THE PROTECTION OF CHILDREN AGAINST DISEASE
_Introductory._--The objects of this department of child-protection
are, first, to prevent the child becoming ill; secondly, if it has
become ill, to cure it. The hygiene of childhood deals with the
former question, and pediatrics with the latter. In this chapter
we shall consider those problems only which concern the health of
children of the poorer classes.
_The Health of Proletarian Children._--Owing to the lesser resisting
power of children, the factors of ill-health operate much more
powerfully in the case of youthful than in the case of adult
proletarians. But other factors are in operation in addition to
this inferior power of resistance. Unfavourable conditions act upon
proletarian women during pregnancy, and affect proletarian children
at the time of birth. The circumstance which more than all others
is injurious to the health of these children, and which contributes
to produce the result that a larger percentage of working-class
than of upper-class children are feeble-minded, is quantitative and
qualitative insufficiency of nutriment. Studies of the relationship
between the prices of food-stuffs and the average working-class
income have shown that the majority of working men have an income
too small to provide for themselves and their children the minimum
quantity of nutritive materials (of the proper quality) which
physiological science has proved to be indispensable to the daily
renewal of the bodily forces. Statistical data prove beyond question
that the height and the body-weight of proletarian children are less
than those of children of the well-to-do. Rickets is principally a
disease of children of the poorer classes. Among upper-class children
the severer forms of this disease is hardly ever seen. Rickets
arises chiefly as a sequel of digestive disturbances; and these, in
their turn, are referable to the deficiencies of artificial feeding.
Among the poor we find many more blind children and many more deaf
mutes than among the rich, the reason being that among the poor, in
so many instances, when the defect is first noticed, no attempt is
made to seek medical advice. According to trustworthy statistical
data, 95 per cent. of the occupants of blind asylums belong to the
poorer classes.
_Causes of the Movement for the Protection of Proletarian
Children._--To-day great stress is laid upon attention to the
health not only of the general population, but in especial to the
health of children. During the nineteenth century the view became
general that in the interests of the health of the children,
society ought to be prepared to make any sacrifices. In the domain
of social hygiene--that is, of the science which occupies the
borderland between the science of public health and the science of
sociology--neither the men of theory nor the men of practice can
venture to adopt a one-sided class outlook. During recent years,
upon the groundwork of these sound conceptions, a number of new
institutions have been founded, by means of which the general
condition of public health and the hygiene of childhood (including
that of proletarian childhood) have been considerably improved. In
many directions the advances in medical science tend to counteract
with success the disorders consequent upon the development of
capitalism. The technique of artificial feeding has been greatly
improved, and this has led to a reduction in infantile mortality;
ophthalmia of the new-born can now be efficiently prevented, and this
has led to a decrease in the number of blind persons.
To the upper classes of society the health of the lower classes is
of importance for two reasons--(_a_) the former have need of the
working powers of the latter, and in bad hygienic conditions these
working powers are impaired; (_b_) if the health of the lower classes
is neglected, it is not these classes alone which suffer, but the
rich suffer as well. For example, the well-to-do are endangered
when nothing is done to check the spread of infectious diseases
among the poor, and when poor persons attacked by these diseases are
left without proper treatment. If the health of poor children be
neglected, the results are extremely serious, not for these children
alone, but for the children of the well-to-do and for adults.
_Institutions._--Institutions are of great importance. A larger
proportion of the children of the poor than of the children of the
well-to-do are dealt with in institutions, for well-to-do parents
live in commodious houses, in which their children can be properly
cared for, they are able to summon the doctor whenever necessary,
and so on. The most important institutions in this connection are
hospitals for infants and young children. Children’s hospitals are
not as yet very numerous; hospitals for infants are still fewer. The
majority of these institutions are maintained, not by the State or by
the local authority, but by the community at large. It is owing to
the fact that children’s and infants’ hospitals are so few in number
that medical practitioners are so inadequately trained in respect
of the hygiene of childhood and pediatrics, and in especial in the
hygiene and therapy of infant life. The need for such hospitals is
not satisfied by the foundation of children’s clinics. A combination
of hospitals for infants with lying-in hospitals or foundling
hospitals is unquestionably along the proper course of development.
If we wish to ascertain the value of institutions for children
who are blind, deaf-mute, crippled, or feeble-minded--if we wish
to learn whether it is socially worth while to take special pains
for the care of such children, or whether they can be adequately
cared for in general institutions, and what would be the cost of
these respective methods--we must study statistics bearing on these
questions. But, unfortunately, these statistics are defective and
extremely untrustworthy. They are defective, because they fail to
give us precise information concerning personal data and concerning
the percentage of such children who are or may become fit to earn
their own living. They do not classify properly according to age, and
they do not state accurately how many of the children have inherited
and how many have acquired the defect from which they suffer. (The
youngest children will usually be found to suffer from an inherited
defect, since they will hardly have had time to acquire it. Among
those suffering from such defects, the young present a larger
proportion of sufferers than we find among the general population,
because the mortality of the children thus affected is higher than
the mortality of healthy children.) The statistics are untrustworthy,
because the existence of deaf-mutism is often overlooked until
childhood is comparatively advanced, and feeble-mindedness may not
be recognised at all. In the twentieth century, in the civilised
countries of Europe, we find, per 100,000 of the population, from
50 to 130 blind persons, from 60 to 250 deaf persons, 70 to 450
feeble-minded and insane (minimal and maximal figures), and about 120
cripples. According to certain statistical data, one-fourth of the
blind and two-thirds of the deaf-mutes are competent to earn their
living, and 90 per cent. of the cripples are endowed with perfectly
normal mental powers. It is even maintained that from such children,
if they are otherwise healthy, we can, with comparatively trifling
effort, obtain useful members of society.
