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all the problems of physical, mental, and moral degeneracy originate
with the child. The physician traces the weakness and disease of the
adult to defective nutrition in early childhood; the penologist traces
moral perversion to the same cause; the pedagogue finds the same
explanation for his failures. Thanks to the many notable investigations
made in recent years, especially in European countries, sociological
science is being revolutionized. Hitherto we have not studied the great
and pressing problems of pauperism and criminology from the child-end;
we have concerned ourselves almost entirely with results while ignoring
causes. The new spirit aims at prevention.

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



The white symbol of a child’s death hangs on a door in the background.

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

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]


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:—

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.


Danny’s Best Smile


Rickety, Ill fed, and Neglected


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


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

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.

It is not my intention to attempt the impossible task of sifting the
death returns so as to measure the sum of infantile mortality due to

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Online LibraryJohn SpargoThe Bitter Cry of the Children → online text (page 2 of 22)