If our vital statistics were specially designed to that end, they could
not hide the relation of poverty to disease and death more effectually
than they do now. It is impossible to tell from any of the elaborate
tables compiled by the census authorities what proportion of the total
number of infant deaths were due to defective nutrition or other
conditions primarily associated with poverty. No one who has studied the
question doubts that the proportion is very great, but it is impossible
to present the matter statistically, except in the form of a crude
estimate. There is much of value in our great collections of statistics,
but the most vital facts of all are rarely included in them.
In the great dispensary a little girl of tender years stands holding up
a baby not yet able to walk. She is a “little mother,” that most
pathetic of all poverty’s victims, her childhood taken away and the
burden of womanly cares thrust upon her. “Please, doctor, do somethin’
fer baby!” she pleads. Baby is sick unto death, but she does not realize
it. Its breath comes in short, wheezy gasps; its skin burns, and its
little eyes glow with the brightness that doctors and nurses dread. One
glance is all the doctor needs; in that brief glance he sees the
ill-shaped head and the bent and twisted legs that tell of rickets.
Helpless, with the pathetically perfunctory manner long grown familiar
to him he gives the child some soothing medicine for her tiny charge’s
bronchial trouble and enters another case of “bronchitis” upon the
register. “And if it wasn’t bronchitis, ’twould be something else, and
death soon, anyhow,” he says. Death does come soon, the white symbol of
its presence hangs upon the street door of the crowded tenement, and to
the long death-roll of the nation another victim of bronchitis is
added—one of the eleven thousand so registered under five years of age.
The record gives no hint that back of the bronchitis was rickets and
back of the rickets poverty and hunger. But the doctor knows—he knows
that little Tad’s case is typical of thousands who are statistically
recorded as dying from bronchitis or some other specific disease when
the real cause, the inducing cause of the disease, is malnutrition. Even
as the Great White Plague recruits its victims from the haunts of
poverty, so bronchitis preys there and gathers most of its victims from
the ranks of the children whose lives are spent either in the foul and
stuffy atmosphere of overcrowded and ill-ventilated homes, or on the
streets, underfed, imperfectly clad, and exposed to all sorts of
weather.
For nearly half a century rachitis, or “rickets,” has been known as the
disease of the children of the poor. It has been so called ever since
Sir William Jenner noticed that after the first two births, the children
of the poor began to get rickety, and careful investigation showed that
the cause was poverty, the mothers being generally too poor to get
proper nourishment while nursing them.[14] It is perhaps the commonest
disease from which children of the working-classes suffer. A large
proportion of the children in the public schools and on the streets of
the poorest quarters of our cities, and a majority of those treated at
the dispensaries or admitted into the children’s hospitals, are
unmistakably victims of this disease. One sees them everywhere in the
poor neighborhoods. The misshapen heads and the legs bent and twisted
awry are unmistakable signs, and the scanty clothing covers pitiful
little “pigeon-breasts.” The small chests are narrowed and flattened
from side to side, and the breast-bones are forced unnaturally forward
and outward. Tens of thousands of children suffer from this disease,
which is due almost wholly to poor and inadequate food. Here again
statistical records hide and imprison the soul of truth, failing to
yield the faintest idea of the ravages of this disease. The number of
deaths credited to it in 1900 was only 351 for the whole of the United
States, whereas 10,000 would not have been too high a figure.
[Illustration:
BABIES WHOSE MOTHERS WORK—THEY ARE CARED FOR IN A DAY NURSERY
]
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
poverty. These figures and the table which follows are not introduced
for that purpose; I have taken only a few of the diseases more
conspicuously associated with defective nutrition and other conditions
comprehended by the term poverty, and, supported by a strong body of
medical testimony, made certain more or less arbitrary allowances for
poverty’s influence upon the sum of mortality from each cause. Some of
the estimates may perhaps be criticised as being too high,—no man
knows,—but I am convinced that upon the whole the table is a
conservative one. No competent judge will dispute the statement that
some of the estimates are very low, and when it is remembered that only
a few of the many causes of infantile mortality are included and that
there are many others not enumerated in which poverty plays an important
part, I think it can safely be said that in this country, the richest
and greatest country in the world’s history, poverty is responsible for
at least 80,000 infant lives every year—more than two hundred every day
in the year, more than eight lives each hour, day by day, night by night
throughout the year. It is impossible for us to realize fully the
immensity of this annual sacrifice of baby lives. Think what it means in
five years—in a decade—in a quarter of a century.
TABLE SHOWING INFANTILE MORTALITY FROM ELEVEN GIVEN CAUSES AND THE
ESTIMATED INFLUENCE OF POVERTY THEREON
════════════════════╤══════════════╤══════════════╤═══════════════════
DISEASE │NO. OF DEATHS │EST. PER CENT │EST. NO. OF DEATHS
│ UNDER FIVE │ DUE TO BAD │ DUE TO BAD
│ YEARS │ CONDITIONS │CONDITIONS—POVERTY
────────────────────┼──────────────┼──────────────┼───────────────────
Measles │ 8,465│ 85 │ 7,195
Inanition │ 10,687│ 90 │ 9,618
Convulsions │ 14,288│ 70 │ 10,000
Consumption │ 4,454│ 60 │ 2,648
Pneumonia │ 37,206│ 45 │ 14,340
Bronchitis │ 10,900│ 50 │ 5,450
Croup │ 10,897│ 45 │ 4,900
Debility and Atrophy│ 12,130│ 75 │ 9,397
Cholera Infantum │ 25,563│ 45 │ 11,502
Diarrhœa │ 3,962│ 45 │ 1,782
Cholera Morbus │ 3,180│ 45 │ 1,431
────────────────────┼──────────────┼──────────────┼───────────────────
│ 151,732│ 51.57 │ 78,263
════════════════════╧══════════════╧══════════════╧═══════════════════