There is no doubt that when once such children have been born, we
must do the best we can for them and with them. They must either be
destroyed, or, in default of this, must be developed and educated
to the fullest extent of their powers; unless this is done, great
evil ensues, for the children become permanently dependent upon
public assistance; or else (and this applies especially to the
feeble-minded) become confirmed criminals. When the defect is a
serious one, such children should on no account be brought up in the
family circle, or educated in ordinary schools; it is absolutely
necessary to provide special schools and institutions for each
class of such defectives--blind schools, deaf-mute schools, cripple
schools, &c. Feeble-minded children, however, whose mental level is
only a very little below the average, or who are merely backward
from a temporary retardation of development, may be educated in the
ordinary schools, or in special classes of these schools. Children
with defective hearing should not attend the public elementary
school. Even if such a child is exceptionally talented, and if
it receives the greatest possible amount of help at home, these
circumstances will not make up for the educational defects inevitably
attendant upon its deafness. As soon as examination by the school
doctor shows that serious defect of hearing exists, or if such
defect is obvious even before medical examination has been made, the
child should be transferred to a special class or to a special school
for the deaf. As far as I am aware, such institutions exist as yet
only in Berlin.
In the treatment of defective children, the school teachers as
well as the doctors have a very important part to play. It is best
that those who teach such children should themselves have received
specialised medical and educational training. It was not until the
beginning of the latter half of the eighteenth century that any
serious effort was made to grapple with the problem of the education
of the blind and the deaf-mutes; it was more than a hundred years
later before the problems of the education of feeble-minded and of
crippled children respectively began to receive serious attention.
_Country Holiday Funds and Open-air Schools._--The health of
town children sometimes needs a thorough restoration, in default
of which the child would become seriously ill in the dusty and
contaminated air of our large towns. But in children of school age
such restoration is possible only during the summer holidays. This
is where the country holiday funds can play a very useful part.
These began to come into existence in Switzerland about thirty
years ago, and have now obtained a wide diffusion in all civilised
countries, and especially in manufacturing countries. As with every
new branch of public care for the needs of the poor, and especially
with the institutions considered in this chapter, the first steps in
this matter were taken by the community at large--that is to say,
by private associations. It will be a task of the near future to
organise and unify these associations. Such country holidays are an
important feature of the campaign against tuberculosis. They have
the further advantage, that they provide the child with manifold new
experiences. The societies take poor and weakly, but not actually
diseased children, and send them to the country for the summer
holidays, in some cases boarding them with families, in other cases
sending them to special institutions. The advantages of the family
system are those of family life in general, and in addition that in
such a family the town child will learn much more about the details
of country life. Of late some of these societies have gone on to the
foundation of permanent holiday homes for the relays of children they
send to the country. Inasmuch as the good effect of the summer visit
to the country tends soon to pass off, the after-care of the children
during the winter is very useful. In the case of children who for one
reason or another (for example, because they lack suitable clothing,
or because the society does not possess adequate funds) cannot be
sent to the country for a sufficiently long time, semi-urban colonies
and milk-stations are not without their value. The children during
the holiday season are taken by the teacher in large groups (forty
to sixty) into the open, are well fed, and, if opportunity offers,
given baths, and in the evening taken home to their parents. Of
late years has originated the idea of the open-air school, which
occupies an intermediate place between the school and the sanatorium
for children. During the holiday season the children stay in the
forest, and receive every day a few hours’ instruction in the open
air. Holiday playgrounds provide opportunities for town children to
play, under the guidance of suitable persons, in school-yards and
in parks. In this connection may also be mentioned arrangements for
the exchange of children during the holiday season between town and
country families. Certain weakly and sickly children should during
the summer be sent to a spa or a sanatorium. There already exist
special spas, Kurorts, and sanatoria for children. There are, for
example, special seaside resorts for rickety and tubercular children.
[_e.g._ in England, for tubercular children, Margate.]
_Proposed Reforms._--It is the duty of the poor-law boards to devote
great attention to the health, not merely of those children for
whose care they are directly responsible, but also for poor children
in general. The law should provide a right of interference on the
part of the local authority in the case of children whose health is
endangered by prolonged confinement to the house--for example, where
there is grave danger from exposure to infection--and this in cases
in which it is not possible to speak of “neglect” in the narrower
sense of the term. But if powers are given, in such cases, to remove
a child for institutional care, it should only be till such a time as
is requisite for the domestic conditions to be transformed, so that
the child may return home without danger to its health. In respect
of the hospitals under the direct control of the local authorities,
it is necessary that the latter should have the right of removal of
children needing hospital treatment whose parents do not send them to
hospital on their own initiative. This last idea is already partially
realised, inasmuch as certain modern foundling hospitals receive
for treatment sick children who have not entered the hospital as
foundlings.
_Need for Enlightenment._--It is really astounding how little
the laity know about the elementary principles of the hygiene of
child life, and more especially of infant life. In respect of the
management of infants, the most absurd practices prevail, some of
which are largely responsible for the extent of infant mortality. It
is therefore of enormous importance that the population in general,
and especially the lower classes, should be properly instructed
in these matters. But even medical practitioners lack sufficient
instruction in respect of the hygiene and therapy of childhood, and
even more in respect of the hygiene and therapy of infancy. This is
due to the fact that there is no proper teaching of these specialties
at most universities. Quite recently, however, there has been some
improvement in these respects.
_The Tendency of Evolution._--The importance of such institutions as
those we have been discussing will become ever greater. Indeed, the
great majority of sick persons will ultimately receive institutional
care. The functions we have been considering, at present administered
by the community at large and by the local authority, will eventually
be taken over by the State.