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to-day may be Justice to-morrow,”—I have nothing but praise.

[Illustration:

A “CLEAN MILK” DISTRIBUTING CENTRE IN A BAKER’S SHOP, ROCHESTER, N.Y.
]

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

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

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


VI

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

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

[Illustration:

PACKING BOTTLES OF “CLEAN MILK” IN ICE BEFORE SENDING THEM TO THE
CITY, ROCHESTER, N.Y.
]

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

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


VII

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

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

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

[Illustration:

A MAKESHIFT: HAMMOCKS SWUNG BETWEEN THE COTS IN AN OVERCROWDED DAY
NURSERY
]


VIII

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

The question of reducing the rate of infant mortality is, it will be
seen from the foregoing, most complicated. It is not without reluctance
and misgiving that I have ventured upon this detailed discussion of
measures to that end, and in doing so I have kept from speculation and
theory, confining myself almost entirely to those measures which have
been tested by experience and found beneficial. If Berlin has been able
to reduce its infantile death-rate from 200 per thousand to 80 per
thousand, Australia to reduce its rate from 15 per cent to 8 per cent;
if Rochester can reduce its summer death-rate of infants by 50 per cent,
it is surely evident that, given the determination to do so, we can at
least hope to save one-half of the babies who, under present conditions,
are perishing each year. In other words, it is possible to save almost
100,000 babies annually from perishing in the first year of life. No
greater, worthier task than this ever challenged the attention of a
great nation.


IX

When all the evidence is piled up, we are irresistibly driven to the
conclusion that no attempt to educate hungry, ill-fed children can be
successful or ought to be attempted. Danton’s fine phrase rings
eternally true, “_After bread_, education is the first need of a
people.” That education is a social necessity is no longer seriously
questioned. But the other idea of Danton’s saying, that education must
come after bread,—that it is alike foolish and cruel to attempt to
educate a hungry child,—is often lost sight of. In the early days of the
public agitation for free and compulsory education, it was not
infrequently urged that before the state should undertake to compel a
child to attend its schools and receive its instruction, it ought to
provide for the adequate feeding of the child. That argument, happily,
did not prevent the establishment and development of public education,
but now that the latter system has been firmly rooted in the soil of our
social system, there is an increasing belief in the inherent wisdom and
justice of the claim that the state has no right to attempt to educate
an unfed or underfed child.[172]

There is something attractive about such elemental simplicity as that of
the Czar who drew a straight line across the map from St. Petersburg to
Moscow, when his counsellors asked him what course he wished a railroad
between the two cities to follow, and said, “Let it be straight, like
that.” I suppose that every worker for social improvement has felt
oppressed at times by the complexity of our social problems, and wished
that they could be solved in some such simple and direct manner. But
social progress is not made along straight lines in general. What seems
to the agitator axiomatic, simple, and easy, appears to the constructive
statesman doubtful, complex, and difficult. There is at least one
European municipality, however, which has solved this problem of the
feeding of school children in a delightfully direct and simple way. The
city of Vercelli, Italy, has made feeding as compulsory as education![I]
Every child, rich or poor, is compelled to attend the school dinners
provided by the municipality, just as it is compelled to attend the
school lessons. Not only food, but medical care and attention, are
provided for every child, as a right, on the principle that it is absurd
and wrong to attempt to develop the mind of a child while neglecting its
body. It is a mocking judgment of our civilization that such a natural,
intelligent solution of a pressing problem should be impossible for our
greatest and richest cities, though attained by a little Italian city
like Vercelli.

I do not suppose that it will be found possible to apply such a
principle generally until many years have passed and our social system
has been modified considerably. In the meantime, some less thorough and
comprehensive system, like that of the French _Cantines Scolaires_, for
instance, will probably be adopted. It is not, however, my intention
here to advocate any particular scheme. I can only reiterate that the
feeding of school children is an imperative, urgent, and vital
necessity, and emphasize certain principles. Elsewhere I have given a
résumé of the methods adopted in several other countries,[J] and I need
not, therefore, go over that ground. Whatever is done should be free
from the taint of charity. There must be no resorting to the pernicious
principle, sometimes advocated by our so-called “practical reformers,”
of subsidizing charitable societies to undertake the work. There must be
no discrimination against the child whose parents have failed to do
their duty. The child of the inebriate, the idler, or the criminal must
not be made to suffer for his parent’s sin. The state has no right to
join with the sins of the fathers in a conspiracy to damn the children’s
lives, and only a perverted sense of the relation of the child to the
state could have made it possible for such a proposal to be made. Upon
the principle that every child born into the world has a right to a full
and free supply of the necessities of life during the whole period of
its helplessness and training for the work of the world, so far as the
resources of the world make that possible, the state should proceed
until in all schools where children attend compulsorily, free,
wholesome, and nutritious meals are provided for all children as a
common right.

Of course, the cry will be raised that such a system would result in
wholesale pauperization. I am not afraid of that cry—it has become too
familiar. When I first went to school in the West of England, I used to
carry my school fees—six cents a week—each Monday morning. Under that
system it was necessary for the school authorities to employ officers to
see that the fees were paid, and frequently defaulting parents were
summoned. The children of poor parents were exempted from paying the
school fees, but they had to present big cards to be marked by the
teacher, and were thus made conspicuous. I remember very well that when
it was proposed to make the schools free to all, the same bogey of
pauperization was raised.[173] The school fees were abolished, however,
and the objection was heard no more. In the early days of the Free
Libraries movement, a similar outcry was heard, but one never hears it
nowadays, nor does anybody consider that he is pauperized when he takes
home a book from the city library to read. And so one might go on,
through a long list of things which were opposed upon the same grounds
by many earnest people, but are now commonly enjoyed. If, moreover, the
alternative to pauperization is slow starvation and suffering, I
unhesitatingly prefer pauperization.


X

Next to the feeding of school children in importance is the need of a
much more efficient and thorough system of medical inspections in all
our schools. In most of our cities something is already done in this
direction, but it is very little. As a rule, the medical inspections now
made are most perfunctory and superficial. With a few honorable
exceptions, the practice is to look only for cases of contagious and


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Online LibraryJohn SpargoThe Bitter Cry of the Children → online text (page 16 of 22)