whoever has seriously contemplated the misery and suffering which, like
a poisonous cloud, encompasses modern society, must have experienced
doubts and fears for the future, and, like the chastened patriarch of
Uz, felt his hope “plucked up like a tree.” So many of the beacons that
have shone out over the rough, perilous path of Humanity’s pilgrimage
have turned out to be false lights, like the swinging lantern-lights of
the old Cornubian wreckers, which lured trusting mariners to head their
vessels to destruction upon the rocks, that we sometimes lose faith and
despair of the visions of world-ecstasy, the “passionate prefigurings of
a world revivified,” with which the seers of the race have beckoned us
onward. And such despair blights and starves the soul of progress. When
men cease to yearn for, and to believe in, justice, when they no longer
aspire to social perfection, when old men cease to dream dreams, and
young men to see visions of a nobler world than this economic anarchy,
there can be no progress. Beautiful ideals seem to mock us at times, but
it is doubtful if ever a beautiful ideal found lodgment in the heart of
the humblest man without enriching the world.

If I were asked wherein the hope of the future lies, I should adopt for
answer the message of a great rock. Travelling along the Yellowstone
River, in the autumn of 1904, I saw an immense rock column, a veritable
landmark for many miles, upon which some enthusiast had painted in large
red letters, “Socialism is the Hope of the World.” Doubtless some
ranchman, dreaming of a future world-righteousness, had conceived the
idea of making that great natural obelisk a missionary for the faith he
held, just as other enthusiasts had pasted the similar legends I had
seen along the trails of the North Dakota prairies. I share that faith
and hope, and believe that nothing short of the socialization of the
means of life will ever fully and finally solve the problems inhering in
our present industrial system, resulting in strife, bitterness, and the
denial of human brotherhood. But long, weary years of suffering and
struggle stretch between the present and that ideal state of the future.
Socialism will, it is to be devoutly hoped, save the world from red ruin
and anarchy and make possible a sweeter, nobler heritage for the
generations yet unborn. But the most sanguine Socialist must see that it
is little short of mockery to talk of the future triumph of his ideal in
connection with the problem of relieving present misery and distress, to
answer the hunger-cry of to-day with the promise of a coöperative
commonwealth in far-off years. All the Socialist parties of the world,
with the exception of a few minor and unimportant factions, frankly
recognize this and have formulated programmes of palliative measures for
the amelioration of present evils. So far as I am aware, no
non-Socialist political party has ever included in its programme demands
for such measures as the abolition of child labor, the feeding of school
children by the municipality, and the maintenance of municipal
_crèches_—demands which are included in practically all Socialist
programmes. In suggesting only such remedial measures as may be taken by
society or individuals within the present social state, and involving no
fundamental change in the social structure, I do so, therefore, as one
believing in the ultimate necessity of such change, and the right of
every child born into the world to equal opportunity and equal share in
all the gifts and resources of civilization.


II

In view of all the difficulties by which the problem is surrounded, the
uncertain results which have attended some of the most intelligent and
sincere efforts in that direction, he would be foolish indeed who
ventured to dogmatize upon the reduction of the infantile death-rate, or
the best methods to be adopted toward that end. There are, however,
certain well-established facts, certain verities, upon which I would
insist. It is perfectly obvious, for instance, that every child should
be ushered into the world with loving tenderness, and with all the skill
and care possible. The slightest blunder of an incompetent, unskilled
midwife may involve fatal consequences to mother or child, or such
injuries as are irreparable.[153] So that the very first principle upon
which everybody agrees, theoretically at least, involves the need of
important legislative reform providing for the supervision of midwives,
and the establishment of a system of training and education without
which no midwife should be allowed to practise. That such a law would
have the effect of materially lowering the rate of infant mortality, as
well as that of mothers, no one who has ever given the matter serious
consideration can doubt. From personal observation, and the testimony of
gynecologists and obstetricians of large experience, I am satisfied that
this reform alone would save many hundreds of lives each year, alike of
mothers and infants. It is appalling to think of the large number of
ignorant women who are practising as midwives. Many of them have no
conception of the importance of their work; they are often dirty and
careless, as well as ignorant of the first principles of obstetrical
science. Knowing nothing of the need or value of antiseptic precautions,
they are responsible for thousands of cases of blood-poisoning every
year, and because they are ignorant of the methods of restoring
asphyxiated infants they kill thousands of babes in the passage from the
wombs of their suffering mothers.[154]

In most states there is very little supervision of midwives; in some
cases practically none at all. New York, always rather prone to take
pride in its record upon such matters, has regulations which are wofully
inadequate. All that is necessary to enable a woman to practise as a
midwife is: (1) a certificate or diploma from some school of midwifery,
native or foreign, or (2) signed statements as to her fitness and
character from two physicians. No inquiry whatever is made into the
_bona fides_ or character of the school granting the certificate, nor
are the physicians held responsible in any way for the women they
recommend.[155] So long as the applicant meets either of the foregoing
slight requirements, the authorities must issue her a permit to practise
as a midwife. She becomes a “registered midwife,” and the title creates
an altogether unwarranted confidence in the minds of the people. It is
not only the poor, illiterate immigrants who are thus deceived, but many
very intelligent citizens are under the impression that a “registered
midwife” has had some sort of training. Immigrants coming from countries
like Germany, where all midwives have to undergo a thorough training,
are naturally unsuspicious of the fact that here we have nothing of the
kind. It is impossible to present the evil results of the employment of
untrained and incompetent midwives statistically, or even to estimate
them. Some idea may be gathered from the fact that, while the physicians
of the New York Lying-in Hospital, in 1904, attended over four thousand
confinements, 2766 _of them in the tenement districts_ among the very
poor, with only _three deaths_,[156] one midwife, in a very similar
tenement district, showed me a list of _sixty-two cases_ she had
attended with _five deaths_. And she spoke proudly of her “good record”!

[Illustration:

A FREE INFANTS’ MILK DEPOT (MUNICIPAL), BRUSSELS
]

In Germany for some years midwives have had to pass a regular
examination. In England, under the Midwife Act of 1902, they are placed
under a much stricter supervision than ever before, and are made
responsible for the cleanliness and care of mother and child during the
lying-in period of ten days. While it is felt that this law is
inadequate, it is believed that its enforcement tends to improve
conditions materially. For years the New York County Medical Association
and other medical societies of standing, supported by Boards of Health
and the leaders of the medical profession, have tried to get legislation
enacted providing for the establishment of a standard of education and
training for midwives. In every state legislation of a uniform character
should be enacted providing that no person shall practise as a midwife
or accoucheur without having first undergone a thorough training and
passed an examination set by the State Board of Regents or some similar
authority. They should be held responsible for malpractice,
incompetence, or neglect, just as physicians are held responsible. While
it is true that such a reform would inflict a certain amount of hardship
and suffering upon many women, on the other hand, it would raise
midwifery to the dignity of a profession, and provide lucrative
avocations for many other women. In any case, it is a most tragic folly
to set the hardship involved against the enormous gain to society.

It is probable that such trained midwives would command a much higher
rate of remuneration for their services than many of the incompetent
women who now act in that capacity, and that many poor mothers would be
unable to afford to employ them. Even now there are thousands of women
who cannot afford attendance of any kind at their lying-in, and doctors
tell of children, little girls ten years old,[157] for instance, caring
for their mothers through the pain and peril of parturition and for the
newly born children. The remedy for such a condition lies, not in the
employment of incompetent midwives licensed to destroy life because they
are willing to do it “cheaply,” but in the extension of free medical
service, maternity hospitals, and properly trained midwives as part of
our district nursing services. This subject of the extension of our
public medical service is a most important one. There is a tendency in
some quarters to decry everything of this nature, and to magnify unduly
the extent to which such services are abused. That they are sometimes
abused, if by that term is understood their use by those who could
afford to pay for such services, is undoubtedly true, though it would be
easy to overestimate the extent of such abuses. On the other hand, it is
certain that in many of our cities we have scarcely begun to make
provision for the needs of the suffering poor. It is astonishing to find
a manufacturing city of more than sixty thousand inhabitants, with a
tenement-house problem as distressing as that of New York City, and with
the most appalling poverty, having no city physician upon whom the
suffering poor can call by right. I do not know if there are many other
cities in the United States so utterly indifferent to the claims of the
sick poor as Yonkers, the “city of beautiful homes and great industries”
upon the Hudson, but I do know that there are many cities in which there
is a sad and shameful failure to provide proper medical care and
attention for the needy.


III

In order that the child may be surrounded at its birth with all possible
care and skill, it must be born somewhere else than upon the floor of a
factory. Notwithstanding all that may be said in its favor, it is little
likely that the Jevonian proposal to forbid the employment of any mother
within a period of three years from the date of the birth of her
youngest child will be adopted for many years to come, if ever at all.
Among the foremost opponents of such a proposal would be many of the
advocates and defenders of “women’s rights,” begging the whole question
of children’s rights, and ignoring the question whether it can ever be
“right” for mothers to leave their babies and enter the factory,
displacing men, or, what is finally the same thing, lowering their
wages. It would be difficult, however, to imagine any such opposition to
the proposal that the employment of women should be forbidden within a
period of six weeks or two months prior to and following childbirth.
Decency and humanity alike suggest that such a law should be embodied in
the factory legislation of every industrial state, as is the case in
most countries at the present time.

With our cosmopolitan population it is certain that the enforcement of
such a law would be no easy matter.[158] Little difficulty would seem to
be necessarily involved in the enforcement of the period of rest _after_
confinement; all that would be necessary would be to insist upon a copy
of the birth certificate of the youngest child, accompanied by the sworn
statement of the mother. If the whole onus of responsibility were placed
upon the employer, and penalties were imposed in a few cases, there is
no reason to suppose that the law in this respect would be less
effective than other laws relating to employment. That it would not be
perfectly successful is no more an argument against its enactment than
the partial failure of child-labor laws, for example, is an argument for
their repeal. But the period of exemption prior to childbirth is a much
more delicate and difficult matter. It has not, I believe, been found
possible in European countries to enforce the law in this direction with
as much success as in the other, but the results have been sufficiently
successful, nevertheless, to warrant continued effort. In actual
practice such a law would have a tendency, doubtless, to discourage the
employment of married women in factories, since employers as a rule
would not care to take the trouble, or to assume the risks, thus
involved in their employment.

But, as already noted, if working mothers are to be forced into
prolonged periods of idleness, in the interests of their offspring and
the future of society, some means must be provided whereby they may be
maintained and secured against want. The philanthropic experiments noted
in an earlier chapter owed all their success to such provisions. While
it would perhaps be too Utopian to advocate as a measure for immediate
adoption state pensions for childhood and youth as well as old age, as
Mr. C. Hanford Henderson does in his wonderfully suggestive and
stimulating book, _Education and the Larger Life_, it is not, it seems
to me, too much to demand that the state shall (1) allow no mother to
imperil her own life and that of her offspring by working too close to
the period of parturition, nor (2) allow any mother to suffer want
because she is prevented from, or of her own free will and intelligence
avoids, such work. If the right of the child to be well born, to be
ushered into the world with loving care and all the skill possible, is
to be anything but a mere cant phrase, the safeguards thus briefly
sketched cannot, it seems to me, be lightly denied. Recently I visited
the stables of a friend interested in the breeding of horses. I saw that
he had taken great care and pains to secure a well-trained veterinary
surgeon, that the brood mares were patiently and lovingly cared for and
tended, both before and after foaling. No humane and intelligent breeder
of animals would deny them the protection and care here suggested for
human beings. Until the state is willing to care for its children, at
least as well as enlightened individuals care for their horses, or their
dogs, it is mockery to speak of it as being “civilized”!


IV

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.

[Illustration:

A GROUP OF WORKING MOTHERS

Photograph taken in the yard of a Day Nursery, where the babies are
left during their mothers’
absence at work.
]

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


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